Root Cananls and Mechanical Valves

[Gary Miller]

Anyone had any experience with having a root canal after AVR with a mechanical valve? I have this humongous mercury filling from the service and my dentist said that some day it might give me problems and I maybe would need a root canal or even extracted. How long after AVR before it is safe to have dental work done while on Coumadin?x

 

[Eva]

Gary,

Cardios recommend to wait six months after surgery before any dental work. I, personally, waited a year before I went for cleaning! I stayed on the same dose of Coumadin.

It is of utmost necessity to take the recommended 1000 mg anti-biotics one hour before any dental work.

 

[bradvo]

I went to the dentist last month and he told me the same thing, come back after 6 months to do the work. So in May I will have cleaning and 2 cavities filled, also will need 2 crowns soon
Gary,
Sounds to me the dentist is saying to monitor it, would have been nice to have a plan for you, just saying someday you might need a root canal or extraction....kinda crappy to be faced with that.
You do not want decay, it creates bacteria.

 

[tobagotwo]

First, I would look for a dentist who will replace the amalgam filling with a ceramic casting - my dentist did that (some years ago) with several old, very large amalgam fillings. Problem solved. Amalgam never quite becomes fully hard, so as you bite down on it, it spreads the force of the bite outward, eventually cracking the tooth. Ceramic castings are solid, and glued in to the remaining tooth structure, so they don't realign the forces of biting outward.

Second, if the first isn't going to happen (root canal costs more than ceramic - it isn't really worth waiting), if you take an antibiotic, do not take a one-time bolus (premedication dose). It has not been proven to prevent infectious endocarditis. If you are going to bother to take an antibiotic, ask for a full antibiotic course, starting the morning of the dental work.

As far as bleeding, there are no known cases where anyone on Coumadin (warfarin) has bled to death due to dental work. There are cases of people going off their Coumadin and having strokes: so don't. You can work out getting to the lower end of your safe INR zone.

There have been some cases where people had to go to a hospital eventually to get the bleeding to stop, but that is quite rare. For almost everyone, it's not a big beal.

Best wishes,

 

[Mentu]

Gary, the potential to develop endocarditis following dental work is the same for us all whatever type of valve we have. Since it doesn't sound as though the filling is currently causing you discomfort, you may want to ask your dentist for clarification about the time frame in which he feels the tooth should be repaired. I found that several doctors did not want to perform even relatively simple procedures such as lens replacement until six months after my AVR unless it was imperative to do so. Bob addressed the issue of your anti-coagulation therapy and raised another issue that I would second. The only proven way to avoid endocarditis following dental work is by taking a regular course of antibiotic. The effectiveness of taking a large dose one time is questionable even though it is standard practice. This is a real concern because infection via the teeth has long been known to be a source of infection that can develop and attack the heart.

Best wishes on your AVR this week, Gary.

Larry

 

[greg]

Gary, I don't remember how long after surgery before I had work done... Sorry. I can tell you I had a tooth pulled last Nov and the dentist wanted my INR below 'about 2.4'. I was at 2.0 and had 1 gram (1000 mg) of antibiotic with no problems. Got back to normal dose quick, too. Now I'm going for an implant and another dentist says the same... 'around 2.3/2.4'. He is emphatic about taking 2 grams of antibiotic (ampicillian)1 hour before the proceedure.