T
thecman321
What is the true consensus here?
Also how long post op mechanical valve should you wait before routine dental work?
Also how long post op mechanical valve should you wait before routine dental work?
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JimL
Well-known member
Do not stop coumadin for routine dental work.
Be sure to premedicate.
Unless you get really, really nervous about dental work, get done what you need to get done.
Be sure to premedicate.
Unless you get really, really nervous about dental work, get done what you need to get done.
G
geebee
I have had root canals, crowns, veneers and cleanings all while on coumadin. The first question I ask a new dentist is whether he/she is willing to treat me while on coumadin.
I have had a couple turn me down but I found a wonderful dentist in CA and a new one once back in Ohio.
I would think there may need to be bridging done for extractions but other than that - don't let them bully you. They have equipment to stop bleeding.
I have had a couple turn me down but I found a wonderful dentist in CA and a new one once back in Ohio.
I would think there may need to be bridging done for extractions but other than that - don't let them bully you. They have equipment to stop bleeding.
Based on my readings, unless it is an emergency, you should wait three months after AVR for any invasive dental work, six months if you've had part of your aorta repaired/replaced as well.
Invasive dental work would be as defined in a table in the AHA/ACC Guidelines, which have also been adopted by the ADA. Here's a link to a post that contains it: http://www.valvereplacement.com/forums/showthread.php?p=106283#post106283post106283
The reason is less for your mechanical valve, as warfarin is a great stroke preventer, but rather for complete healing of the epithelium in the operated area. The time immediately following your surgery represents the highest risk period you will ever have for both endocarditis and stroke, although those risks are still quite small. That risk is both caused and exacerbated by any unhealed epithelium in the blood-path.
Waiting until healing has completed, if reasonable, makes great sense. I certainly would not agree to go off of warfarin for dental work or anything else during that time. (Not that you should have to anyway.)
Please note from the guidelines table referred to in the link that fillings are not considered invasive. Cleanings are, extractions are, and root canal is under most circumstances.
Best wishes,
Invasive dental work would be as defined in a table in the AHA/ACC Guidelines, which have also been adopted by the ADA. Here's a link to a post that contains it: http://www.valvereplacement.com/forums/showthread.php?p=106283#post106283post106283
The reason is less for your mechanical valve, as warfarin is a great stroke preventer, but rather for complete healing of the epithelium in the operated area. The time immediately following your surgery represents the highest risk period you will ever have for both endocarditis and stroke, although those risks are still quite small. That risk is both caused and exacerbated by any unhealed epithelium in the blood-path.
Waiting until healing has completed, if reasonable, makes great sense. I certainly would not agree to go off of warfarin for dental work or anything else during that time. (Not that you should have to anyway.)
Please note from the guidelines table referred to in the link that fillings are not considered invasive. Cleanings are, extractions are, and root canal is under most circumstances.
Best wishes,
H
Heinz
Coumadine, and routine dental work
Coumadine, and routine dental work
I would not recomment stopping your coumadin prior to routine dental work,
however if you have a mecanical valve you should consider a pre-dental antibiotic regiment to prevent an infection to the valve.
Heinz
Coumadine, and routine dental work
thecman321 said:
I would not recomment stopping your coumadin prior to routine dental work,
however if you have a mecanical valve you should consider a pre-dental antibiotic regiment to prevent an infection to the valve.
Heinz
G
Gemma
Heinz,
Anyone with a valve issue - whether pre- or post-surgery - and with a mechanical or a tissue replacement valve - needs to pre-medicate with antibiotics prior to dental work where there is any risk of bleeding. This is when bacteria can enter the blood stream and latch onto either the compromised native valve pre-surgery or the sutures/valve itself post-surgery.
Gemma.
Anyone with a valve issue - whether pre- or post-surgery - and with a mechanical or a tissue replacement valve - needs to pre-medicate with antibiotics prior to dental work where there is any risk of bleeding. This is when bacteria can enter the blood stream and latch onto either the compromised native valve pre-surgery or the sutures/valve itself post-surgery.
Gemma.
T
thecman321
thanks
thanks
thank you all for the isight!!!
Well appreciated!!!
C
thanks
thank you all for the isight!!!
Well appreciated!!!
C
M
McCln
I am not sure on the major dental, but on a routine cleaning, get premedicated with anitbotics before the cleaning to prevent infection to creat problems with the heart. Be sure to premed before any dental work done. Please.
B
Barry
Coumadin hasn't been a problem for me for routine dental work - although as noted in previous posts, do be sure to take prophylactic pre-med antibiotics. If I has something bloody coming up, e.g. a tooth extraction, I'd call my cardiologist for advice.
G
Guest
I have a chart showing what dental procedure is safe at various INRs on my website at http://www.warfarinfo.com/dentalprocedures.htm
dental work
dental work
Great info Al. Dad had a routine dental cleaning at the nursing home and the Dentist did it with dad fully anticoagulated. He is being scheduled for a deep scaling and I discussed it with the Dentist and he is fine doing the scaling with dad at 2.5 -3.0. Don't know if it has anything to do with the fact that the Dentist is very young but he probably does not have any pre-concieved notions as far as the way things used to be done. Also the traveling dental practice is from Cleveland and that area of Ohio seems to be up to date with current standard's. Maybe that's because of the Cleveland Clinic and the fact that there protocol's are very much up to date.
dental work
Great info Al. Dad had a routine dental cleaning at the nursing home and the Dentist did it with dad fully anticoagulated. He is being scheduled for a deep scaling and I discussed it with the Dentist and he is fine doing the scaling with dad at 2.5 -3.0. Don't know if it has anything to do with the fact that the Dentist is very young but he probably does not have any pre-concieved notions as far as the way things used to be done. Also the traveling dental practice is from Cleveland and that area of Ohio seems to be up to date with current standard's. Maybe that's because of the Cleveland Clinic and the fact that there protocol's are very much up to date.
G
Guest
It might also have something to do with the fact that a lawsuit I was involved with several years ago involved a dentist in southern Ohio who had a patient stroke in his chair.
A
alicia
Al, Was the patient off Coumadin at that time when he had a stroke? Makes you wonder....
Alicia
Alicia
Al, Correct me if I am wrong but through my research of Coumadin related lawsuits the person had stopped coumadin before the dental procedure and it was before a lot of the protocol's were changed. If this is the one I think it is, the dental patient had a stroke in the chair and he had been ordered to stop taking coumadin 4 or 5 days prior to procedure. The protocol for doing the procedure fully anticoagulated came out shortly after his stroke and was not admissable. Had the protocol been published prior to his event the dentist probably would not have had a very good defense. Does this sound familiar..
G
Guest
The protocol had come out before the incident I was involved with. However, it was not very widely accepted. I think that I know about the one that you are referring to also.
I was hired by the malpractice insurance company to defend the dentist in this case. The first thing that I was told was that the jury was going to love the plaintiff because she answered all questions with, "Yes", "No", or "Because the doctor told me to". Since it was obvious that we could not win on the merits of the case, we had to resort to diversions. Sort of like wearing pajamas to court when the testimony is going to be bad. The trial was to be in a small town. The other side had professors coming in to testify against my man. Having grown up in a small town and living in a small city now, I told the attorneys how to dress for court and the keywords to say to make it look like city-slickers were coming in picking on the town's loyal dentist. The suit was dropped - I guess the plaintiff saw that she was going to lose. So far as I know, the dentist got off clean. It was my baptism into learning that lawsuits are not always decided on the facts.
I was hired by the malpractice insurance company to defend the dentist in this case. The first thing that I was told was that the jury was going to love the plaintiff because she answered all questions with, "Yes", "No", or "Because the doctor told me to". Since it was obvious that we could not win on the merits of the case, we had to resort to diversions. Sort of like wearing pajamas to court when the testimony is going to be bad. The trial was to be in a small town. The other side had professors coming in to testify against my man. Having grown up in a small town and living in a small city now, I told the attorneys how to dress for court and the keywords to say to make it look like city-slickers were coming in picking on the town's loyal dentist. The suit was dropped - I guess the plaintiff saw that she was going to lose. So far as I know, the dentist got off clean. It was my baptism into learning that lawsuits are not always decided on the facts.
Periodontists Wrong advice
Periodontists Wrong advice
My insurance company will pay for routine scaling only when it is done by a specialist (periodontist) causing me to attend a new dentist.
This specialist in Guelph told me to stop taking warfarin 5 days prior to the scaling. Thanked my lucky stars I knew better than that.
He was not happy with this and phoned my PCP and it was straightened out,
In view of the "colonoscopy" postings I don't think the dentist knew the position he was putting both of us in. Now I will have a little chat with him at my next appointment because he "might" advise someone else to discontinue the warfarin. Actually a warning is more like it.
It's hard to believe that "professionals" in various medical disciplines don't know about such a common drug. Actually it's frightening.
PCP told me if I'm in the dentist's chair for anything--get medicated.
Cheers!
Periodontists Wrong advice
My insurance company will pay for routine scaling only when it is done by a specialist (periodontist) causing me to attend a new dentist.
This specialist in Guelph told me to stop taking warfarin 5 days prior to the scaling. Thanked my lucky stars I knew better than that.
He was not happy with this and phoned my PCP and it was straightened out,
In view of the "colonoscopy" postings I don't think the dentist knew the position he was putting both of us in. Now I will have a little chat with him at my next appointment because he "might" advise someone else to discontinue the warfarin. Actually a warning is more like it.
It's hard to believe that "professionals" in various medical disciplines don't know about such a common drug. Actually it's frightening.
PCP told me if I'm in the dentist's chair for anything--get medicated.
Cheers!
