Routine tooth cleaning - Precautions

[brijeshb]

Dear All - I have a tooth cleaning appointment in 5 days (because of some tartar build up and causing mild occasional bleeding of gums). My dentist told me to take Augmentin 1 mg twice daily and start the dose 2 days prior to appointment.W.r.t to stopping aspirin and warfarin he said just skip one dose prior to appointment. I am on On x Aortic valve (done close to 2 years back because my native AV was bicuspid and had endocarditis) and I do weekly home monitoring of INR to keep it between 2 -3 and I am almost 95% within this range.

Should I take any more precautions ? Is stopping anti coagulant for a day safe without taking Heparin injection ?

Please help me with expert advices

Regards,
Brijesh

 

[Warrick]

I never been asked to skip a dose of warfarin to have my teeth cleaned or any dental procedure, seems very over the top for not much gain in skipping one dose. I dont think you will bleed to death from your gums...
I take 2000mg of an antibiotic 1 hour prior to my dental appointment.

 

[Warrick]

If you search “dental” in the forum there are lots of threads on this topic
https://www.valvereplacement.org/search/289772/?q=Dental&o=relevance

 

[slipkid]

I never been asked to skip a dose of warfarin to have my teeth cleaned or any dental procedure, seems very over the top for not much gain in skipping one dose. I dont think you will bleed to death from your gums...
I take 2000mg of an antibiotic 1 hour prior to my dental appointment.

Ditto for me.

And that includes while I was on BOTH warfarin AND Plavix (double whammy of two different types of anti-coagulants). Neither was stopped prior to cleanings.

 

[JLmatus]

I have an ON X Aortic Valve also. I have never been asked to skip a dose of warfarin before a routine dental cleaning appointment. I take 2000 MG of an antibiotic one hour before my dental appointment. This seems to be the accepted practice for preparing for a dental cleaning. I have never had a problem with bleeding.

 

[pellicle]

ATS mechanical
2000mg of amoxicillin 1 hour prior to dental cleaning. I make no alteration to dose. My dentist used to remark that I bleed less than many patients who aren't on warfarin.

 

[dick0236]

Like the others who have responded.....I take 2000mg(4-500 tabs) of Amoxicillin anti-biotic one hour before a dental appointment (cleaning, extraction, etc). I have never withheld or modified any warfarin dose for dental work. My INR is 2.5-3.5 and I have never had excessive bleeding after dental work.

 

[tom in MO]

The standard protocol is 2g of amoxicillin 1hr before dental cleaning. You do not need to stop warfarin or aspirin. Your dentist is incorrect per my cardio, dentist and a paper I read. If you cannot take amoxicillin, there are other drugs you can take.

I never trust the dentist or other specialists (e.g. urologist, orthopedist) and always ask the cardio. They are in charge of your anticoagulation and know how your specific model of valve can handle various procedures. Dentists are not experts in heart valves. My urologist and orthopedist won't tell me yes or no for certain things but say "I will check with your cardio and either their or my nurse will get back to you." With my cardio, it's his nurse that calls me back.

You can skip warfarin for procedures without bridging. It depends upon the valve type and location. With a St. Jude in the aortic position, I've done it for a TURP. Your cardio will tell you what to do.

 

[Chuck C]

Dear All - I have a tooth cleaning appointment in 5 days (because of some tartar build up and causing mild occasional bleeding of gums). My dentist told me to take Augmentin 1 mg twice daily and start the dose 2 days prior to appointment.W.r.t to stopping aspirin and warfarin he said just skip one dose prior to appointment. I am on On x Aortic valve (done close to 2 years back because my native AV was bicuspid and had endocarditis) and I do weekly home monitoring of INR to keep it between 2 -3 and I am almost 95% within this range.

Should I take any more precautions ? Is stopping anti coagulant for a day safe without taking Heparin injection ?

Please help me with expert advices

Regards,
Brijesh

I had a mechanical aortic valve put in 10 weeks ago and had a dental cleaning 4 weeks after my surgery. Following the guidelines of my surgeon and dentist, I took 2000mg of Amoxicillin an hour before the cleaning. Your dentist is not qualified to tamper with your anti-coagulant and this should be the territory of your cardiologist and/or surgeon. I would encourage you to check with your cardiologist or surgical team before stopping your warfarin or aspirin. I can think of no legitimate reason to stop these prior to dental cleaning. If it is for concern of bleeding, I don't believe he knows what he is talking about.

I had no bleeding from my cleaning and even if you did, it is not reasonable to suggest that this could be life threatening:

Unless this is your dentist:

 

[Warrick]

Just to add also something iv noticed is many professionals dont know the difference between someone on warfarin for a valve and someone on warfarin for afib.

 

[slipkid]

If you cannot take amoxicillin, there are other drugs you can take.

Correct. I can't take amoxicillin any more (had an allergic reaction about 10 years ago) so for dentist/cleaning I take - let's see if I can spell it right - azithromycin. I 4get the dosage off top of my head.

Oddly it was flagged by my dentist for warfarin interactions after I had already been taking it like 4-5 times as prescribed BY THE DENTIST and OKed as per my GP doctor, but the dentist said that he would not allow me to take it without a cardiologist signing off and that he would no longer fill the script. So I had to jump through more hoops on that....

 

[Keithl]

My dentist just makes me take 4 x 500 amoxicillin 1 hour prior, same as before my heart surgery

 

[pellicle]

Just to add also something iv noticed is many professionals dont know

I think often enough we can leave right it there

 

[Unicusp]

Are you all sure that antibiotics are necessary before a routine dental cleaning? Dental cleanings are non invasive and very similar to normal daily dental hygiene. The heart org endocarditis card that I received does not specify that antibiotics are required for cleanings.
I guess if one bleeds alot during normal flossing, then yes. My Cardiologist, PCP, and dentist all said not necessary for cleanings. Did anyone find this requirement documented in literature? Thanks.

 

[QuincyRunner]

All I know is that a routine dental cleaning without antibiotics caused my endocarditis and all I had going in was a slight heart murmur.

 

[AZ Don]

Your dentist is not qualified to tamper with your anti-coagulant and this should be the territory of your cardiologist and/or surgeon.

This is so true. My step father's brother was on warfarin for something, and stopped it on his dentists say so. He had a severe stroke and was never the same. It's good to discuss this with your dentist but essential to discuss it with your Cardiologist or surgeon.

 

[Unicusp]

All I know is that a routine dental cleaning without antibiotics caused my endocarditis and all I had going in was a slight heart murmur.

Wow, sorry to hear. I wonder if there are different levels of "cleaning ". All mine consists of is scraping the teeth, flossing, and polishing.
What happened afterwards?

 

[QuincyRunner]

Unicusp - yes, there is deep cleaning/scaling that is much more aggressive but mine was just my 2X year routine cleaning. Although instead of flossing my dental hygienist used a different procedure she had adopted which felt like sand blasting and stung my gums causing a little more bleeding than usual. She still works there but my dentist now keeps us apart! Anyway, about 10 days later I became very sick and a week after that I was delirious and sleeping most of the time. My wife took me to the ER and after being checked in it still took a week or two before I was properly diagnosed. Then it was emergency OHS the next morning. The surgeon said my mitral valve was shredded and he was surprised I had stayed alive all that time. I was very fit before the endocarditis, which he credited for my survival. So, I have had a mechanical mitral valve for 10 years this September and I am very pleased with both the valve and the level of fitness that I have been able to return to.

 

[carolinemc]

Dear All - I have a tooth cleaning appointment in 5 days (because of some tartar build up and causing mild occasional bleeding of gums). My dentist told me to take Augmentin 1 mg twice daily and start the dose 2 days prior to appointment.W.r.t to stopping aspirin and warfarin he said just skip one dose prior to appointment. I am on On x Aortic valve (done close to 2 years back because my native AV was bicuspid and had endocarditis) and I do weekly home monitoring of INR to keep it between 2 -3 and I am almost 95% within this range.

Should I take any more precautions ? Is stopping anti coagulant for a day safe without taking Heparin injection ?

Please help me with expert advices

Regards,
Brijesh

Due to being a heart patient, it is very important, even for cleaning, to be pre-medicated, to prevent infection from the mouth to travel to the heart. There have been cases of heart patients having endocarditis from the mouth from cleaning., or dental work. I have been taking pre-medication since I was 9 years old. Do take the Anticoagulant unless you are getting dental work done and/or teeth pulled. Use precaution and never take a chance. It only takes one time without pre med to cause you illness from the mouth. Expert since birth.

 

[carolinemc]

Are you all sure that antibiotics are necessary before a routine dental cleaning? Dental cleanings are non invasive and very similar to normal daily dental hygiene. The heart org endocarditis card that I received does not specify that antibiotics are required for cleanings.
I guess if one bleeds alot during normal flossing, then yes. My Cardiologist, PCP, and dentist all said not necessary for cleanings. Did anyone find this requirement documented in literature? Thanks.

Yes it is very important to pre-medicate for anything, including cleaning, to prevent endocarditis. You can have infection in the mouth and anything can happen. Many cases of people taking chances, infection in the gums, travel to the heart. I have been pre-medicating for even cleaning since I was 9 years old.