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Thread: Dental Work Questions - Post-Op

  1. #1
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    Default Dental Work Questions - Post-Op

    Now that I have a new Aortic Valve, I've got some questions about dental work.

    1) For the last 20 years or so, due to my heart "murmor" (which was known to be due to a bicuspid valve), but before my surgery, they'd always make me take anti-biotics before any dental appt. Then a couple years ago, still before surgery, they said that was no longer needed due to some change made by the folks that make those recommendations. Why the change? It made me a little nervous to stop doing that.

    2) Even though it sounds like the recommendation pre-surgery is now that you don't have to take antibotics before a dental appt, the recommendation post-surgery (at least for me - on Coumadin) is that I go back to doing the anti-biotics. Which is not an issue (easy to pop 4-6 penicillin horse pills before my teeth cleanings). But... I've always wondered... If getting my teeth cleaned is dangerous due to the bleeding it can cause, what happens if I get bleeding in my mouth that's NOT caused by dental work??? Like if I'm brushing or flossing and a gum starts bleeding (which happens once in a while to me). Or bite my tongue or cheek and it bleeds. Or get a bloody lip, etc, etc. Is that type stuff dangerous too? And since I didn't know I was gonna do those things beforehand, I wasn't on penicillin, so am I now in severe danger???

    3) More for others than for me, since I'm not gonna switch valve types now, lol. But I'm curious if this need to be on antibiotics before dental work is just because I have a mechanical valve, or if it's for everyone (mechanical or tissue)?

    4) I might have to have some fairly significant dental work done at some point (replace some crowns I got 30 years ago due to a car accident). Will I have to go through some type of Bridging (Heperin?) for something like that?
    - Andy
    Born with BAV; Moderate/Severe Stenosis/Regurgitation by age 49; AVR Surgery 5/5/10 by Dr. Robert Emery, St. Josephs Hospital, St. Paul, MN; St. Jude Regent Mechanical Valve

  2. #2
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    I have bovine valve and my surgeon, cardio, PCP and dentist all are firm I should pre-medicate for all dental work, especially cleanings.

    I agree with your interest re: gum bleeding from flossing, brushing etc Not much we can do about that ..... we can't live on antibiotics for just in case during our day to day life and dental maintenance.

  3. #3
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    Default

    Quote Originally Posted by ARGreenMN View Post
    Now that I have a new Aortic Valve, I've got some questions about dental work.

    1) For the last 20 years or so, due to my heart "murmor" (which was known to be due to a bicuspid valve), but before my surgery, they'd always make me take anti-biotics before any dental appt. Then a couple years ago, still before surgery, they said that was no longer needed due to some change made by the folks that make those recommendations. Why the change? It made me a little nervous to stop doing that.

    2) Even though it sounds like the recommendation pre-surgery is now that you don't have to take antibotics before a dental appt, the recommendation post-surgery (at least for me - on Coumadin) is that I go back to doing the anti-biotics. Which is not an issue (easy to pop 4-6 penicillin horse pills before my teeth cleanings). But... I've always wondered... If getting my teeth cleaned is dangerous due to the bleeding it can cause, what happens if I get bleeding in my mouth that's NOT caused by dental work??? Like if I'm brushing or flossing and a gum starts bleeding (which happens once in a while to me). Or bite my tongue or cheek and it bleeds. Or get a bloody lip, etc, etc. Is that type stuff dangerous too? And since I didn't know I was gonna do those things beforehand, I wasn't on penicillin, so am I now in severe danger???

    3) More for others than for me, since I'm not gonna switch valve types now, lol. But I'm curious if this need to be on antibiotics before dental work is just because I have a mechanical valve, or if it's for everyone (mechanical or tissue)?

    4) I might have to have some fairly significant dental work done at some point (replace some crowns I got 30 years ago due to a car accident). Will I have to go through some type of Bridging (Heperin?) for something like that?
    I, too, had a heart murmur and was taking antibiotics pre-dental. Then a few years ago, I was told that I know longer had to take it. I had mitral valve repair last year not a replacement. I am now told that I need to premedicate again before dental. It seems consistent.
    Robotic Mitral Valve Repair using a 31mm ATS annuloplasty band, 06/18/09: Dr. Douglas Murphy, St. Joseph's Hospital/Atlanta

  4. #4
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    Default

    There has never been any conclusive proof that giving antibiotics before dental cleanings prevents anything. As a patient, I chose to take that extra precaution and medicate. It's not worth risking another valve replacement over teeth cleaning!

    http://www.americanheart.org/present...entifier=11086

    Antibiotic prophylaxis with dental procedures is recommended only for patients with cardiac conditions associated with the highest risk of adverse outcomes from endocarditis, including:

    Prosthetic cardiac valve
    Previous endocarditis
    Congenital heart disease only in the following categories:
    –Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits

    –Completely repaired congenital heart disease with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure*

    –Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

    Cardiac transplantation recipients with cardiac valvular disease
    *Prophylaxis is recommended because endothelialization of prosthetic material occurs within six months after the procedure.


    You don't have to worry so much about being punched in the mouth, biting your tongue or someone else biting it, but the nasty bacteria resides around your tooth base, so it is important to be medicated for dental procedures.

  5. #5
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    Gabe gets medication before visits. I think a few years back they changed the recs to say he didn't because he has a tissue valve, but his PC was not comfortable with such a new change. I was looking at the ADA site last year and under the FAQ it clearly stated that any patient w/ a replaced valve should get the antibiotics. So I think they took it away and then decided it was too risky to go without. My thinking is that a big dose of a med every 6 months or so isn't likely to make him resistant. He is allergic to penicillin so he gets another one.

    As for the bleeding while brushing, I was told no big deal. I was also told by the dentist that when he needs orthodontic work he likely won't get antibiotics each time, but it is very important to do the orthodontic work. Very crooked teeth harbor bacteria so better to do it than not for a heart patient. Gabe did get a few doses of penicillin (before the allergy developed) after a mouth injury once. He was running w/ a toothbrush in his mouth. It went through the area under his tongue. Tons of blood and since it was a germy toothbrush I took him to the ped. He refused to order anything. It was my least favorite ped and his reasoning was that he would have needed them before the injury to be effective at all. He also said something about how we didn't want to upset his stomach. My thinking was that I'd rather he have a day or 2 of stomach pain than need a new artery/valve. So I promptly went home and called the Cardiologist, who immediately ordered a few days of meds. He felt the way I did. Not worth the risk of endocarditis when we could possibly prevent it. Gabe had already had 2 surgeries and lots of scar tissue at that point. His doc considers him to be at higher risk for it. And really if it were me I think I'd rather take a few doses of a med than go through IV antibiotics or surgery!

    Becca

  6. #6
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    AR But really a Texan at heart!
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    I have always medicated before dental procedures. For a few years after AVR had to go to the hospital for antibiotics by IV, then the recommendation changed to oral. For the last year it's been almost a monthly thing for I've had a problem with an old root canal. My dentist and endodontics fully agree. In fact, medicated for this mornings appointment and tonight will start another 10 days of Cephalexin.
    Dayton

    AVR, 6/91, 23 mm St Jude Mechanical, age 56, Texas Heart Institute.
    Home testing and dosing 2/09

  7. #7
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    It's not the bleeding issue so much as the release of all those germs from cleaning and/or a major injury. My understanding is the premeds can be taken as much as an hour or so AFTER cleaning if necessary. My dentist has a niece with CHD, so she's up on those protocols and reviews them with me every time I come in.

    What Ross said, in English:
    It's not the coumadin, it's the suceptability to BE that's the issue. They changed the protocols a few years back (like around 2004, 2005) from anyone with a murmur needing premeds to anyone with an artificial valve, whether tissue or mechanical. Even a tissue valve is prosthetic. It's fake. It ain't yours.
    I'm not certain about those on the waiting list for new valves. They don't seem to be on Ross' list. I'd think premed would be wise if your valve is bad enough for surgery. BE is no walk in the park.

    As for bridging with lovenox for extensive dental work, that's a whole separate issue, discussed ad nauseum in earlier threads. I'm sure you'd need premeds for that, as much as for cleanings.
    Laurie
    MVR & maze & pacemaker-2006
    ICD-2007;
    AVR & tricuspid repair w/ ring 8/11/2010
    home testing since 2006

  8. #8
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    Sep 2006
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    Montreal, Canada
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    Default My endocarditis not from dental work

    I have pre-medicated for dental work ever since I knew I had a mitral valve prolapse. Then, out of the blue, in 2004 I got sub-acute bacterial endocarditis caused by the bacteria streptoccocus viridans (sp?), a bacteria in the mouth around the teeth! I think I might have had a little blood when I brushed my teeth, but as you said, this type of thing happens from time to time. I have to say that I become paranoid now when it happens, but so far so good!
    Mitral valve repair & maze procedure - October 20, 2005 - Montreal Heart Institute
    A-Fib - August 2005
    Endocarditis - 2004

  9. #9
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    Quote Originally Posted by AgilityDog View Post
    It's not the bleeding issue so much as the release of all those germs from cleaning......

    ......As for bridging with lovenox for extensive dental work, that's a whole separate issue, discussed ad nauseum in earlier threads. I'm sure you'd need premeds for that, as much as for cleanings.
    This is what dentists have told me is the reason for the anti-biotic. I continue to take 2000mg Amoxicillin prior to any procedure that requires drilling or "digging around in my teeth or gums". I have had root canals, crowns, extractions and periodontal treatments done without ever using bridging. I have probably gone off warfarin for short time periods, can't remember.
    Starr-Edwards mechanical AVR 1967 at age 31.....University of Kentucky Med. Ctr., Dr. Richard Wood & Dr. Gordon Danielson surgeons. No surgery (heart or otherwise) since. On Warfarin ACT since surgery. No diet, lifestyle, or activity restrictions....and I live one day at a time.

  10. #10
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    I think it depends on the Dentist, one told me take them , one said not neccesary , this was pre AVR. When my tooth broke 4 weeks ago I took the meds just to have bonding put on my broken tooth. Appointment all set to start my root canal woo whoo (dam life saver)

    Better to be safe,take the horse pills.
    Kathi
    Aortic Valve Replacement & Cabg 1X 5/7/2010
    Dr David H Adams Mount Sinai

  11. #11
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    Quote Originally Posted by AgilityDog View Post
    It's not the bleeding issue so much as the release of all those germs from cleaning and/or a major injury. My understanding is the premeds can be taken as much as an hour or so AFTER cleaning if necessary. My dentist has a niece with CHD, so she's up on those protocols and reviews them with me every time I come in.

    What Ross said, in English:
    It's not the coumadin, it's the suceptability to BE that's the issue. They changed the protocols a few years back (like around 2004, 2005) from anyone with a murmur needing premeds to anyone with an artificial valve, whether tissue or mechanical. Even a tissue valve is prosthetic. It's fake. It ain't yours.
    I'm not certain about those on the waiting list for new valves. They don't seem to be on Ross' list. I'd think premed would be wise if your valve is bad enough for surgery. BE is no walk in the park.

    As for bridging with lovenox for extensive dental work, that's a whole separate issue, discussed ad nauseum in earlier threads. I'm sure you'd need premeds for that, as much as for cleanings.
    Note: BE = Bacterial Endocarditis, a Serious Condition that can Ruin a Heart Valve

  12. #12
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    Woodbury, MN (USA)
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    Thanks everyone! I certainly plan on taking antibiotics before any dental work. I guess what I was really wondering is whether I should worry when a gum bleeds from flossing or brushing. Someone above said it might still help to take an antibotic up to an hour after a dental appt. I wonder if the same applies to an accidental bleeding (i.e. if your gums bleed, take a bunch of antibotics just to be safe). Might ask my dentist next time I'm in.
    Last edited by ARGreenMN; July 19th, 2010 at 06:50 PM.
    - Andy
    Born with BAV; Moderate/Severe Stenosis/Regurgitation by age 49; AVR Surgery 5/5/10 by Dr. Robert Emery, St. Josephs Hospital, St. Paul, MN; St. Jude Regent Mechanical Valve

  13. #13
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    So just to be clear ........premedicate does NOT mean a few shots of vodka

  14. #14
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    [QUOTE=ARGreenMN;463140] I guess what I was really wondering is whether I should worry when a gum bleeds from flossing or brushing. [QUOTE]

    When I was a child, my mother always told me to brush 'till my gums bled. A dentist later told me that that advice was "an old wives tale" and healthy gums should not bleed when brushing or flossing. After I had periodontal treatment and began taking better care of my mouth, my bleeding virtually stopped. I also think taking anti-biotics for bleeding gums would be using anti-biotics unnecessarily and could lessen the effectiveness of the anti-biotic when it is needed. I have never had a dentist or dental tech warn me of infections from a simple gum bleed.....but I have also learned to never say never.
    Starr-Edwards mechanical AVR 1967 at age 31.....University of Kentucky Med. Ctr., Dr. Richard Wood & Dr. Gordon Danielson surgeons. No surgery (heart or otherwise) since. On Warfarin ACT since surgery. No diet, lifestyle, or activity restrictions....and I live one day at a time.

  15. #15
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    Thanks, Andy, for bringing all that up--very informative!!
    My question is, I'm 5 and a half weeks post-op--do I have to wait a certain amount of time before I can go to a dentist and get a cleaning? Is it too soon to go right now??--Valerie

  16. #16
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    Valerie,
    I think it's advised to wait 3 months to have dental work done. Did you get written info when you were discharged? It might be in there, or call doctor's office and ask if there's a time frame to wait post-op.

  17. #17
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    Quote Originally Posted by ARGreenMN View Post
    3) More for others than for me, since I'm not gonna switch valve types now, lol. But I'm curious if this need to be on antibiotics before dental work is just because I have a mechanical valve, or if it's for everyone (mechanical or tissue)?
    I have a tissue (pig's) valve ... and have always pre-medicated for dental procedures.

    When I was younger, it was a few pills before the procedure ... and then another 2-3 AFTER.

    NOW, though ... it's about 4 pills prior to the procedure only.



    Cort | 36.m.IL | 5 Monte Carlos.1 Caprice Classic | pig valve.pacemaker * NoreastrTrekRT=Aug2010 *
    MCs.CC | models.HO.legos.CHD.RadioShows | RoadTrips.us66 = http://www.chevyasylum.com/cort
    "This is not where you belong" ... Restless Heart ... 'Why Does It Have To Be (Wrong or Right)?'

  18. #18
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    I've had pre-meds for 20 years before cleaning based on a heart work-up by my eletrophysiologist (EP) (specialist in heart rhythm disturbances). It's not the bleeding so much as the plaque that is the issue is what I was told. I also quit asprin therapy for about 7- 10 days prior to a cleaning. When they came out with the studies 2004-05 saying you didn't need pre-meds my EP was furious. He said something to the effect that some tree-hugging dentist came up with that load of -- anyway I still take premed on all dental appointments. No pre-med - no go. Both my cardio (for the heart murmur) and EP told me when my dentist could do open heart surgery he could then tell me to quit taking pre-meds. Also, use an electronic toothbrush like OralCare or Sonicare. Make sure the dental hygientist shows you how to use it correctly. Hey, your good to go!

  19. #19
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    Quote Originally Posted by valerie415 View Post
    Thanks, Andy, for bringing all that up--very informative!!
    My question is, I'm 5 and a half weeks post-op--do I have to wait a certain amount of time before I can go to a dentist and get a cleaning? Is it too soon to go right now??--Valerie
    My surgeon and cardiologist insisted I wait six month post op before any dental visit for any reason. That is why they made sure I had dental clearance prior to my surgery so as to minimize the chance of an unexpected dental need.

    I kept my fingers crossed I wouldn't break a crown or whatever and was lucky all was well.

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