Why they won't learn any different

[Guest]

A professor at the University of Colorado School of Pharmacy just published an article about sending questionnaires to dental schools around the country. 21% of the dental school professors said that they teach their students that warfarin must be stopped when someone needs to have their teeth cleaned.

 

[PJmomrunner]

Unbelievable, yet believable.

 

[Ross]

Really. None of these "Professors" have kept up with the journals?

 

[geebee]

Teeth cleaning takes such a short time that all the people who have strokes from coming off coumadin are long gone from the dentists by the time it happens. I am sure these inadequate professors making inadequate dentists never connect their patients' strokes with anything they did or taught.

Pretty sad.

 

[tobagotwo]

My dentist and my endodontist and their dental technicians have similar rules about Coumadin, which I hound them about regularly. They insist they know what they're talking about, and see me as something of an uninformed and obnoxious ass. Of course, that part may be true; but I wish I could change their minds about warfarin anyway.

I think of the people on this site when I'm at either place, and I try to speak up for their right to have dental work without risking a stroke for the privilege.

Solidarnosc,

 

[Guest]

I wrote something similar to this to the professor about the article. It seems that the only thing that will teach them is a lawsuit. People complain about so many lawsuits but unfortunately this is the only "quality assurance" available in many cases.

Large group practices of physician have at least informal procedures to assure that associates are not way out of line. Hospitals have committees to be sure that standards are followed. However, most dentists are individual practitioners with nothing to monitor quality assurance except the belief that they are doing a good job.

There are some dental school professors who are becoming very aggressive at being expert witnesses.

 

[Karlynn]

They insist they know what they're talking about, and see me as something of an uninformed....

And here in lies the big problem. A field of people who think that because they have MD, RN or any other alphabet after their name they automatically know more than the patient. Even though they themselves know that they haven't bothered to research any changes in years. I think they figure that if something had changed, they automatically "sense" it. It frosts me!!!!!

There are people here who have been critical of my inability to grant uncontested respect in general to the medical field. This is one of the many reasons why I do not.

This really upsets me, to think of the number of people put in jeopardy by this idiocy by some in the dental field. Yes, some will get sued over it. Others will have their patients stroke out and just blame it on that horrible drug Coumadin, none the wiser that it's their lack of education that placed the patient in jeopardy.

 

[florenze]

Why they won't learn any different

I'm stating the obvious here but there are good dentists and there are bad dentists as in any field. So if your dentist chooses not to keep up with new advances, find ANOTHER ONE THAT DOES!!! Luckily, my dentist knows that you do not have to stop the coumadin temporarily for cleanings and he also knows that that I have to take antibiotics before any dental procedure since I have a mechanical valve. I learned the hard way about good doctors and bad doctors-I feel I may not have a heart valve today if the doctors I had at the time were a little more on the ball!!! Since then, I have a new group of doctors I am happier with. And sure, you can consult a lawyer (ambulance chasers are quite popular here in Florida) but the damage is already done to you and my own personal opinion is that these attorneys are out to make a buck rather than look out for you or the general population. Another idea is if you are really unhappy about your doctor(s), file a complaint with your insurance company. My insurance company is pretty aggressive about doing investigations as I'm told and if an insurance company chooses not to keep them on their "payrolls" this may hit the doctor where it counts-their wallet and patients!!! These doctors and dentists will learn when patients stop seeing them. These are just my opinions.

 

[Karlynn]

I agree Florenze.

The unfortunate thing is that many people trust the instructions their doctor or dentist gives them. If they have been not told otherwise, or haven't researched on their own, they would think it is standard procedure to go off warfarin for a cleaning because those were the instructions given to them.

Having had doctors who were supposed to know what they were doing yet really messed me up, I've learned to always question. Sounds like you had to learn the hard way too.

Fortunately, I have not had to look around for a dentist who knows correct SOP for warfarin patients. The first dentist I went to passed the test with flying colors and I've kept him for 10 years.

 

[Guest]

If you look at the thread of oral contraceptives and heart valves, Florenze is being grossly mismanaged.

 

[geebee]

I am in agreement with Karlynn. Most people do not know what they do not know. They think their dentist knows how to handle things and blindly follow instructions. It is still very common to think doctors know everything. That is why research is so very important as well as getting the word out whenever we can.

 

[imhayley]

YOU are my teachers!

YOU are my teachers!

Im so glad to have this site to come to so that I can be ahead of the game when it comes to managing my warfarin. Thank You! My dentist had a heart attack some years back and is well informed about coumadin.....One less Doctor to argue with!

 

[florenze]

why they never learn

why they never learn

This is the same reply I posted under oral contraceptives and heart valves-

One very significant detail I left out was that I am participating in a non-randomized reduced anticoagulation study by MCRI who manufactures the ON-X valve. My doctor, Dr. Vinay Badhwar, is quoted on the website: http://onxvalves.com/Patients_AnticoagulationStudy.asp. The ON-X valve is made of a pure pyrolytic carbon which causes less clots than silicon carbide. There are other advantages to this valve as well which I will not get in to. You can read all about them on the website. And as part of the study, I have a home monitoring machine (Protime) that I am supposed to test my INR weekly. Since I started my oral contraceptive (OC) last Tues, I made the choice to test on Wed and Fri.-my doctor's office did not tell me to test on Wed and Fri. I have done nothing different all week to make my INR increase other than take the OC. I find that just about any med I take affects the coumadin-maybe I'm just the exception who knows.

I really appreciate all your expertise, Al but I think you will find I have a very competent doctor.

 

[Marty]

My dentist not only doesn't stop warfarin for his patients, he doesn't prescribe prophylactic antibiotics for patients with MVP or mechanical valves! He researched the problem while teaching at one of our prominent university dental schools and said he found no scientific evidence for antibiotic prophylaxis.( Sort of like Al saying there is no evidence that heparin bridging works.) I've been his patient for over 30 years and never got endocarditis or had a bleed related to a dental procedure since I've been on warfarin. Years ago one of our most prominent internists did a study at Mayo to see if wiping with alcohol decreased infection when giving a shot vs. just giving the shot. Result? No difference. Did Mayo then stop using alcohol wipes? Of course not! 99% of dentists will continue to prescribe antibiotics and a lot of them will stop warfarin and aspirin four days before teeth cleaning.If you are one of their patients just hope you do not have an anaphylactic reaction to the antibiotic or stroke while holding the warfarin.

 

[florenze]

why they never learn

why they never learn

Funny, because they thought when I had endocarditis that it was caused by some dental work I had done a couple of weeks before I was diagnosed with it. They don't know for sure but they suspect. If I had a good cardiologist at the time that saw on the ECHO about 10 years ago that I had mitral valve prolapse, I might not have a mechanical valve!!! I did not take antibiotics b/c supposedly there was no reason to. I just think it's a good precaution if you have a mechanical valve or mitral valve prolapse to take antibiotics. It's a lot better than possibly having heart surgery...

 

[Christina]

Al,

My Dental Hygenist (sp) argues with me about that same subject every time I come in for my dental cleanings, and every time I tell him the same thing that I don't participate in that absolute nonsense and never will. He may think what he thinks about me but he's the uninformed one here, not me.
How many times do we have to tell them something?

 

[Marty]

Infectious disease specialists believe promiscuous use of antibiotics for every little thing is the cause of dramatic increase in antibiotic resistant bugs like the potentially lethal methicillin-resistant staph aureus.(MRSA).

 

[ALCapshaw2]

Al,

My Dental Hygenist (sp) argues with me about that same subject every time I come in for my dental cleanings, and every time I tell him the same thing that I don't participate in that absolute nonsense and never will. He may think what he thinks about me but he's the uninformed one here, not me.
How many times do we have to tell them something?

Christina,

Obviously they aren't willing to take the word of a 'mere patient' SO, next time, how about SHOWING them a copy of the latest guidelines from the American Dental Association or one of the published papers on the subject?

Also see what Al Lodwick has on his website (www.warfarinfo.com) and take that in as well.

'Al Capshaw'

 

[Guest]

The page is at http://www.warfarinfo.com/dentalprocedures.htm

 

[Guest]

I had a patient going to Denver today for a cardiac catheterization. Her INR was 2.8. The nurse practitioner up there told me to just give her a dose of vitamin K 5 mg orally. She said that they have a lot of people who cannot have their warfarin stopped and that they do a lot of cardiac catheterizations with INRs around 2.5.

Makes stopping warfarin for a week to get the teeth cleaned look pretty silly doesn't it?