acceptable period between heart attack and tooth cleaning

[drdavedds]

I am a dentist who recently was advised by my RDH staff  that a 6 month period always exists between a heart attack and the patient's prophylaxis.  This was taught in their school.   Until now, for 31 years, I have relied on the advisement, case by case, of the patient's MD and also the evaluation that we make of the patient's health and periodontal condition prior to the appointment.  Sometimes we wait a few months, sometimes we have seen a patient only weeks after an event.  Obviously their periodontal condition has an impact on what we decide.  Is there a dogmatic rule that 6 months must elapse?  

[Gingerpeaches]

This link was sent to me by the director of the Columbia College of Dental Medicine who reviews statements regarding teeth cleaning for the Colgate website.

I am working with them and the AHA to get a statement published regarding teeth cleaning post MI.
http://jada.ada.org/cgi/content/full/137/5/576

Studies show that patients can have their teeth cleaned as early as 1 month post MI.

[Gingerpeaches]

After seeing this post along with other similar statements on the Internet, I communicated extensively with my cardiologists and his colleagues, my own dentist and his hygienists of 25 years, the American Heart Association, the American Dental Hygienist Association.

There is NO such recommendation for waiting 6 months after an MI to do a teeth cleaning.  This has turned out to be an urban legend that must stop for the sake of all heart attack survivors who of all people need excellent preventive dental health care especially to prevent endocarditis.

[ed34]

I agree. I know in the UK, everyone is automatically put onto 75mg of Apirin and it's just taken for granted it will effectively do the right job.

[kenkeith]

QUOTE: "I am on 75mg of aspirin daily and have had two wisdom teeth pulled with no bleeding problems. Perhaps different people are affected more than others by the effect of aspirin?"

There are differences with each individual and that may be the underpinning for the problems of excessive bleeding with some people. Therefore, it may be better to use platelet aggregation measurements to evaluate rather than assume a particular dose is adequate for every individual ..

[ed34]

My Dentist refused to pull a tooth while I was on antiplatelets. My GP gave permission to come off aspirin / plavix for a few days before the procedure and then restart them 48 hours after the tooth was extracted. My cardiologist went absolutely nuts. He said a tooth can be pulled with the medication and bleeding would easily have been brought under control. So, I think this is another thing where there are differences in opinion. However, I suppose we have to remember the cardiologist really understands the importance of antiplatelet medication.

[kenkeith]

The doctor knew I had a prior heart attack,  and I was on anti-platelet medication.  The tooth had split in half and had to be pulled and fixed bridge was part of the procedure (no problem).

I  

[cath911]

I am on 75mg of aspirin daily and have had two wisdom teeth pulled with no bleeding problems. Perhaps different people are affected more than others by the effect of aspirin?

Was you Dentist aware you was taking aspirin?

[kenkeith]

I experienced excessive bleeding after having tooth pulled.  I was told to bite down on  teabag on the site of extraction...took about 7 hours to stop bleeding and I am on baby aspirin. One doctor who has an opinion of plavix is not very scientific...(s)he doesn't have data on a wide spectrum of the tooth extractrion population, and it is the probability of the risk with a random patient that is the issue.

Not so long ago, I have read a post where the dentist would not perform an extraction and the doctor would not give permission to discontinue plavix...I believe the resolution was to discontinue plavix for 7 days.

[cath911]

I watched an online surgery video recording where a patient had stents inserted. The cardiologists then took questions from an audience of doctors and the public. One question posed was "does plavix have to be stopped for dental surgery". The reply was "no, plavix has actually been shown not to produce uncontrollable bleeding and even a tooth extraction is very safe". This was a video from 2009, so I'm wondering if the general concensus has now altered.

[kenkeith]

February 2007, the American Heart Association, the American College of Cardiology, the
Plavix will cause excessive bleeding (personal experience) but a laser procedure on soft tissue creates minimum bleeding and anti-platelet medication my not be an issue.

Society for Cardiovascular Angiography and Interventions, the American College of Surgeons, and the American Dental Association published their consensus opinion about drug-eluting stents and anti-platelet therapy. The advisory document states that healthcare providers who perform invasive or surgical procedures (i.e. dentists) and are concerned about periprocedural and postprocedural bleeding should contact the patient’s cardiologist regarding the patient’s antiplatelet regimen and discuss optimal patient management, before discontinuing the antiplatelet medications. Given the importance of antiplatelet medications post-stent implantation in minimizing the risk of stent thrombosis, the medications should not be discontinued prematurely.
______________________________________________
You may be confused with a published opinion about 2 years ago by the medical community that revised the guidelines for bacterial endocarditis prevention.

They found the following information to be proven true, and therefore Traditionally, patients who were considered at risk of developing endocarditis were advised to take antibiotics as a preventive measure before any dental, gastrointestinal or urinary tract procedure. Recently, a group of experts appointed by the American Heart Association conducted a review of the scientific literature to determine the value and effectiveness of antibiotic prophylaxis (preventive antibiotics) before such procedures in reducing the risk of bacterial endocarditis. Guidelines for bacterial endocarditis prevention has been revised and whether or not to take antibiotic medication may not be necessary for many dental procedures if at all.

[cath911]

"These medications could result in excessive bleeding during some oral surgery procedures"

Is that still the case? I thought most cardiologist now say that even tooth extraction is fine on plavix/aspirin because the bleeding will not be much longer than normal?
The contrast is quite amazing when open heart surgery is given to patients who have taken their daily dosage of both aspirin/plavix and very often clexane on top. It makes one wonder how they heal.

[kenkeith]

Dental Care After Heart Attack  (American Heart Association):

Wait a minimum of six months after a heart attack before undergoing any dental treatments. Tell your dentist if you are taking anticoagulants (blood-thinning drugs). These medications could result in excessive bleeding during some oral surgery procedures. Ask your dentist if oxygen and nitroglycerin are available in case a medical emergency should arise during your office visit.