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Dental Work, Plavix, Antibiotics and Stents

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Stent patients: post experiences with dental work, regarding how the dentist or oral surgeon dealth with your having to stay on Plavix; also if you've had any discussions or questions about antibiotics.

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Current Postings on This Page (52):

• Ivonne - You had posted to a different topic, so we've recategorized your post to this one. If you read through the posts, you'll see that the American Dental Association and other groups have weighed in on this issue, and concluded that there is no additional risk of bleeding for patients who need an extraction and also must stay on Plavix (clopidogrel). Feel free to refer your dentist/doctors to our article from 2007, "New Advisory: Will Stent Patients and Their Doctors Get the Message?" Yes, that's seven years ago and obviously the message has still not been received. Here's a quote from the ADA's position paper:
"Although there is a longstanding concern on the part of dental practitioners about the possibility of prolonged bleeding during and after invasive dental procedures on patients receiving antiplatelet drugs, a recent prospective study of single tooth extractions on patients randomized to aspirin versus a placebo failed to show a statistically significant difference in postoperative bleeding. Although there are no prospective studies of invasive dental procedures on patients taking a thienopyridine alone or in combination with aspirin, there are also no well-documented cases of clinically significant bleeding after dental procedures, including multiple dental extractions. Given the relative ease with which the incidence and severity of oral bleeding can be reduced with local measures during surgery (eg, absorbable gelatin sponge and sutures) and the unlikely occurrence of bleeding once an initial clot has formed, there is little or no indication to interrupt antiplatelet drugs for dental procedures."
Angioplasty.Org Staff, Angioplasty.Org, August 22, 2014

• I had an infarct of the main artery in May 30, 2014. I was told to have 3 metal stents. I had an infection on one of my molars before it happened. Because of the infarct and the medication, I was told no way to have the extraction because I cannot stop my medication. I wish somebody can let me know if this is true or if there is a way to treat this infection which seems to be worse now.
Ivonne, Quebec, CANADA, August 18, 2014

• I see very little on bleeding and dental work for patients on Effient and aspirin. Effient is a more efficient anti platelet medication than Plavix. I have scraped my arm twice (minor abrasion) and it took half hour to stop once and a full hour the second time, even with a lot of applied pressure. I would like some EVIDENCE that dental procedures on this combination is no problem and what to do if bleeding doesn't stop. Thanks, PB.
PB, Cold Spring, Kentucky, USA, September 17, 2013

• i had a stent placed in Jan '08 recently had a deep cleaning lots of bleeding no antibiotics. worried now that any bacteria swallow could enter the blood and cause an infection
worried patient, RVC, New York, USA, August 11, 2012

• my father had a single stent put for his heart as part of an angio. he is on aspirin and clopilates for about a month and a half. his molars have come loose and he needs to get it removed. the dentist refuses saying the bleeding will not stop. is there a way out?
Vishnu, Chennai, Tamil Nadu, INDIA, June 17, 2012

• MarciaLee -- we don't believe there is any study showing a problem with this, except for that fact that you may bleed more easily, since you are most definitely on Plavix and aspirin, which you should stay on! But the American Dental Association has even instructed its members that stent patients should have no problem with dental procedures, including extracting teeth, and that Plavix and aspirin should not be stopped for such procedures.
Angioplasty.Org Staff, Angioplasty.Org, April 30, 2012

• After stents are placed, how long should I wait before having my teeth cleaned by the hygienist?
MarciaLee, Jacksonville, Illinois, USA, April 25, 2012

• I recently developed a maxillary abscess from a failed root canal, approximately 2 months after insertion of 3 stents. I am on Plavix 75 mg and ASA 81 mg and Lipitor 40 mg. The abscess was large and required an apico approach (through the gum and bone) in order to remove the infection and treat the area. I had major curetting done of the bone. I had some minimal oozing for about 24 hours after surgery. My oral surgeon was completely unfazed by my medications, saying that many of his patients are on these drugs (we are in Florida) and he doesn't have problems with operative or post-op bleeding. If your dentist refuses to do necessary work right away--find yourself another dentist/ endodontist/ oral surgeon who knows how to care for patients on these drugs.
DoctorAl, MEDNAX, Inc., Sunrise, Florida, USA, December 21, 2011

• Stent patient on Plavix and have had multiple extractions, have had some excessive bleeding but nothing that couldn't be controlled with a stitch, some gauze, and bite down pressure. Even had some molars out last month. Going in again for ten more so ill be under iv sedation and surgeon wanted me off Plavix 5days prior but cardio said no way! So hope there confident they know how to use gauze and a suction hose, and polished up on sewing class!
Wiseguy, Salem, Massachusetts, USA, September 14, 2011

• Doctor from Bangladesh -- Guidelines in the U.S. recommend clopidogrel for one year minimum after DES. It may be okay for you mom to stop -- however, you should DEFINITELY consult with her cardiologist first. If you read the advisory noted below (in our post from August 20) you will also see the tooth extractions can be done without taking the patient off clopidogrel. Your mom's cardiologist and the dentist should talk to each other about this issue.
Angioplasty.Org Staff, Angioplasty.Org, August 24, 2011

• my mom has stent (DES) FOR THE LAST 1YR 4 MoNTHS. Now she has to extract 3 teeth.Clopidogrel 150 mg daily i proceed?
doctor, chittagong, bangladesh, August 24, 2011

• Leo from Missouri -- since you are from the "show me" state, you should show this article to your wife's dentist. It's called "New Advisory: Will Stent Patients and Their Doctors Get the Message?", except that the advisory is not new. Our article reports on an advisory put out by six major professional societies and in the advisory, here's what they say about dental procedures for patients on Plavix:

"Although there is a longstanding concern on the part of dental practitioners about the possibility of prolonged bleeding during and after invasive dental procedures on patients receiving antiplatelet drugs, a recent prospective study of single tooth extractions on patients randomized to aspirin versus a placebo failed to show a statistically significant difference in postoperative bleeding. Although there are no prospective studies of invasive dental procedures on patients taking a thienopyridine alone or in combination with aspirin, there are also no well-documented cases of clinically significant bleeding after dental procedures, including multiple dental extractions. Given the relative ease with which the incidence and severity of oral bleeding can be reduced with local measures during surgery (eg, absorbable gelatin sponge and sutures) and the unlikely occurrence of bleeding once an initial clot has formed, there is little or no indication to interrupt antiplatelet drugs for dental procedures."

As for your wife's situation, you didn't mention if your wife is taking Plavix because she had a stent implanted. If this is the case, when was the stent implanted? Recommendations are for 12 months minimum if she had a drug-eluting stent.
Angioplasty.Org Staff, Angioplasty.Org, August 20, 2011

• My wife had a root canal scheduled and upon seeing she was on Plavix the Endodontist refused to do the procedure without a waiver and a specific time frame of the number of days she was to be off the medication from her Primary doctor an endocrinologist. After a pissing match from both Doctors, her primary relented and sent the instruction s to be off 7 days. She was referred by her periodontist and she said she did not have to go off plavix that she does surgeries and other procedures all the time without taking patients off plavix. Who is right?
Leo, Independence, Missouri, USA, August 19, 2011

• My mother is 77 years old suffered two heart attacks, suffered two major strokes causing paralysis on her left side, has hypertension and diabetes. Saw three dentists -- all say the same thing that she needs four extractions. in fact one tooth has affected her gum and root badly. She is on Plavix. Am unsure what to do now cause I lost my dad after two weeks he did a tooth extraction.
Tina, Selangor in Malaysia, July 27, 2011

• i was diagnosed with weak heart condition and left bundle branch it ok to have a molar extraction without antibiotics and a teeth cleaning....called and talked to the heart center nurse she asked me if it was needed like she didn't know...?
Denisee, Sacramento, California, USA, May 10, 2011

• well, I have CHF stage IV and am on a pre heart transplant list. I did have an absessed crowned molar tooth and simply told the new dentist I wanted to have it pulled out. My cardiologist and dentist both called in a prescription for antibiotics. Its all healed up now and NO more pain. Thank God and that great Oral Surgeon in Auburn, California.
Marion, Sacramento, California, USA, September 4, 2010

• pt had under gone angioplasty and came to me for filling i had to perform crown lengthening procedure and then do filling which may induce bleeding does he has to be put on antibiotic prophylaxis to prevent sub acute bacterial endocarditis.also wanted to know the precautions to be taken before the procedure and the complications had stopped anticoagulants threee days prior to the procedure
Sri Venkateswara Dental Clinic, Hyderabad, Andhrapradesh, INDIA, September 3, 2010

• I am on Plavix and aspirin I must have two teeth pulled asap my question is whether or not I should go ahead and have the procedure done while continuing these meds
Gregory Hood, Bolingbrook, Illinois, USA, June 3, 2010

• I was on Plavix for one year and needed to have my teeth cleaned. They only wanted to do the top and I would come back the following week to finish. Before, I could get home I started bleeding a little and really didn't think too much about it. However; I kept bleeding and called the dental office and was told to come back in. I continued bleeding for over 5 hours. The dental office sent me to another dentist to see if he could get my bleeding stopped. After 5 hours and over 12 shots in the roof of my mouth I finally stopped. I was told that this was caused by me taking plavix and a baby aspirin. I advised the first dental office that I was on the plavix and I was told that should be no problem. So, now I need to go back to the dentist but am afraid to. I am back on plavix again. I am going to a new dentist and he told me he never heard of anyone having side effects like I did. I called my heart doctor and he advised me to stop taking plavix 3-4 days before my appointment.
O.B., Oklahoma City, Oklahoma, USA, April 16, 2010

• Dolores -- regarding antibiotics, here is a 2007 scientific statement from the American Heart Association, titled "Most patients don't need antibiotics before dental procedures to prevent infective endocarditis". However, every patient is an individual and you should always consult with your interventional cardiologist (the physician who placed your stent) for advice on these matters.
Angioplasty.Org Staff, Angioplasty.Org, March 12, 2010

• I had a stint [stent] put in 4 days ago and my filling came out of tooth holding my partial. All papers from hospital said do not have teeth cleaned for 1 month and then take antibiotics for 4 days before. I am very concerned. It this safe after only 4 days.
Dolores H., Indiana, USA, March 12, 2010

• Hi, My father is having moderate to severe pain in his lower jaw and the dentists have recommended the wisdom tooth be removed (Consulted 2 dentists and both have the same opinion. One suggested that to go for a gum massage and take paracetamol when in pain) . Our cardiologist has suggested to try and delay the process for the first 1 year of angioplasty (he has 1 stent for 99% blockage done 9 months ago.) My father is also diagnosed with Moderate levels of Cholesterol and Blood pressure and is also getting medicated for them. Can someone please suggest whether the procedure of extraction be done or should this pain itself is a cause for some other ailment?
Balaji, India, January 28, 2010

AV, Albany, New York, USA, December 28, 2009

• I had an eluting stent inserted over a non-eluting stent in August. I now have an abscessed, cracked tooth under a crown that is not responding to antibacterials and the pain is debilitating. My cardiologist (and I) feel I must stay on the plavix, but my oral surgeon will not do the extraction. I am devastated by the pain and need the extraction NOW. What should I do?
David Arnold, Harrisburg, Pennsylvania, USA, December 17, 2009

• Just adding my experience yesterday. I had a MI last April (2009) and fortunately walked away with only a DES. I'm on Plavix and a full strength aspirin daily. The usual conflicting advice about stopping these before a needed tooth extraction until I found an oral surgeon (DDS & MD) head of a residency program who said no problem. He was right. Tooth out yesterday with no change in meds and absolutely no problem with very minor bleeding.
Richard G., Omaha, Nebraska, USA, November 25, 2009

• I have dental work scheduled. I was told by my cardiologist I do not need to be pre-medicated. He said only if I have a valve problem is it considered necessary.Likewise I was told there should be no problem, even though I take 325mg aspirin and a Simvastatin 20mg daily
Ken, Hudson, Florida, October 29, 2009

• Hi Lynn. Plavix doesn't "break up" plaque -- it prevents blood from clotting and forming a thrombus (a mesh of blood platelets) in the arteries. When this happens, it happens very quickly. Thrombus formation is distinctly different from plaque buildup. However, your concern is a valid one in other situations, such as carotid stenting, where any emboli (plaque particles) breaking off and rushing to the brain could cause a stroke. This is why an embolic filter is always used in carotid stenting, to catch these particles. They are used in certain coronary situations as well.
Angioplasty.Org Staff, Angioplasty.Org, August 17, 2009

• I don't see anything on this page about perio and taking plavix or any other meds addressing plaque. Is it possible for any of these meds to break up the plaque too quickly and move it through the blood stream in a larger chunk causing blockage internally causing stroke, heart attack or even death?
Lynn D., Florence, Kentucky, USA, August 5, 2009

• Dear Eileen -- the danger of stopping antiplatelet therapy if you have a stent is stent thrombosis. He doesn't have one. The danger of taking aspirin for the dental work is possible bleeding complications. We do know that stent patients have written in that they had extractions done while on both Plavix and aspirin with no problem. But we cannot comment or give any medical advice regarding these issues. He should discuss this with his dentist. Good luck.
Angioplasty.Org Staff, Angioplasty.Org, April 15, 2009

• My son has been diagnosed with congestive heart failure and is taking Coreg, Lisinopril, Hydrochlorotiazide and the 81 mg aspirin. He does not have a stent. Thank you.
Eileen C., California, USA, April 15, 2009

• Eileen -- is your son taking aspirin because he has a stent??
Angioplasty.Org Staff, Angioplasty.Org, April 15, 2009

• My son is on 81 mg aspirin and the dental office called this morning and said he had to discontinue it before they pulled 8 teeth. He won't take it today but still wants to keep the appointment tomorrow with them believing he quit the aspirin 3 days ago. Is this dangerous?
Eileen C., California, USA, April 15, 2009

• Elliott -- were these drug-eluting stents? Guidelines say 6-12 months or longer of Plavix plus aspirin. Stopping earlier increases the risk of stent thrombosis. Read the postings on this topic and you'll see how others have fared with dental work. The idea is to have the interventional cardiologist and dentist discuss this issue.
Angioplasty.Org Staff, Angioplasty.Org, April 13, 2009

• I had stents placed in LAD, Ramus, and PDA 3 months ago. Now on plavix and 81mg aspirin. Person who placed them said continue plavix 6 months, and cardiologist says forever. Am going to need major dental with 12 tooth extractions. How does one go about finding an oral surgeon that can deal with that. I live on Long Island NY. Thanks in advance.
Elliott, New York, April 13, 2009

• i am on plavix and aspirin and have an abscessed tooth under a crown. The dentist has attempted to scrape and clean it by going through he crown but I am still experiencing pain when I bite and the dentist recommended a new crown but I have read that crowns are only 50% successful so why would I spend another $1500.00 on a new crown. They did 4 root canals this week and attempted to reseal the crown. Perhaps I should just have it extracted but I am very frightened with being on the Plavix and aspirin. When I told the dentist I didn't want to do another crown he said just wait. Once again I have little faith in the medical/dental system.
David E., Cincinnati, Ohio, USA, December 8, 2008

• JS -- read the postings below, and also those in the Forum Topic on Plavix and Surgery. The American Dental Association specifically has issued guidelines to its membership that tooth extraction does not necessary require cessation of antiplatelet therapy -- or, if it is necessary, there are strategies to minimize the risk.
Angioplasty.Org Staff, Angioplasty.Org, December 7, 2008

• How will a dentist extract a tooth if you are on Plavix and must continue it for one year? Cardiologist and dentist will conflict on their recommendations . So how do you have a tooth extracted?
J S, Arizona, USA, December 7, 2008

• Well my story is the same as some here. I had 2 medicated stents placed in December 07. I am on lots of meds but the 2 that come into play are plavix and full aspirin. I am sure like your Doc told you TAKE PLAVIX AND ASPRIN EVERY DAY do not stop for anything. Well in May 08 I went to the dentist and he said you have to have 3 wisdom teeth pulled right away, it cannot wait. Well I started to stress out as I was told no surgery s as I will have a problem with bleeding. I got the cardiologist and Oral Surgeon together and the cardiologist said I must stay on the plavix and full aspirin. So after 2 month of stressing over it we had the day set. I went in, the Oral Surgeon put me under and pulled all 3 teeth without issue. I went home within a few hours and had very little bleeding and very little swelling. All went fine and I stayed in all my meds, pulled 3 teeth and had no complications. I can only recommend that you get a great oral surgeon and don t over stress.
David B., California, USA, September 6, 2008

• I have been on Plavix for 4 years. I have 5 stents. 4 Cypher and one Taxus. Can you believe with even being on Plavix for 4 years that Plavix did not keep the Taxus DES stent opened? I was shocked when I learned this after a recent heart cath. (he ballooned this as he did not want another stent in there) When did it re-stenose? God only knows but I know I will stay away from Taxus stents in the future. In regards to dental work. I am the dental queen. Since Plavix I have had 4 teeth extractions, and 5 implants and deep perio cleanings. I never had a problem but I had great dentists that knew how to handle emergencies if need be. Some DDS I had talked with before choosing what i felt are the best..all had excuses as to why they did not want me as a patient or telling me to be off Plavix for a minimum of 5 days. Never been off this med. I did well and have complete faith in my Oral Surgeon, Periodontist and Prostodontist. Ole Lady in Houston.
Rose, Houston, Texas, June 13, 2008

• I'm one of the Catch-22 folks. I had a drug-eluting stent placed about 2 months ago and recently discovered I have a large (4"+) cyst that is destroying my jaw bone. Knowing that I couldn't stop Plavix and Aspirin, the dental surgeon performed initial procedure of biopsy and drilling my jaw. After a day of significant bleeding, the plans for allowing the cyst to drain via tube were abandoned and the incision was sewn up. Four days later I'm still bleeding at the same rate I was after stitches.. My cardiologist, "actually the doctor on call", now says I can stop Plavix for 2 days. I asked about the possibility of trying a short term reduction, but he discouraged it. Are there tests available to help determine if they can individualize the dosage without significantly increasing my risk of sudden restenosis? I'd love to stop bleeding, without risking my life.
William H., Tennessee, USA, May 25, 2008

• Thanks T.C. -- You are correct. Actually the new AHA Guidelines were issued a year ago, but were no doubt amplified at the recent ACC/SCAI meeting in Chicago. Antibiotics are not necessary EXCEPT for patients at high risk for developing infective endocarditis. Here's a link to the April 2007 AHA Guidelines titled, "Prevention of Infective Endocarditis"
Angioplasty.Org Staff, Angioplasty.Org, May 10, 2008

• Regarding antibiotics and dental cleanings, etc. I recently had dental work about one month post catheterization I have been given antibiotics prior to any dental work for years. My Cardiologist having just returned from convention in Chicago was very specific that the recommendations and guidelines have changed a great deal. Antibiotics are NOT necessary in all cases. You should contact your Cardiologist for each specific dental treatment for guidelines based on YOUR heart disease. New Information ***March/April 2008***
T. C., Texas, USA, May 9, 2008

• We suggest all stent patients who are told to stop their antiplatelet therapy for dental work show their dentists our article about last year's Joint Advisory, titled "New Advisory: Will Stent Patients and Their Doctors Get the Message?". Also read over the related topic on "Plavix and Surgery". In brief, don't ever stop without discussing it with your interventional cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, February 1, 2008

• i need teeth pulled asap. but I'm on plavix and aspirin i bleed like a pig even when i nick myself shaving my legs. I'm scared to have the dental work done but the pain in my mouth has to go. Is it safe to have teeth pulled and still take plavix and aspirin?
Marcella, Kentucky, USA, January 14, 2008

• My mother-in-law had a heart bypass last year with a stent in one artery and is now on plavix. She needs an infected tooth to be extracted and her dentist tells her that unless she stops the plavix she could bleed to death as a result of the operation. Is this true? For now he has put her on antibiotics and told her she might need to be on them for life if there is no way to remove the tooth. That doesn't sound like good advice. Any suggestions?
Andrew A., California, USA, October 2, 2007

• Hi all, I just wanted to post my experience with a wisdom tooth extraction I had today with the hopes that it can make some facing this procedure more at ease. First some background (sorry this is long). I was seeing a cardiologist since 2001 for high bp/cholesterol and family history of heart disease. Was taking full aspirin, 10mg altace and 20mg lipitor since 2001. In december 2006 I had an angiogram and they found 2 blockages in my circumflex, 99% in the lower bend and 90% in the om2 branch. They chose to implant a cypher stent in the 99% blockage (don't remember having a chance to discuss this, lol) and said the other was too risky to do at the same time. The report mentioned that further stenting might be required to get the other blockage. My regular cardiologist said we would just treat it with drugs. Then in march 2007 I was having chest pain again....they said to go to the er. to make a long story short I got a second drug eluting stent in the om2 branch of the circumflex. All done at Albany Med in NY. Since then so far I feel great, knock on wood. I am on plavix, full aspirin, altace, toprol xl, pravachol and a whole slew of supplements. I am working of increasing exercise, better diet and various vitamins but that is another story. I have a wisdom tooth for about a year now that my regular dentist said needed to be removed. I kept putting the extraction off and about a month ago, now that I am on Plavix and aspirin, it decides to flair up. My cardiologist said that I was stable to have the extraction but that I could not stop the plavix and aspirin and that I could not have any epinephrine. My regular dentist decides he doesn't want to do it and sends me to an oral surgeon. The oral surgeon was conservative and said he wants me to have iv sedation to reduce any stress. He also says he wants to do the opposing wisdom tooth but not in the same procedure. To make a long story short, I had the extraction all went great with actually very little bleeding. The iv sedation was great...a little expensive since my dental insurance didn't cover it for 1 tooth but the whole procedure went so fast....I have very little memory but also I had very little stress. So for anyone needing a tooth extraction...don't let them tell you to stop you antiplatelet therapy and don't will clot. Have an oral surgeon do it and get the iv sedation! Mike
Mike S., Albany, New York, USA, May 3, 2007

• Thanks Carole. You're right and here is the link to the AHA info. And thanks also to Ron -- we are putting your post on our topic "Plavix and Surgery" as well.
Angioplasty.Org Staff, Angioplasty.Org, March 31, 2007

• Sorry Francis. The friend is right. My periodontist has several advanced degrees. He would agree with the friend. He has articles posted in his office which are related to dental work and heart trouble in people who do NOT take antibiotics about an hour before the procedure. Last week he told me that the AHA now requires it of patients with heart problems. According to him, AHA says 2,000 mg of amoxicillin. Note: my first mother-in-law died a few weeks after routine procedures because her dentist didn't believe in antibiotics before treatment. After her autopsy, he did!
Carole, Atlanta, Georgia, USA, March 26, 2007

• Hi, I had 6 DES 'inserted' just over 2 years ago. I am on plavix, aspirin, and needed to have a tooth extracted about 3 months ago. Was a little concerned, but was reassured by the dentist that all would be well. It was! Dentist administered two small, pain killing injections and extracted the offending tooth. More bleeding than normal - to be expected of course. All that was required to stem the bleeding was two sutures. Left the dental surgery with a little packing and almost no bleeding. No subsequent problems. Would have no hesitation about further extractions if required. Hope this helps.
Ron Walker, Adelaide, Australia, March 21, 2007

• That's a question I've been meaning to ask. I was slated to have a tooth pulled earlier this month,but, due to my having a heart attack, and being on Plavix, the dentist refused to pull that tooth. Said something about needing some sort of medicine to take before going in to the dentist? Is this normal procedure? And, what kind of medication is it I'd have to take?
Nita, Wichita, Kansas, USA, March 19, 2007

• Your cardiologist is right. There is no indication to take antibiotics just because you had a history of an iliac stent. Did your friend go to 4 years of medical school, 3 years of internal medicine, and 4 years of fellowship training for cardiology?
Francis L., North Carolina, USA, July 26, 2006

• I had an iliac angioplasty with a Medtronic Bridge Assurant Stent put in. My Cardiologist said it was okay to have my teeth cleaned without an antibiotic. A friend insists that this could cause me a lot of problems. I am inclined to listen to my Cardiologist, but my friend really has me worried.
Barbara Gannon, Schererville, IN USA, February 27, 2005

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