Mitral Valve Prolapse

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I have started treatment planning a dental implant rehabilitation for a patient with mitral valve prolapse with regurgitation. 

She will be receiving multiple dental implants and two dental implant supported bridges.  She routinely
takes an antibiotic premedication (amoxicillin) for dental treatment that involves gingival bleeding, surgery, etc.  A periodontist will be placing the dental implants and I will be restoring them.  When should I have her take the amoxicillin?  Every time I try in the abutments and bridge components? Any thoughts or comments would be appreciated.

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9 Responses to “ Mitral Valve Prolapse ”

• Joseph Kim, DDS April 11th, 2006

  
  

  Only when significant bleeding is indicated. For trying in of components, no. For cementation, depends on condition of gingiva.

• Anonymous April 11th, 2006

  
  

  I do not see that you would have to routinely give antibiotics for try in of abutments etc. She will do more with routine hygiene than you will with try in of the abutments. If you have to debride or trim tissue in order to place the abutments, then you will need to give them. Otherwise a good rinse with peridex should suffice.

• John April 11th, 2006

  
  

  Sometimes the tissue adheres to the healing screw and gets “torn” when the screw is removed. Is this enough of a reason to premedicate?

• Michael Katzap, DDS April 11th, 2006

  
  

  when placing healing abutments at uncovery, and between visits I place bacitracin on to the screw and inferior portion of the the abutment. I find it keeps the tissue healthy and looking well between visits. Peridex….always welcome

• JML April 12th, 2006

  
  

  Caution! You are dealing with a life and death situation. Premedication can cover the patient so why take the chance.

• prsnk April 12th, 2006

  
  

  Every clinical situation involving bleeding should be covered with antibiotics( in this case, wich is a high risk one). And I think, this only reduces the danger of colonisation, but doesn’t preclude it!
  So, we should determine the likelihood of bleeding and bacteriaemia during our intervention in order to decide about antibiotic coverage.
  But tell me, how many of your interventions trully go without bleeding?
  I don’t think 2+2=4 here, and the eventual falures are unthinkable.

• Francisco Salvado - Portugal April 13th, 2006

  
  

  Every dentist must read the American Heart Association protocol for dental treatment…and after you must think that you are not treating teeth or implants but patients.

• Ossama Ghorab April 17th, 2006

  
  

  I do believe that we are treating a patient having teeth, so, it is recommended to give the patient of mitral valve prolapse from 2 to 3 gram of amoxicillin maximum one hour prior any dental procedure even if you are try in the implant abutments for more patient safety

• Chia-Ming Lee April 18th, 2006

  
  

  Clinical decisions are made after weighing the risks and benefits. Pre-medication increases the risk of building bacterial resistance, so how far apart do you want to separate your appointments to avoid that? 2 weeks? 2 months? Ultimately, the risk is also something the cardiologist can provide useful input on. So why not contact her cardiologist also for his/her recommendation, before you make that decision? Note that they cannot make that decision for you - you still have to, and it will still be your responsibility; but at least get his/her opinion as to the specific risk this particular patient presents with.
  LCM

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