Remember to Pre-Medicate

As I was eating dinner the other night, an unusual sensation came over me. I knew what it was, nothing serious. I also knew that it would mean a trip to the dentist.

The phone call was normal: “We can get you in at 2 pm,’’ said one of the receptionists. “Remember to pre-medicate an hour before your procedure.’’

You must understand my mouth was rebuilt several years ago. Many of my teeth, nearly a dozen doing their job thanks to root-canal therapy, are implants that replaced originals that were decayed. Just about all my teeth are crowned. So when I was told to pre-medicate — my stipulation is Plavix and aspirin therapy leads to more bleeding in my gums and possibly a higher risk of infection – my lunch was accompanied by four 500-gram Amoxicillin pills.

I really don’t mind taking the antibiotics prior to a procedure. For years, almost anyone with any condition of the heart was told to pre-medicate. The concern was bacteria from the mouth could enter the bloodstream during treatment, lodge in the heart valves, inflame the myocardium and cause ulcerations to the inner walls of an artery.

All that changed in April, 2007, when the consensus was of the opinion the risks of taking the antibiotics outweighed the benefits to the patient. Last year, however, the American Heart Association, in its scientific journal Circulation, issued new guidelines as far as dental treatment and the development of infections such as endocarditis.

Since brushing and flossing can also send bacteria into the bloodstream on a daily basis, did the antibiotics make that much of a difference? The AHA didn’t think so. Removed from the pre-medication list were patients with:

• Mitral valve prolapses.

• Rheumatic heart disease.

• Bicuspid valve disease.

• Calcified aortic stenosis.

• Congenital heat conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

The group still requested to pre-medicate, those with the greatest risk of a bad outcome of they developed a heart infection - includes those with:

• Artificial heart valves.

• A history of infective endocarditis.

• Certain specific serious congenital heart conditions including:

A. Unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits.

B. A completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure,

C. Any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or prosthetic device.

D. A cardiac transplant that develops a problem in a heart valve.

I will admit, when it comes to repairing crowns, cleaning off excess cement and the like — which can cause some bleeding, the pre-medication my prosthodontist advises – is not something I fight. The discussion of whether an individual dental patient should pre-medicate is often decided in a conversation between the two. Yet there still is a bit of confusion, so a patient should always ask.