Can Tooth Extraction Be Done for a Heart Patient with Stents?

If you have had a stent placed due to a myocardial infarction and the dental clinic is hesitant to extract a tooth, what should you do?

Hello, doctor.
My father-in-law is 78 years old.
He had a myocardial infarction last year and received two stents at Linkou Chang Gung Memorial Hospital.
He is currently experiencing unbearable tooth pain, but the local dental clinic is hesitant to extract the tooth and has advised him to be hospitalized at Chang Gung for the extraction.
However, he cannot tolerate the pain any longer.
Is there a dentist available in the emergency department, and can he have the tooth extracted while he is in pain?

Kelly, 40~49 year old female. Ask Date: 2013/12/28

Dr. Zhang Xiangyuan reply Dentistry

Dear online friend,
According to the description provided, individuals with a history of cardiovascular disease may have certain medications that they take regularly which could affect bleeding control during tooth extraction.
If these medications are not discontinued beforehand, there is a concern that bleeding time after the extraction may be prolonged.
It is advisable to consult with an internist or the treating cardiologist to assess the situation before deciding on the timing of the extraction.

Additionally, for those who have experienced a myocardial infarction within the last six months, it is recommended to postpone any tooth extractions.
For those whose last incident occurred more than six months ago, it is still advisable to consult with an internist or the attending physician to evaluate whether extraction is appropriate.

If you are currently experiencing persistent pain, you may seek emergency treatment and medication from a physician.
Once the symptoms are alleviated, you can proceed with the appropriate management as mentioned above.
Large medical centers typically have on-call emergency dental physicians.

Thank you for your inquiry, and I wish you safety and well-being.

Reply Date: 2013/12/28

More Info

Tooth extraction in a heart patient with stents, particularly someone who has had a myocardial infarction and undergone stent placement, requires careful consideration and coordination between dental and medical professionals. Given your father-in-law's medical history, there are several factors to consider before proceeding with the extraction.

First and foremost, it is essential to understand the implications of having stents in the coronary arteries. Patients with stents are often on antiplatelet medications, such as aspirin and clopidogrel (Plavix), to prevent blood clots from forming around the stent. These medications significantly reduce the risk of stent thrombosis, which can lead to serious cardiovascular events. However, they also increase the risk of bleeding during and after surgical procedures, including dental extractions.

Before any dental procedure, it is crucial to consult with the cardiologist who manages your father-in-law's heart condition. The cardiologist can assess the risks associated with stopping or continuing antiplatelet therapy during the dental procedure. In many cases, the cardiologist may recommend continuing the antiplatelet medications to minimize the risk of cardiovascular complications, even if it increases the risk of bleeding during the extraction.

In terms of the urgency of the dental issue, if your father-in-law is experiencing severe tooth pain, it is essential to address this promptly. While it is advisable to have the extraction performed in a hospital setting where medical support is readily available, many dental offices are equipped to handle such cases, especially if the dentist is experienced in treating patients with complex medical histories.

If your father-in-law is in acute pain, visiting an emergency department that has dental services or an oral surgeon on staff may be a viable option. Emergency departments often have protocols in place for managing dental emergencies, and they can provide immediate relief while ensuring that his cardiac health is monitored.

In summary, tooth extraction can be performed on a heart patient with stents, but it must be done with careful planning and coordination between the dental and medical teams. Here are the steps you should consider:
1. Consult the Cardiologist: Before proceeding with any dental work, consult with your father-in-law's cardiologist to discuss the risks and benefits of continuing or temporarily stopping antiplatelet therapy.

2. Choose the Right Setting: If the extraction is deemed necessary, it may be safer to perform it in a hospital setting where medical support is available, especially if there are concerns about bleeding or other complications.

3. Emergency Care: If the pain is unbearable, seek care at an emergency department that has dental services. They can provide immediate relief and assess whether extraction is appropriate.

4. Post-Extraction Care: After the extraction, close monitoring will be necessary to manage any potential bleeding and to ensure that your father-in-law's cardiovascular health remains stable.

In conclusion, while tooth extraction is possible for a heart patient with stents, it requires a collaborative approach to ensure safety and minimize risks. Prompt attention to dental pain is essential, and appropriate medical oversight is crucial to navigate the complexities of managing both dental and cardiac health.

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