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Dental Work, Plavix, Antibiotics and Stents
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Current Postings on This Page (52):
• 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. • 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. • 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 • 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?
• After stents are placed, how long should I wait before having my teeth cleaned by the hygienist? • 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. • 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! • 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. • my mom has stent (DES) FOR THE LAST 1YR
4 MoNTHS. Now she has to extract 3 teeth.Clopidogrel 150 mg daily running.how
i proceed? • 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:
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. • 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? • 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. • i was diagnosed with
weak heart condition and left bundle branch block..is 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...? • 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. • 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 involved.pt had stopped anticoagulants threee days prior to the procedure • 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 • 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. • 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. • 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. • 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? • I HAVE 3 STENTS IN MY CHEST AREA SINCE MAY 14,2009.
I NOW HAVE AN ABCESS TOOTH AND NEED TO TAKE AN ANTIBIOTIC. I AM TOLD TODAY
BY A DENTIST WHO HAS NOT
EVEN LOOKED IN MY MOUTH YET. TOMORROW IS MY APPT. HOWEVER.SHOULD I TAKE THE
ANTIBIOTIC WITHOUT DISCUSSING IT WITH MY CARDIOLOGIST? IN THE PAST HE HAS
SAID I CANNOT
GET OFF PLAVIX EITHER FOR A FEW MORE MOS.UNLESS I HAVE AN INFECTION WHICH I
THINK I HAVE NOW... • 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? • 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. • 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 • 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. • 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? • 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. • 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 -- is your son taking aspirin because
he has a stent?? • 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? • 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. • 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. • 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. • 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. • 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? • 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. • 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. • 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. • 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" • 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*** • 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. • 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? • 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? • 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 today....it 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 worry...you
will clot. Have an oral surgeon do it and get the
iv sedation! Mike • 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. • 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! • 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. • 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? • 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? • 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. |
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