Antibiotics not needed before dental work

Dear Dr. Gott: I am 69 years old and in fairly good health.

Three years ago, my doctor prescribed clindamycin to be taken before dental procedures. I have since switched doctors, and now my new doctor says this is not necessary. I am willing to discontinue using the antibiotic but am wondering if use in the past has any harmful effect and how do I get the dental staff convinced I don’t need it?

Dear Reader: You do not mention why you were put on the clindamycin in the first place. Do you have heart disease or some other cardiac abnormality?

For many years, dentists and physicians have been routinely prescribing one or two doses of antibiotics prior to dental work if the patient has heart disease, stents or deformed heart valves. Recent studies have shown that such antibiotic coverage is not particularly useful in helping patients avoid heart infections, so antibiotic therapy is now only recognized as appropriate in certain cases. Your doctor can advise you in more detail.

You have not been harmed by your previous antibiotic usage, and I am certain that your dentist is now aware of the current guidelines. He or she can work with your primary-care physician to decide whether you need to continue preventive measures or whether you truly don’t need the medication anymore.

Dear Dr. Gott: My husband is 72 and has had an implantable cardioverter defibrillator for seven years. Recently, he was shocked seven times. It was a painful and traumatic experience. After two days in the hospital, he was sent home on medicine. He is terrified of getting shocked again. When the heart is no longer able to function, will the device keep going off or at some time will it stop?

We know this device is a lifesaver, but it seems like it could be extreme torture when it’s time to go. We are both faithful readers of your column.

Dear Reader: The purpose of a defibrillator is to prevent the heart from beating in too fast a pattern. I urge you and your husband to meet with his cardiologist, who can answer your questions in more detail.

Your husband should also be under the care of a physician who specializes in implantable defibrillators. The device should be checked at least once a year to ensure it is functioning properly. If it is not, the specialist can repair or replace it.

A defibrillator should shut off if the heart stops beating. Nonetheless, your husband’s device needs checking if it is firing inappropriately. Newer devices are superior to old ones, such as your husband’s. The defibrillator specialist can advise your husband whether it is appropriate to consider having a newer one.

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease.” Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.