Dental treatment after bypass

[Donny64]

Can any of you good people out there advise me please? I had a triple heart bypass 23 months ago and all is well. I need to have a complicated tooth extraction and my dentist won't do the procedure until I find out whether I need antibiotic cover for when he extracts? He says bacteria getting into a wound in the mouth can affect the heart? My problem is I can't get any answers from the hospital. Nobody is ringing me back or answering emails? Anybody out there know?Regards

[Lowerfield_no_more]

Talk to the PALS team at the hospital. That's what they are there for, to help coordinate between patients and the specialist care team when patients are having difficulty getting the attention they need.

[Donny64 in reply to Lowerfield_no_more]

Cheers for that 👍

[Digger0 in reply to Lowerfield_no_more]

Seconded

[Taviterry]

My dentist seemed very familiar with the British Dental Association guidance on this, when I had a broken tooth shortly after my TAVI. Time was when I would have been advised to pause my anti-platelet medication (Clopidogrel), but current thinking is that it's usually better to continue this.

Your dentist is certainly correct about the risk of heart infection.

And I sympathise with your not getting any replies to your query.

(On Friday, I had my first "bleeding" experience since my TAVI in July 2023. I was being wheelchaired out of a day ward when a nurse asked if my canula had been removed. It hadn't, and I winced a bit when a nurse started on it. My thinned blood ran out of the first pad, prompting a more senior nurse to run up and staunch the flow with a medicated wipe. Some of my blood still dripped onto the chair ... The second pad did the trick, and when I removed it this morning there was no trace of blood.)

[Donny64 in reply to Taviterry]

Thanks for the info 👍

[Happyrosie]

just to interject - I was told that the dentist would be the one to decide whether antibiotic cover was needed.

[Donny64 in reply to Happyrosie]

Thank you, that's interesting as my dentist won't have anything to do with that decision !!

[Bookworm60]

It's definitely an issue.My surgeon issued me with a letter post AVR surgery to show to dentists telling them I need antibiotics if having any 'invasive' treatment. I had a couple of dentists refuse and was told NICE guidelines say it's not necessary...I kept looking till I found a dentist who was happy to be guided by the surgeon's advice!Does the surgeon who did your bypass have a secretary you could contact?

Good luck!

Penny

[Traveldreams]

Hi, obviously contact but I got a card to take to dentist stating necessity for antibiotics.

[Elephant-1]

it is usually the dentist that provides a prescription, if it’s a complex extraction I would ask them to refer you to an oral surgeon

[Jcdg]

Good Morning Donny64, I am having the same trouble , it has to the stage I am desperate to have these teeth out , I even called 111 yesterday I was in so much pain , have emailed the cardiologist secretary again this morning !

🤞you get the treatment you need !

[MountainGoat52]

After having a heart attack and stents, my dentist extracted two of my wisdom teeth. He extracted one at avtime to limit bleeding as I was on aspirin, but there wasn't much either time. I did not have antibiotics for the extractions.

I had a bypass operation in 2018, 11 months after my heart attack. Recently I've had two implants and a crown. Antibiotics were given for the implant work, but not for the crown. I think this is standard practice. I react to antibiotics and come out in red spots, but my dentist assured me that it is better to take them than take a risk.

[devonian186 in reply to MountainGoat52]

I read all this in some trepidation this morning having expected to have a tooth out this afternoon and dreading it. However the dentist decided it wasn't necessary at present if I wasn't experiencing pain.

I do have several gaps though. Can you tell me roughly how much implants are and how you found the whole process?

[MountainGoat52 in reply to devonian186]

For implants you will normally have to go private and they cost £2,000 to £3,000 each. It will depend on your dentist... you should be able to get a quote. If your dentist is NHS, they should be able to give you a recommendation. I had to use part of my small private pension to fund mine, but I needed them so I could chew my food. No problem with pain... anaesthetic given and strong Paracetamol and Erythromycin taken when he did the drilling. The whole process took around 6 months. Hope you get sorted.

[devonian186 in reply to MountainGoat52]

NHS dentist? You will be telling me next that you manage to get a face to face appt with your GP!

That's a lot of money. Will have to see how I get on.

[MountainGoat52 in reply to devonian186]

I haven't had an NHS dentist for almost a decade. As for seeing a GP, the last one I saw was in 2018 when I got signed off my recovery period after my bypass op so i could drive again.... by a GP that I had never met before! Since then I've only seen nurses at the practice when I've had vaccinations.

As for the cost of implants, yes it was expensive. I still have one gap which I would like to fill, but at the age of 72 it's not really viable spending on it when I can cope without it. The two I had were essential.

[Donny64 in reply to devonian186]

I've got the NHS dentist but no chance of seeing my GP 🤣That would be a challenge

[Winniesmum]

Hi I had mitral valve surgery just over a year ago and my surgeon wrote a letter to my dentist to let them know I needed a strong dose of antibiotics before any dental treatment. I even had to take it before my hygienist appointment recently. However, he did state in the letter that this was contrary to new advice. So I think your dentist may be correct and to be sure I would definitely wait to get an answer from your consultant. Hope that helps and good luck with it

[T666]

coming at it from a different angle. I was on warfarin and needed an extraction. Dentist insisted on me getting a blood test. Level was acceptable and went ahead with extraction. I bled and bled for 3 days I felt a little better on day 4 and went for a walk. That day I had a heart attack followed by triple bypass

12 months ago…. Subsequently my dentist has said any future extractions will need to be carried out at the hospital

Definitely exercise caution and following instructions but also be aware medics are frightened of litigation, in our best interests of course 😁

[Megaladon]

I actually have an answer for you as a person who had mitral valve replacement 2 years ago:

Due to broken toot i had to have a Tooth extraction in uk- they gave me antibiotic 1 hour before my procedure, dis not stop warfarin and then heavy bleeding foreced me to end up in a&e next day. However they gave me a course of antibiotic for days to continue. So a heavy course an hour before touching my tooth and then 5 days normal antibiotic- this was in London

Then I went for an implant of the tooth extracted in Turkey in July 2024. Spoke to cardiologist. On his advice and letter dentists stopped the blood thinners 2 days before the procedure, started giving me injection 2 days before my trestment to prevent heavy bleeding. After the procedure they gave me 10 days long antibiotic. Zero bleeding, zero head ache. Now i am going back for the implant itself and they said nothing to be changed as there won’t be any bleeding in my mouth.

basically in uk i could not possibly speak to a cardiologists but went to soecialist. In turkey cardiologist said antibiotic is a must take and warfarine is to be cut before the operation.

Hope this answers your questions

[Audi1955]

Why don't you get your dentist to write you a prescription and just take the antibiotics..if it's nhs it's free if he's private it will cost approx £30 for 2 doses and its safer for you anyway.

[Vms49]

I was given a card to carry after my Tavi to show to dentist and says I need antibiotics when work is done at or below gum level

[Soldierboy]

Ditto to all you have said. I'm going to try 111?

[petrh63]

Hello, my cardiologist insists on antibiotics before all dental treatment, that includes the hygienist. Three years after the heart op still I take anti-biotics one hour before treatment.

[Shabana1974]

Ask him to refer you to hospital, my Dentist as referred me to UCLH London. As they are best equipped to do the job, if they need answers for your hospital they can get it very quickly.

Hope this helps

[momander]

Gosh!!! Well all I can tell you is I had a tooth extraction after my bypass and there was no problem at all. I hope you are able to find out from someone!! I've never heard of this problem with bacteria???

[Cookie2020]

I had the same problem but I got it solved in the end. I’ve got my Dentist to write to the Maxi Facial clinic in my local hospital and ask their advice their advice to the Dentist on my behalf was they were coming and I should go and see them and have the treatment done under them instead of a normal dentist just in case there are any bleeds or infection. They look after it from day one now everything is fine, don’t be afraid to ask your Dentist to do it because I can be a bit stubborn good luck

[Reggaelover]

Hello Donny64. I had mitral and tricuspid valve repair surgery in April and was told to inform my dentist as there are risks of damage to the heart if bacteria are released into the body, for example due to infection. If there is such a risk, it is common for dentists to prescribe a course of antibiotics. But it is worth checking this with medical professionals such as your cardiologist.

[Samsoncat]

Consider yourself fortunate to have a dentist who insists on not proceeding with dental treatment without antibiotics clearance. Ineffetive endocarditis is rare but life threatening illness. This really needs to be considered for those who have had heart surgery.

[Coper10]

My cardiologist wrote a letter for my dentist confirming the need for prophylactic antibiotics before certain dental procedures as per NICE guidelines. I have had an Aortic Valve Replacement and my understanding is that I am at a higher risk of infective endocarditis as a result of the replacement valve. However, which specific dental procedures are not listed and the guidance refers to disturbance of the gingival layer where they may be some bleeding. The most recent update to the guidelines was in 2016 as far as I know (sorry, can't find the link to add). Despite this, I still have to highlight the issue with my dentist and ask them if the procedure needed requires antibiotics as per the guidelines. Whilst I don't want to take them unnecessarily, I also don't want the raise the risk of endocarditis. They can be reluctant to prescribe.

[cappachina]

I was told by my surgeon that I must have antibiotic cover before work on teeth after I had a valve replacement via TAVI

[Craig53]

I was advised before I had heart surgery for value replacement 2 and something to do with root I had all my teeth taken out because of infestation so bit different but mouth and teeth can affect heart