Prescribing meds for a heart murmur (not of the innocent type)

[SugarNaCl]

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Ok, here is my question. I'll post this in the dental threads too, but I figure someone here probably has parents or whatever that work in the field. A friend of mine went to the dentist for some routine work, who subsequently asked him if he had a heart murmur. Now it's pretty much general knowledge, I'm assuming, that if you have a structural defect of the heart (aka not an innocent heart murmur) you have to be on antibiotics even before getting a cleaning because the risk of infection is increased, and an infection of the heart muscle could be fatal. My assumption. My friend was told to come back in 3 days on antibiotics with a script from his physician. My question is this. Why wasn't the dentist able to prescribe the antibiotics this man needed? Do dentists have medical records of their patients? Was it a dosage issue? I don't know.

 

[koochooloo]

i wouldn't know why you asking me 😕

 

[HermeytheElf]

Patients with mitral valve prolapse or regurgitation need antibiotic prophylaxis before receiving dental treatment, but because it is a heart condition it needs to be managed by a cardiologist. Bottom line is that a dentist isn't trained to treat heart problems, so they need to send the patient to someone who is.

 

[SugarNaCl]

Patients with mitral valve prolapse or regurgitation need antibiotic prophylaxis before receiving dental treatment, but because it is a heart condition it needs to be managed by a cardiologist.

I see. Are there actually regulations on this? I mean if a dentist gave a prescription for such a drug, would it not be filled, or would there just be red flags all over the place?

 

[The Musketeer]

Ok, here is my question. I'll post this in the dental threads too, but I figure someone here probably has parents or whatever that work in the field. A friend of mine went to the dentist for some routine work, who subsequently asked him if he had a heart murmur. Now it's pretty much general knowledge, I'm assuming, that if you have a structural defect of the heart (aka not an innocent heart murmur) you have to be on antibiotics even before getting a cleaning because the risk of infection is increased, and an infection of the heart muscle could be fatal. My assumption. My friend was told to come back in 3 days on antibiotics with a script from his physician. My question is this. Why wasn't the dentist able to prescribe the antibiotics this man needed? Do dentists have medical records of their patients? Was it a dosage issue? I don't know.

Usually recommended antibiotic is amoxicillin 250 mg - take 4 tabs 1 hr before dental procedure. The dentist should be able to write the prescription - unless if the dentist is not too comfortable/familar in issuing prescription drugs (dosage & tabs). And patient should follow up with physician

 

[svetoslava]

Ok, here is my question. I'll post this in the dental threads too, but I figure someone here probably has parents or whatever that work in the field. A friend of mine went to the dentist for some routine work, who subsequently asked him if he had a heart murmur. Now it's pretty much general knowledge, I'm assuming, that if you have a structural defect of the heart (aka not an innocent heart murmur) you have to be on antibiotics even before getting a cleaning because the risk of infection is increased, and an infection of the heart muscle could be fatal. My assumption. My friend was told to come back in 3 days on antibiotics with a script from his physician. My question is this. Why wasn't the dentist able to prescribe the antibiotics this man needed? Do dentists have medical records of their patients? Was it a dosage issue? I don't know.

Oh I actually happen to know the answer to this one, b/c I was a patient with mitral valve prolapse who, too, was sent to a physician to get a prescription for antibiotix. In my case at least, I was told by physician who examined me that I can go and get dental work of any kind without antibiotics. I was diagnosed with MVP when I was 15 and by age of 20, although I didn't do any echoKG's in five years, I assumed I still have the condition and faithfully confessed it to my new dentist, but turns out that MVP goes away sometimes and costly and not so healthy antibiotics weren't needed. that may be one of more reasons of course, but I suppose your friend who was sent to physician didn't have recent checkups on his/er condition.

 

[HermeytheElf]

As far as I know, mitral valve prolapse doesn't necessarily require antibiotics, but patients with mitral regurgitation will require antibiotic prophylaxis. The dentist can prescribe the antibiotic, but the best thing to do would be to send them to a cardiologist who could properly diagnose and treat the condition. So to answer your question sugar, yes the dentist can prescribe the antibiotic, but whether or not thats a good idea is debatable.

 

[capisce?]

Patients with mitral valve prolapse or regurgitation need antibiotic prophylaxis before receiving dental treatment, but because it is a heart condition it needs to be managed by a cardiologist. Bottom line is that a dentist isn't trained to treat heart problems, so they need to send the patient to someone who is.

There are multiple errors in your post.

First off, patients can have prolapse and not need sbe premed.

Secondly, not all treatment needs coverage.

Yes, dentists aren't trained to treat heart problems, but we are trained to consult the patient's cardiologist. Why in the world would I have the patient call their cardio for an Rx for my treatment every time they come in. All it takes is for me to call the cardio office, have them fax over a cardio summary and ask if they want premed. The decision on medication is now mine, and I will Rx it.

The usual request to the cardio is the following: "I had the pleasure of seeing your patient, bob smith, in my office. He listed having tetralogy of fallot on his medical history, and I would like to have his cardio summary faxed to my office. I will be prescribing amox 50mg/kg per AHA guidelines prior to treatment requiring sbe. Do you have any other suggestions regarding his sbe coverage in our office?

The AHA has explicit guidelines and the ADA in conjunction has a heirarchy of antibiotics to prescribe based on patient weight.

If you are going to post on a topic, make sure it's something you are knowledgeable about and not just posting hot air.

 

[capisce?]

Usually recommended antibiotic is amoxicillin 250 mg - take 4 tabs 1 hr before dental procedure. The dentist should be able to write the prescription - unless if the dentist is not too comfortable/familar in issuing prescription drugs (dosage & tabs). And patient should follow up with physician

Incorrect.

It's 50mgs/kg up to 2g of amoxicillin, or 20mg/kg up to 600mg for clinda.

For an adult, the recommened sbe prophylaxis would be 500mg x 4 tabs, not the 1 gram you suggested but 2 grams.

 

[aphistis]

There are multiple errors in your post.

First off, patients can have prolapse and not need sbe premed.

Secondly, not all treatment needs coverage.

Yes, dentists aren't trained to treat heart problems, but we are trained to consult the patient's cardiologist. Why in the world would I have the patient call their cardio for an Rx for my treatment every time they come in. All it takes is for me to call the cardio office, have them fax over a cardio summary and ask if they want premed. The decision on medication is now mine, and I will Rx it.

The usual request to the cardio is the following: "I had the pleasure of seeing your patient, bob smith, in my office. He listed having tetralogy of fallot on his medical history, and I would like to have his cardio summary faxed to my office. I will be prescribing amox 50mg/kg per AHA guidelines prior to treatment requiring sbe. Do you have any other suggestions regarding his sbe coverage in our office?

The AHA has explicit guidelines and the ADA in conjunction has a heirarchy of antibiotics to prescribe based on patient weight.

If you are going to post on a topic, make sure it's something you are knowledgeable about and not just posting hot air.

This is all correct, and it's why asking for and giving medical advice on SDN isn't allowed. I count at least three posts in this thread giving erroneous advice that, if it were followed, could result in real harm to the patient in question.