Antibiotic Premedication

[Chiquita]

Hello You All

I Have A Question In Regard A Patient I Had Today.
He Is Had A Cardiac Stent Put On 3 Weeks Ago.
His Appointment Was For A Regular Prophylaxis And Periodontal Charting.
I Tough It Was Better Even To Premed For Safety Purposes Or Wait Three More Weeks Before Seen Him Again, Since It Is A Cardiac Procedure... Wait Is Your Oppinion About It?

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[openwyd22]

If you see him/her in the first month post-stent, I would definitely recommend covering with antibiotics. It is indicated for periodontal probing. I think the view thereafter is that a stent probably doesn't require premeds, but many dentists still do it. Many physicians also recommend it if you ask for a consult from them.

 

[Holy Thursday]

Hello You All

I Have A Question In Regard A Patient I Had Today.
He Is Had A Cardiac Stent Put On 3 Weeks Ago.
His Appointment Was For A Regular Prophylaxis And Periodontal Charting.
I Tough It Was Better Even To Premed For Safety Purposes Or Wait Three More Weeks Before Seen Him Again, Since It Is A Cardiac Procedure... Wait Is Your Oppinion About It?

Aaaaargh! This question angers me to no end! No decent dentist would practice dentistry based on what ppl write in a thread. Go to JADA, the ADA, or the AHA to find the answer to this question. Practice dentistry based on published, legal guidelines created by legitimate organizations and NOT on what some jo-shmo writes in a forum. Make sure you get the "nitty-gritty" details down like "how long after replacement of a joint can you stop giving antibiotics prophylactically" and like "how soon after surgery should you be performing routine dental procedures." I mean, what are you gonna tell the state board about giving antibiotics to your pts? "Well, some jo-shmo on SDN told me to prophylax ppl with innocent murmurs but not ppl with acquired murmurs." [Aside: for those whose sarcasm radar is down, that is actually the opposite of what you should do.] Jo-shmo's opinion won't hold up in court!

Further, no decent dentist should write the information here for you to see [at least not without citing references] as that dentist could then be sued along with you.

Hate to sound like a school teacher, but GO LOOK IT UP AND THEN WRITE A 500 WORD REPORT ON IT! Oh, and don't forget to include a bibliography.

 

[capisce?]

Further, no decent dentist should write the information here for you to see without citing references as that dentist could then be sued along with you.

Could get sued, maybe so. Could lose the lawsuit for posting on here, not a chance!

 

[toofache32]

Aaaaargh! This question angers me to no end! No decent dentist would practice dentistry based on what ppl write in a thread. Go to JADA, the ADA, or the AHA to find the answer to this question. Practice dentistry based on published, legal guidelines created by legitimate organizations and NOT on what some jo-shmo writes in a forum. Make sure you get the "nitty-gritty" details down like "how long after replacement of a joint can you stop giving antibiotics prophylactically" and like "how soon after surgery should you be performing routine dental procedures." I mean, what are you gonna tell the state board about giving antibiotics to your pts? "Well, some jo-shmo on SDN told me to prophylax ppl with innocent murmurs but not ppl with acquired murmurs." Jo-shmo's opinion won't hold up in court!

Further, no decent dentist should write the information here for you to see without citing references as that dentist could then be sued along with you.

Hate to sound like a school teacher, but GO LOOK IT UP AND THEN WRITE A 500 WORD REPORT ON IT! Oh, and don't forget to include a bibliography.

I Agree. Why Do You Care What Some Strangers On the Internet Say? You Should Be Going With The Facts And Recommendations From The ADA/AHA Who Have Already Studied This Very Question. Why Do You Want To Re-invent The Wheel? This Is Standard Knowledge That Should Be Memorized By All Dentists.

Also, Giving The Premed "For Safety Purposes" Shows Extremely Poor Judgement And Lack Of Critical Thinking. There Are Many Risks To Antibiotics (Including Penicillin) Such As Colitis, Anaphylaxis, Stevens-Johnsons Syndrome, And Others. You Should Never Think Lightly Of Giving Antibiotics, Or Any Med. One Of My Biggest Pet Peeves With Dentists Is That They Are Too Willing To Throw Antibiotics At Any Unusual Problem They See. Never Give An Antibiotic Without Knowing What You're Treating.

Also, Not All "Cardiac Procedures" Are The Same.

 

[scalpel2008]

Hello You All

I Have A Question In Regard A Patient I Had Today.
He Is Had A Cardiac Stent Put On 3 Weeks Ago.
His Appointment Was For A Regular Prophylaxis And Periodontal Charting.
I Tough It Was Better Even To Premed For Safety Purposes Or Wait Three More Weeks Before Seen Him Again, Since It Is A Cardiac Procedure... Wait Is Your Oppinion About It?

sO, wHaT dId YoU dO wItH tHe PaTiEnT? sOmEtHiNg Or NoThInG?

 

[capisce?]

I Agree. Why Do You Care What Some Strangers On the Internet Say? You Should Be Going With The Facts And Recommendations From The ADA/AHA Who Have Already Studied This Very Question. Why Do You Want To Re-invent The Wheel? This Is Standard Knowledge That Should Be Memorized By All Dentists.

Also, Giving The Premed "For Safety Purposes" Shows Extremely Poor Judgement And Lack Of Critical Thinking. There Are Many Risks To Antibiotics (Including Penicillin) Such As Colitis, Anaphylaxis, Stevens-Johnsons Syndrome, And Others. You Should Never Think Lightly Of Giving Antibiotics, Or Any Med. One Of My Biggest Pet Peeves With Dentists Is That They Are Too Willing To Throw Antibiotics At Any Unusual Problem They See. Never Give An Antibiotic Without Knowing What You're Treating.

Also, Not All "Cardiac Procedures" Are The Same.

You mean to tell me that antibiotics won't help tooth pain

I think that's the knee-jerk response from ED MDs. Tooth pain? Put them on antibiotics stat.

 

[MsPurtell]

Didn't you discuss this with the preceptor before actually treating the patient? You really should have thought this out during treatment planning and looked up the guidelines.

Hello You All

I Have A Question In Regard A Patient I Had Today.
He Is Had A Cardiac Stent Put On 3 Weeks Ago.
His Appointment Was For A Regular Prophylaxis And Periodontal Charting.
I Tough It Was Better Even To Premed For Safety Purposes Or Wait Three More Weeks Before Seen Him Again, Since It Is A Cardiac Procedure... Wait Is Your Oppinion About It?

 

[Typo]

I Agree. Why Do You Care What Some Strangers On the Internet Say? You Should Be Going With The Facts And Recommendations From The ADA/AHA Who Have Already Studied This Very Question. Why Do You Want To Re-invent The Wheel? This Is Standard Knowledge That Should Be Memorized By All Dentists.

Also, Giving The Premed "For Safety Purposes" Shows Extremely Poor Judgement And Lack Of Critical Thinking. There Are Many Risks To Antibiotics (Including Penicillin) Such As Colitis, Anaphylaxis, Stevens-Johnsons Syndrome, And Others. You Should Never Think Lightly Of Giving Antibiotics, Or Any Med. One Of My Biggest Pet Peeves With Dentists Is That They Are Too Willing To Throw Antibiotics At Any Unusual Problem They See. Never Give An Antibiotic Without Knowing What You're Treating.

Also, Not All "Cardiac Procedures" Are The Same.

This reminds me of my school's course that deals with when to give antibiotic prophylaxis to patients. In the course, our teacher pounded it into our heads over and over again that you should always give antibiotic prophylaxis before certain procedures on certain patients. But then, the course textbook showed that statistically you will kill more patients by giving antibiotic prophylaxis than not due to allergic reactions. What gives?

 

[capisce?]

This reminds me of my school's course that deals with when to give antibiotic prophylaxis to patients. In the course, our teacher pounded it into our heads over and over again that you should always give antibiotic prophylaxis before certain procedures on certain patients. But then, the course textbook showed that statistically you will kill more patients by giving antibiotic prophylaxis than not due to allergic reactions. What gives?

It's called cya, which is why most people give premeds while practicing in the litigious society that we call America. Unfortunate but true.

The irony of it all is this scenario..Say you have a patient who has mvp w/ regurgitation and you consult their cardiologist to see if they want premed. The cardiologist says not to worry about it, so you don't. If the patient were to get SBE (obviously highly unlikely) then it would be your butt on the line in court, not the cardios. Regardless of whether or not you have documentation. You are the treating doc and ultimately it's your decision and your liability.

 

[Holy Thursday]

It's called cya, which is why most people give premeds while practicing in the litigious society that we call America. Unfortunate but true.

The irony of it all is this scenario..Say you have a patient who has mvp w/ regurgitation and you consult their cardiologist to see if they want premed. The cardiologist says not to worry about it, so you don't. If the patient were to get SBE (obviously highly unlikely) then it would be your butt on the line in court, not the cardios. Regardless of whether or not you have documentation. You are the treating doc and ultimately it's your decision and your liability.

Techinically, all the literature so far shows that there is no benefit for any type of patient to receive antibiotics prophylactically. However, the ADA and AHA stand by their guidelines which have become the "standard of care" that we are obligated to follow.

 

[Holy Thursday]

I'm still waiting for the OPer to write that report...BTW, the bibliography doesn't count as part of the 500 words!

 

[Holy Thursday]

Just thinking...this may be one of those boderline cases where some could argue that this forum is for dentists (including dentists-to-be) to discuss this kind of stuff or one could argue that this forum is not for ppl seeking medical advice (even if it is for someone else)....it's a fine line

 

[Holy Thursday]

Also, Giving The Premed "For Safety Purposes" Shows Extremely Poor Judgement And Lack Of Critical Thinking. There Are Many Risks To Antibiotics (Including Penicillin) Such As Colitis, Anaphylaxis, Stevens-Johnsons Syndrome, And Others. You Should Never Think Lightly Of Giving Antibiotics, Or Any Med.

There are VERY serious consequences to the use of antibiotics for some ppl...like having to have their colons resected at the age of 21!

 

[EuroOMFS]

One Of My Biggest Pet Peeves With Dentists Is That They Are Too Willing To Throw Antibiotics At Any Unusual Problem They See. Never Give An Antibiotic Without Knowing What You're Treating.

What, are you an antidentite!? It ain't just dentists that overprescribe antibiotics. How many sore throats aren't treated with penicillin? All docs, dental and medical, have a tendancy to throw antibiotics at patients with common complaints, and the thing is most know it's completly unneccesary, but they do it anyway.

 

[capisce?]

However, the ADA and AHA stand by their guidelines which have become the "standard of care" that we are obligated to follow.

I'm not sure what this response had to do w/ my original thread

I know there are guidelines. The grey area is when a patient comes in and tells you they have MVP but are unable to tell you if they have regurg or if it's an innocent murmer. Your decision on whether or not to premedicate depends on that distinction. In many cases like this, dentists will simply prescribe them to cover their butts. I'm not saying I condone it, but it's a fact of life.

I see kids all of the time in our hospital who come to me with an abscess and have been Rx'd antibiotics by an outside practitioner. Part of the problem is just a lack of understanding of why the abx are even needed. If the infection is confined to the tooth there is no reason to dispense them, yet I bet over half of general dentists would still do it.

Today was another great example. I had a 5 y/o who was seen at another DDS with a c/o pain on his LR (had an P/SSC on #T). The other dentist couldn't find anything wrong but Rx'd amoxicillin and told the mom that the tooth probably was in the initial stages of "getting infected". Clinically, the crown was sound as can be...no signs of resorption. We took a PA which showed a little bit of resorption on the distal root of T due to the ectopic eruption of 30. Whoever did the crown failed to crimp the distal well (side note for GPs...if you are placing SSCs on the Es of a child w/out their 6s yet, make sure to crimp it, esp the distal to prevent this).

Anyways, the kid had some eruption pain and the tooth will be monitored, but there is no need for the abx. The prior DDS was at our satellite so I know he took a film, it was just poor diagnosis.

Unfortunately, this story is repeated probably hundreds of times a day all of the country. I think dental schools should place more emphasis on the use and misuse of antibiotics in the field of dentistry.

JMHO

 

[Recapitulator]

Techinically, all the literature so far shows that there is no benefit for any type of patient to receive antibiotics prophylactically. However, the ADA and AHA stand by their guidelines which have become the "standard of care" that we are obligated to follow.

Didn't you just say "Further, no decent dentist should write the information here for you to see [at least not without citing references] as that dentist could then be sued along with you." I am not saying you are offering advice on treatment but you are certainly providing information on the collective findings of "all the literature" on antibiotic prophylaxis. So lets see some citations.

I would like to see the reference(s) you are citing above. I would find it strange and disturbing to find an article that could determine the relative risk vs. benefit of prescribing antibiotic prophylaxis for SBE, at least enough to go against the current guidelines. Considering it would be unethical to carry out the kind of study that would be required to achieve a level of evidence to either prove or disprove this practice. How could one withhold antibiotic prophylaxis from a group of patients that traditionally would receive antibiotics then see if they get SBE or not vs. a group that did receive antibiotic prophylaxis as indicated?

There is a reason why the ADA and the AHA are still following the current guidelines. I suspect it is because they don't have this kind of the study and they have no way of conducting one, ethically at least.

 

[Holy Thursday]

Didn't you just say "Further, no decent dentist should write the information here for you to see [at least not without citing references] as that dentist could then be sued along with you." I am not saying you are offering advice on treatment but you are certainly providing information on the collective findings of "all the literature" on antibiotic prophylaxis. So lets see some citations.

I would like to see the reference(s) you are citing above. I would find it strange and disturbing to find an article that could determine the relative risk vs. benefit of prescribing antibiotic prophylaxis for SBE, at least enough to go against the current guidelines. Considering it would be unethical to carry out the kind of study that would be required to achieve a level of evidence to either prove or disprove this practice. How could one withhold antibiotic prophylaxis from a group of patients that traditionally would receive antibiotics then see if they get SBE or not vs. a group that did receive antibiotic prophylaxis as indicated?

There is a reason why the ADA and the AHA are still following the current guidelines. I suspect it is because they don't have this kind of the study and they have no way of conducting one, ethically at least.

They don't have good ways of conducting studies that try to follow a group into the future. All they can do is look to ppl who have had invasive dental procedures and then it was later on that they found out that they had a predisposing condition. That research shows very, very slim chances of SBE.

As for not citing evidence, my bad. Straight from JADA [Journal of the American Dental Association 1998 Nov 15; 129(10): 761-9.], their standpoint paper states:

"The study, "Dental and Cardiac Risk Factors for Infective Endocarditis," appearing in the November 15, 1998 issue of the Annals of Internal Medicine, concludes that dental treatment does not seem to be a risk factor for infective endocarditis and that a reconsideration of the usage of antibiotic prophylaxis is in order.

However, the American Dental Association (ADA), like the American Heart Association, believes its current recommendations for endocarditis prophylaxis are valid and that modifications are not indicated at this time.

Here's the kicker:

Further research is warranted to determine whether some heart or valvular conditions would require coverage with pre-procedural antibiotics while others would be precluded."

This is just a little snippet of info showing over and over again that we technically do not have good research to show that antibiotic prophylaxis is needed for dental procedures. This is more of a letigiously precautionary (sadly) use of antibiotics.

For example, we often worry that ppl with SLE may have verrucous cardiac valvular lesions due to deposits of auto-immune complexes on the valves. This can predispose them to a type of endocarditis called Libman-Sacks endocarditis. However, the risk of these patients contracting IE may be 0 or 100%; we do not know. [Miller CS, Egan RM, Falace DA, Rayens MK, Moore CR. Prevalence of infective endocarditis in patients with systemic lupus erythematosus. JADA 1999;130:387–92.] If the risk is zero, why the hell are we prophylaxing? If it is 10%, is there a higher chance (like 99%) that those given antibiotics prophylactically will end up with severe problems as a result of the use of those drugs?

 

[loie]

Hello. I have been bothered for 30 years about dentists and physicians who seem to think there is a need for antibiotics before dental procedures.

1. There has never been a scientific NEED for antibiotics prior to any dental procedure. About 50 years ago, a physician simply said " I think this is a good idea". It has never been backed by evidence.
2. Even if we as dentists did something to cause bacteria to cause a problem on a heart valve, giving a patient antibiotics prior to dental work does not kill any bacteria, does not prevent anything.
3. Giving a patient antibiotics grows resitant bacteria in the body, and if the patient were to get a bacteremia, they would require hospitalization and super antibiotics in order to help them.
4.The giving of antibiotics prior to dental procedures is not warranted in any circumstance, and is dangerous.
5. Dentists need to have intelligent instructors in dental schools who have the courage to stand up to stupidity. Dentists seem to treat patients based on what their friend said, rather than on what the science shows. Are you scientists? or wimps?

 

[toofache32]

....but not as dumb as reviving a 4-year-old thread.