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Avatar universal

Gum disease and antibiotics

Do I need to premedicate for Root deep cleaning due to gum disease?? Was diagnosed aged 20 with mitral valve prolapse and mild regurgitation..25 years later most echos show no sign of regurgitation though..Can I take amoxicillin afterwards??
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Avatar universal
I AM AWAITING A REPLACEMENT FOR MY FAULTY KEYBOARD WHICH WILL ONLY PRODUCE UPPER CASE LETTERS. MY APOLOGIES FOR WHAT APPEARS TO BE POOR NETIQUETTE.

I MAY BE OLD, ENGLISH AND LONG RETIRED AS A DENTAL SURGEON (B.D.S. FROM ONE OF THE TOP UK MEDICAL UNIVERSITIES) BUT I CAN SEE NO LOGICAL REASON WHY A SIMPLE SINGLE LARGE DOSE OF PROPHYLACTIC ANTIBIOTIC (USUALLY AMOXICILLIN FAMILY) IF THE PATIENT CANNOT GIVE A FULL PREVIOUS MEDICAL HISTORY. CHILDHOOD FEVERS, SPECIFICALLY GERMAN MEASLES (RUBELLA) CAN REMAIN IN THE MITRAL VALVE INDEFINITELY AND CAN BE ACTIVATED BY AN ORAL PROCEDURE THAT RELEASES BACTERIA INTO THE ORAL CAVITY THE OP SPECIFICALLY ASKS ABOUT PROPHYLACTIC COVER FOR MITRAL VALVE PROLAPSE BUT REALLY, HOW MANY PATIENTS CAN SAFELY RECALL THEIR ENTIRE MEDICAL HISTORY?

THE ADA ET CETERA DO STATE THAT PROPHYLACTIC MEASURES SHOULD BE TAKEN ONLY IN A FAIRLY RARE NUMBER OF SITUATIONS WHICH IS AGREED BECAUSE OF RISK VERSUS BENEFIT, BUT IN THE ABSENCE OF A FULL PREVIOUS MEDICAL HISTORY I CONTEND THAT THE RISK OF NOT GIVING A PROPHYLACTIC DOSE OF ANTIBIOTIC IS A RISK THAT IS NOT WORTH TAKING AND PRESENTS AS A VERY LOW RISK TO A PATIENT WHO KNOWS THEY ARE NOT ALLERGIC TO THE PENICILLINS. AN EVENT TRIGGERED BY SUCH A PROPHYLACTIC DOSE OF ANTIBIOTIC CAN BE VERY EASILY CONTROLLED IN THE SURGERY SETTING WHEREAS THE RE-CREATION OF BACTERIAL ACTIVITY IN THE MITRAL VALVE IS FAR FROM BEING EASILY CONTROLLED AND TAKES PLACE IN A VERY DIFFERENT TIMESCALE.

I SIMPLY FAIL TO SEE THE "BENEFIT" OF NOT PROVIDING PROPHYLACTIC COVER IN THIS RISK VS BENEFIT SITUATION. IN FORTY YEARS OF PRACTICE I HAVE NEVER SEEN A PATIENT HAVE AN ADVERSE REACTION TO THIS PROPHYLACTIC MEASURE. WHETHER SUCH PROPHYLAXIS WAS ACTUALLY NEEDED OR NOT IS OF COURSE ANOTHER QUESTION. I WOULD SAY BETTER SAFE THAN SORRY WHICH IS A SIMPLE BUT AXIOMATIC MANTRA.
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Avatar universal
Has your deep concern and anxiety abated or were the comments that were left for you unread?
Helpful - 0
1 Comments
I am still very very scared . My dentist has agreed to prescribe amoxicillin before dental cleaning though I am ambiguous about it
Avatar universal
My dentist insists on Amoxicillin before treatment. Last year I had an undiagnosed infected lower molar which may have contributed to the need for mitral valve repair.
Helpful - 0
Avatar universal
Antibiotic prophylaxis is no longer indicated in patients with mitral valve prolapse for prevention of infective endocarditis. The risk of antibiotic-associated adverse effects exceeds the benefit (if any) from prophylactic antibiotic therapy.

Source: https://www.aafp.org/afp/recommendations/viewRecommendation.htm?recommendationId=257

For infective endocarditis prophylaxis, current guidelines support premedication for only a relatively small subset of patients: history of prosthetic heart valve or past valve repair with prosthetic materials; prior infective endocarditis; unrepaired cyanotic congenital heart disease, including palliative shunts and conduits; repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device.

Source: https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
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