Antiobiotics for dental work?

[aembry]

Im having my teeth cleaned for the first time in years, also getting a couple of feelings and I will eventually need my wisdom teeth out. Ive never been told I needed antiobiotics bfore dental work. I have pvcs/pacs and possible svt. My heart is structurally normal according to my recent echo. Im a bit concerned about developing endocarditis. Should I ask my doctor about getting antibiotics even though Ive never been told to take them?? Also, Ive read alot about antibiotics being dangerous and causing long Q. What antibiotics are safe to take if you have pvcs?

[achillea]

I have received an adrenalin type of wallop when my dentist happened to inject epi probably directly into a little artery, and I have asked him not to use the stuff on me because of this.  No problems since then.

Novacaine (procaine) *when applied in HIGH concentration over a large area of the body* can cause cardiac arrythmias, according to livestrong.com, but this is unlikely when you're working with a tiny area such as is the case with dental work.

aembry, you are worrying about details that are almost certainly not an issue for you at all, since your heart has been shown to be essentially healthy.  It is undoubtedly presumptuous of me, but I am going to go ahead anyway and suggest that you talk with a counselor who specializes in anxiety.  You may find that many aspects of your existence will become less troublesome, and life itself is much more fun.

I am serious; this advice is based on my own life experience.

[aembry]

What about the novacaine, can it cause palpitations?

[aembry]

What about the novacaine?? Ive read that it can cause palpitations?

Yes the info about the adrenaline is really interesting. No wonder it has a huge effect on the heart!

[DeltaDawn23]

Thanks for the info on adrenaline -- that explains a lot!  No wonder when I'm stressed my heart rate seems to take on a life of its own.  I can often get the rate down with an extra dose of beta blocker and/or Xanax and deep breathing exercises, but it takes some time and this explains why.  For me, ithe more I know, the better I cope with these situations.

[DeltaDawn23]

In my experience, the anesthetic without epinephrine is shorter acting, but it's been plenty for me for fillings and if it wears off, they can just give you another shot, no problem.  I wouldn't worry about that at all.

[aembry]

Yeah I was wondering about the epinephrine. Someone was telling me I wouldnt stay numb if they didnt use epinephrine?? But I will definetely keep this in mind and talk to the dentist about it.

[is_something_wrong]

What DeltaDawn said is important. The adrenaline from a local anestethic can increase blood adrenaline levels about 5-10 times, and when you add the natural effect of the fact that no one like going to the dentist, you can end up with fairly high adrenaline levels.

The numbers look dramatic, but also keep in mind that adrenaline levels are highly variable. They can increase 2-3 times just by standing up, 10-30 times with stress, 50-100 times with panic attack, and up to 1000 times with pheocromocytoma. But if you have an andrenaline sensitive arrhythmia, you should keep this in mind.

Also, if you are taking nonselective beta blockers (propranolol, timolol, sotalol, nadolol), adrenaline injections may in some cases cause extremely high blood pressure, bradycardia and irregular breathing (vasopressor response).

[DeltaDawn23]

No problem.  I, too, am very anxious about going to the dentist and need a cleaning badly.  And that is important for heart health.  Be sure you get a novacaine without epinephrine.  This is REALLY important.  I have an irregular heartbeat, after having the epinephrine and have heard the same thing from many others going into Afib from it, or having their Afib made worse.  I remind the dentist each and every time.  It's not paranoia when there really is a problem!

[aembry]

Thanks guys, this makes me feel alot better! Im just paranoid and I read too much bad stuff!

[DeltaDawn23]

My EP said the thinking used to be that the dental work would introduce bacteria into the bloodstream that could come to rest on a floppy valve and cause more problems.  I've taken antibiotics most of my life for dental work because of a slight mitral valve regurge.  According to the EP, recent studies show that the same amount of bacteria is in the bloodstream after a meal.  Antibiotics also interfere with Warfarin, or perhaps Vitamin K, if memory serves.  They now only use antibiotics for serious heart issues like metal replacement valves.  There was a thread about this not too long ago, and a couple of people referred to links explaining all this.

[Jerry_NJ]

I had heart surgery to repair my mitral valve in November 2007.  I was prescribed antibiotic by my cardiologist when I went in to the dentist even for just a routine cleaning and check-up.  That was stopped after about two years.  I have not had any antibiotic since then, I'd guess that was 2009.  

I now suffer from permanent atrial fibrillation, and take warfarin, an anticoagulant.  I have to stop taking that for any surgery, even for a colonoscopy (in case polyps are removed, and they always are), but that is a concern about too much bleeding.  I don't take an antibiotic for surgery either, and if I had wisdom teeth (or even wisdom, ha! ) I'm sure they could be removed without me taking antibiotics.  Some of this may be due to the increased concern, at least in the USA, about overuse of antibiotics and a subsequent increase in the immunity by the bacteria (or whatever the anti is about) - so we may now be taking more risk rather than make antibiotic completely ineffective.  

[is_something_wrong]

Why should you take antibiotics if your heart is structurally normal?

Dentists are very aware of this problem, and by the slightest suspicion they will usually give you antibiotics, either systemic meds or rinsing your mouth. Usually, this is done if people suffer from valve dysfunction, previous heart surgery or previous peri/myo/endocarditis.

Antibiotics in general do not prolong QT. Those which do usually end with the name -mycin (clarithromycin, erythromycin and azithromycin in rare cases). This usually only apply to people with known tendency towards prolonged QT.

Ask your dentist, but it seems you have read a bit too much about this ;) I have the same symptoms as you and antibiotics are not used before dental care (I was actually doing that today..)