Dental Surgery

[Guest]

Hi just wondering if anyone has had dental surgery while on warfarin and has a mechanical valve. Any help would be appreciated.

 

[pellicle]

Hi

I myself haven't but there has been some previous discussions of worth:

http://www.valvereplacement.org/for...ation/37571-dental-extraction-with-inr-at-1-9

The first reply on the above thread hit the nail on the head if you ask me: "Think it's more of an issue if your dentist will do it or not, some will some won't."

others
http://www.valvereplacement.org/forums/forum/heart-talk/40527-dental-questions-heart-related

http://www.valvereplacement.org/forums/forum/anti-coagulation/26234-coumadin-oral-surgery


Myself I'm of the view that the biggest issues is sheer ignorance in the medical community. In discussions with my dentist (well qualified and very experienced, the sort of guy who keeps abreast of issues) that a "scale and clean" is a bigger risk for endocarditis than an extraction or other surgery because it deliberately stirs up all the plaque (which are the oral coral reef of bacteria) and irritates all the gums opening many many gaps for which bacteria to pass into the blood stream (perhaps overwhelming your own immune response).

I strongly suggest you have antibiotic cover (say, 2000mg of Amoxicillin) an hour pre-surgery to give your body a solid fighting advantage.

Best Wishes

 

[JLmatus]

I had dental surgery this past July 2018. I have an ON-X aortic valve. My cardiologist had me stop the warfarin 2 days before the surgery. He also bridged me with Lovenox shots. I took 2000mg of amoxicillin one hour before the procedure. The dental surgery was an extraction and bone graft in preparation for a dental implant. Everything went smooth. No problems.

 

[tom in MO]

I'd make sure you talk to your cardiologist as to whether or not the procedure needs you to go off warfarin and what type of antibiotic prophylaxis may be needed. Personally, I like to make sure my mouth is fully rinsed with an antibacterial mouthwash before the procedure starts. This was per recommendation of Surfergirl's infection disease doctor.

 

[Paleowoman]

I had a wisdom tooth extracted a year after AVR. I had antibiotic prophylaxsis. As I was having the tooth extracted in a hospital I asked, when I was in the operating theatre, why wasn't I given some sort of antibiotic rinse or spray in my mouth. The answer was that there are so many different types of bacteria in the mouth that it would be impossible to kill them all, hence the antibiotic prophylaxisis in case any of them make it into the bloodstream.

 

[pellicle]

,,,This was per recommendation of Surfergirl's infection disease doctor.

just curious if you are referring to this:

A few of you may remember me from 2010 when I got an AVR with tissue valve. Well, here's an update!

In August, I ran our local 12km race with over 30,000 of my closest friends. I felt awful, I could NOT believe how hard it was. After I got home I took a nap, and woke up with what I assumed was the flu - all shivery and temp 40C (should be 37C). This was Sunday. Then it got worse, and by Tuesday night I was having mad shaking episodes known as rigors, so I stumbled down to my local GP for whatever the cure is for the flu.

However, she didn't think it was the flu, so she rang my cardiologist (who is the most thorough person on the planet) and he told me to come in to the hospital so we could find out where the infection was.

That was Wednesday. I went downhill. By that evening I had massive pain around the area of my gallbladder and not even morphine could fix it - I was truly miserable. The search for the source of the infection was ON!

By the Friday I was having a transesophageal echo, and that showed a massive buildup of bacteria around my valve with an abscess to boot, and the bacteria were blocking my coronary artery by 60%. I was damn lucky to have lived through the race.

So on the Sunday (one week after my 12km race!) I was having my AVR redone, after being told I might not even live to the surgery, then might not make it through - needless to say this was hugely stressful and I was very grateful to open my eyes after the surgery and realise I was alive!

I've quizzed my cardiologist, my surgeon, and my infectious diseases specialist about how in the heck this happened - I grew Strep sanguinus, which is a common mouth bacteria. Most likely I was just brushing or flossing and poked some bacteria through my gums. We can all do this, but getting as far as I got is extremely rare, even in people with artificial valves.

So how to prevent it? The key seems to be mouthwash before brushing or flossing, then wait five minutes before you brush/floss. I really wish I'd been told this little nugget of advice after the first operation, but maybe some of you can benefit from it now!!!

 

[tom in MO]

I had a wisdom tooth extracted a year after AVR. I had antibiotic prophylaxsis. As I was having the tooth extracted in a hospital I asked, when I was in the operating theatre, why wasn't I given some sort of antibiotic rinse or spray in my mouth. The answer was that there are so many different types of bacteria in the mouth that it would be impossible to kill them all, hence the antibiotic prophylaxisis in case any of them make it into the bloodstream.

That doesn't make sense, if they make you take a broad spectrum antibiotic, the same logic would apply to a broad spectrum antisceptic before it gets in your bloodstream. Surfergirl got her advice from an infectous disease doctor. My dentist said it's not in the "protocol" but makes sense. When I had gum surgery, pre-VR, they gave me a prescription mouth wash, so their are products that kill mouth flora.

 

[pellicle]

That doesn't make sense, if they make you take a broad spectrum antibiotic, the same logic would apply to a broad spectrum antisceptic before it gets in your bloodstream.

not quite. Antiseptic wash will only get the surface, and not even beneath the biofilms let alone between the teeth and under the gums and under plaque getting scraped off and broken up.

and who is surfergirl? I can't find any user surfergirl ...

 

[Paleowoman]

That doesn't make sense, if they make you take a broad spectrum antibiotic, the same logic would apply to a broad spectrum antisceptic before it gets in your bloodstream. Surfergirl got her advice from an infectous disease doctor. My dentist said it's not in the "protocol" but makes sense. When I had gum surgery, pre-VR, they gave me a prescription mouth wash, so their are products that kill mouth flora.

I was surprised too, but it kind of makes sense because if these antiseptic mouthwashes really killed all the bacteria they would eliminate dental decay which they don't appear to entirely do. Our mouth contains the most amazing number of bacteria, a google or yahoo search brings loads of hits about it, I like this one which begins "The oral cavity contains some of the most varied and vast flora in the entire human body" : https://emedicine.medscape.com/article/1081424-overview

 

[ForeverThankful]

I had a tooth extraction and when I asked my cardiologist about it he said just keep my INR under 3.0 and my dentist agreed. I think it was 2.5 when I had it done. There was no excessive bleeding, the only thing I noticed is that the socket oozed blood about twice as long as it would have in the past but no big deal. In general I try to keep my INR in the low 2's when I get any dental procedures done.

Also, I took 2000mg Amoxicillin an hour before which I do for all dental procedures.

 

[jwinter]

Agree with ForeverThankful. My INR the day before extraction was 1.6 and dentist said under 3.0 and all is good. I did take 1 antibiotic before exam and 4 or 5 more before extraction, stitches, and bone graft. Most blood I had he said was when they gave me first injection to deaden tooth. They waited a bit before pulling it but all went well with very little blood. I did take antibiotics for a week afterward along with a round of steroids and that heavy duty mouth wash.

My tooth was broken when I went in so was a difficult pull. My jaw was pretty sore when drugs wore off but they gave me a couple days of the good drugs. Bonus

 

[MrsBray]

I had AVR 5 years ago/On-X/warfarin. About 2 years after surgery I got a tooth infection. DDS gave me 10 days of amox to clear it up. That tooth had already been root canaled 20 years ago, so I opted for a re-do. A year later, the infection came back. I did another 10 days of amox, and started the extraction/bonegraft/implant process. DDS said INR under 3 is good to go, and put me on 5 days of amox prior to extraction, along with an extra 2000mg dose an hour before the appt. The remaining appts I did my regular 200mg/1 hour pre-med.

I didn't have a lot of bleeding.
He let me keep my tooth (I'm weird like that. So far, I'll be able to be buried with everything I came into this world with, except my BAV.)

My DDS is awesome - he told me he spent a good amount of time reading up on cardiac issues/warfarin/pre-med when I told him I was having surgery.

The only part I really disliked about the whole process was the adrenaline they add in the Novocaine now to help speed up the effects. I legit thought I was having a panic attack! The Dental Assistant was worried too, until I explained my symptoms - racing heart, shallow breaths, sweaty palms, general nervousness. I asked that we please not do that again!

I like my implant. I wish I had removed that tooth 10 years ago!

I did lovenox for a different procedure a few years ago. I really don't ever want to do that again.

Meredith

 

[Warrick]

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So far, I'll be able to be buried with everything I came into this world with, except my BAV.)

I’ve still got mine

 

[pellicle]

muffed it ...

 

[Agian]

Holy crap Warrick

 

[MrsBray]

Eew eew eew

Haha, that's actually pretty cool!

 

[ForeverThankful]

Oh wow! That is very cool!