Heart problems and dentistry? Any experience?

[Deleted]

My husband has major heart problems including a combo pacemaker/defibrillator. When they placed it (back in AZ), he had problems with clotting. The nurse had to literally hold the incision together for 30 minutes. This is the result of the blood thinners that he has to take.

He needs dental work. This isn't for cosmetic reasons although the loss of a few teeth does bother him. He has additional loose teeth in the bottom and his gums are sore enough to bother him eating.

We don't know where to start. My dentist certainly can't see him. Do we start with our health insurance company, which doesn't cover dental but would have to cover him if he ends up in the hospital? Do we start with his cardiologist?

Obviously, he will have to be hospitalized to have this performed. Is there a way to make the health insurance company see this before it becomes an emergency?

Any experience?

[Deleted]

DH had dental work done under a general anaesthetic and it was done in the hospital. At the time, this was the only dentist we knew of who was also licensed to use general anaesthesia, and that's where he did the work. I'm not sure how it was covered between dental and medical, but it was covered. You should start with the dental insurer; most will do some sort of pre-treatment agreement if the dentist tells them what needs to be done and why general anaesthetic is needed. From there you can go to the health insurer. A lot of dental policies have an annual limit on what they'll pay for everything and it can be as low as $1,500, so you should definitely get estimates of what they'll pay in writing first.

[The Walk of the Penguin Mich]

This isn't for cosmetic reasons although the loss of a few teeth does bother him. He has additional loose teeth in the bottom and his gums are sore enough to bother him eating.

It sounds like your husband has periodontal disease.....his gums are infected and it's becoming systemic and affecting his heart function. I know that there are many cardiologist who will not touch a patient who has severe dental problems until they get the infection in their mouth resolved. Chances are, if his disease is too bad, he'll have to have his teeth pulled. That has happened more than once where I work.

My suggestion would be to get your husband to the periodontal department at your closest dental school. The dentists here work closely with cardiologist because *most* in academia understand the oral - systemic health linkage and work to resolve problems between all healthcare professionals.

Quite frankly, your general dentist cannot handle something like this. Most of the dentists at a medical center have the training in anesthesia AND the ability to use a hospital, if necessary.

[jujube]

He needs to see a board certified Oral Surgeon. I work in the field and we manage patients all the time in the same situation. Usually we work hand and hand with whomever manages his blood thinners and other meds. Usually procedure can be done in office and occassionally we will admit and perform the procedure in a hospital or out patient facility. If we do admit, we can almost always get the medical to pick up all fees due to medical necessity. Good luck

[Deleted]

Thanks, all! This will really help. I'm giving Jujube the karma because he/she doesn't have any.

[Bluerobin]

I have had several heart attacks, and can generally go to the dentist with no problem. Start with the Cardiologist. He can coordinate with the dentist. If I am having something major done, then, I am off the Plavis for a few days - that is what they did for some surgery I had. Most dental work is not a problem - they dentist just uses guaze and I bite down on it to apply the pressure.
Good Luck

[achelois]

If the work is done under general anesthesia in the hospital, the dentist/oral surgeon does not do the anesthesia. The anesthesia is done by the hospital's anesthesia department.

[The Walk of the Penguin Mich]

Sorry, I should have mentioned that you will need an "Oral Surgeon." You will need an endodontist as well.

The OP needs to find out if the teeth are salvagable, which is why I suggest that she take her DH to a periodontist. Since the teeth are loose, my best guess is that they'll send him to an oral surgeon but a periodontist will be able to determine the extent of the disease and whether extracting all the teeth is necessary, or whether teeth can be salvaged. IME, oral surgeons do not make this decision.

This is the reason why I suggested that she look into her local dental school. You do not necessarily have to go with student dentists, all dental schools that I've worked at have a faculty practice clinic where the faculty does the work. IME, it's a faster way of getting into the system rather than trying to work with students. Not only that, the departments work closely together and it's not a matter of getting referred out to another dentist's office (and hoping that they accept your insurance) - but of going to another floor in the building. Finally, most dental schools will accept a wide array of insurances and even faculty practice, which while more expensive than students, is still about 20% less than what the local dental market will cost.