Silver fillings, dental work, numbing agents

I have a few silver fillings in my teeth. These are probably DECADES old--perhaps from the late 70s or early 80s. One specific tooth with a silver filling is starting to show signs of it breaking down, and it was suggested that it be replaced. More work on other old filling may be warranted as time passes.

For dental work, or dental teeth cleaning (every 6 to 8 months), I pre-medicate with amoxycillin.

I've done a bit of reading, and if I need to be numbed up, I know to ask for the numbing agent that does NOT have epinephrin or adrenaline--things I never even thought about before my dx of a-fib!

I've also read that some of the amalgam or composites (?) now used to fill teeth won't last as long as the silver filling stuff (which had mercury in it?).

I'd appreciate any suggestions about where to go from here regarding pre-medicating and also about replacing the silver fillings as needed. I do have an appointment in early April to replace the one silver filling that's showing signs it needs to be replaced.

Thanks!
Sue

Why do you premedicate for routine dental work? Current guidelines recommend that for very few patients. Remember, antibiotics aren't harmless.

Amalgam fillings are the silver stuff. The white composite filling material is what's generally used now, and although it's said not to last as long as amalgam fillings, I have several that are now decades old. I wouldn't let that one thing push you toward amalgam fillings.

Years ago I was dx with PVCs due to MVP and was told to pre-medicate. Recent EKG has not shown MVP (although some PVCs were noted) however, but my primary MD/DO is fine with my pre-medicating and I'd just as soon stack the deck in my favor. I've heard a lot (including from people I know and with whom I worked!) about folks who did not medicate, ending up with infections localized in an appendage, traced back to their dental cleaning or dental work. Considering how infrequently I use antibiotics, I feel ok about pre-medicating.

Do dentists even use the silver amalgam for fillings anymore--without the mercury component perhaps? If mine is breaking down in one tooth, it seems proactive to address it before it goes further.

Oh, okay, I didn't know (or forgot) about the MVP. The premedication makes sense.

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SueChef
Do dentists even use the silver amalgam for fillings anymore--without the mercury component perhaps? If mine is breaking down in one tooth, it seems proactive to address it before it goes further.

Yeah, some dentists still use amalgam fillings or at least offer them. I would definitely go with a composite replacement even if it doesn't last as long.

Sue - Yes, be sure you ask for the 'epi-free' anesthesia if you need that for the procedure... as the epi can stimulate an AF event. I had that experience long ago with a crown prep.

If you want to avoid the mercury contamination from amalgam fillings, you need to determine if the dentist 'guarantees' he doesn't use the mercury/amalgam filling material which is definitely cheaper.

Rather than the amalgam filling material, request a fluoride-free composite filling which is tooth colored and works well.

Now, very important.....when for the removal of the old amalgam filling, which is undoubtedly a mercury/amalgam filling... request that a rubber dam and saliva evacuation system is used so you don't have the fine particles or slurry in contact with the tissues in your mouth and tongue (oral mucosa). If that's not possible, then look for a biologic dentist who does.

Jackie

22 years ago, I was diagnosed with PVC's caused by MVP, but 5 years later, the correct diagnosis was determined and it wasn't MVP, it was afib. The ultrasound test for the MVP was just wrong. So during the 5 years of the bogus MVP, I also took antibiotics, but when the afib was found on an ECG, then the antibiotics stopped. Be sure you have the correct diagnosis.

Jackie, thank you so much for your information! I would have never thought of a rubber dam & saliva evacuation system! I'll stop by my new dentist's office on Mon or Tues and ask about this specifically. Is this kind of thing challenging if the tooth is waaaaay in the back upper right, and I have a strong gag reflex?? (let's add my positional vertigo to the mix, too)

I'll also request that he use a (tooth-colored) fluoride-free composite filling. I'm getting an education and I thank you!!! I'm not as concerned about the tooth-colored filling because the filling will be waaaaaaay in the back, and I don't smile *that* big!

Ken, thanks for ringing in here. On both my recent ECG and Holter results-- taken many weeks apart-- PVCs were noted, so I guess I'm still good to go for pre-medicating.

Sue

This is a guess, but it's not the PVC's that dictate antibiotics, it's the MVP. So, just having PVC's should not require antibiotics, UNLESS the PVCs are caused by MVP. No one here has said that people with PVC's, either with afib or without should be on antibiotics.

Sue - yes the dam and high-volume evacuation system will help with the tendency to gag. You may also have to just give them advance directions... such as... "If I signal you with my hand, for example, that means I need to have a break to relax
my jaw and 'come up for air'... during the procedure." It prolongs the procedure time a bit but is perfectly normal and definitely considerate that the patient be as comfortable as possible. Sometimes, a topical lidocaine spray can be put on your tongue to help reduce the gag reflex since the local anesthetic on the upper won't numb your tongue. Many patients have similar trouble as you've described so don't hesitate to have a preliminary talk before they begin. The last molar is often a challenge for access as well as patient comfort.

On the PVCs, you don't need to pre-medicate for those... it's only if you have a confirmed MVP... or in very special cases that involve joint replacements where the orthopedic surgeon thinks the patient is at risk.

I hope it is a 'total non-event' for you.

Jackie

Thanks, Ken and Jackie--I really appreciate the advance directions for the dentist, and the helpful input for what else may help.

I have positional vertigo, and that's of concern to me as well since the tooth in question is in the waaaaay back of the upper right side!

Is there anything I can take for positional vertigo since I also have a-fib and some meds may be contraindicated (for a-fib, I'm taking Pradaxa every 12 hours, and extended release metoprolol) ?

I've emailed both my primary care MD/D.O. as well as my EP and they are both out of the office until early April, so no help there--and I'd be over here asking the same thing anyway if I had their input because they don't have a-fib, they only have "book learning" and *experience.*

Thanks!
Sue