Living with a left ventricular assist device, or LVAD, does not rule out dental care. Most check-ups, cleans and fillings can be done in an ordinary dental clinic. What changes is the preparation: the dental team needs to know about the device, your blood-thinning medicine and your VAD team's contact details before anything more than a check-up is booked.
This article is general patient education, not medical advice. Your cardiology or VAD team should always be part of the plan for dental treatment.
The pump, the blood thinner and the driveline
An LVAD is a mechanical pump implanted to help a weakened left ventricle move blood around the body. It is powered through a driveline that leaves the body through the skin and connects to a controller and batteries worn outside. It may be used while someone waits for a heart transplant or as longer-term treatment.
Three things about an LVAD matter at the dentist. The pump can form clots, so almost everyone with one takes a blood thinner, usually warfarin and often aspirin as well. People with an LVAD are living with advanced heart disease. And any infection that reaches the bloodstream or the driveline site is a serious problem. None of this makes dental care unsafe, but it is why planning comes first.
Blood thinners stay in place unless the VAD team says otherwise
Stopping a blood thinner raises the risk of a clot forming in the pump, which can cause the device to fail or lead to a stroke. A 2024 literature review in General Dentistry by Kim and colleagues noted that interrupting anticoagulation before dental treatment is not recommended for people with an LVAD, and that most dental care can be done as an outpatient with close coordination with the LVAD or transplant team.
Never stop, skip or delay a blood thinner dose on your own. Before an extraction or any surgery, the dentist will confirm the plan with your VAD team or prescriber. For people on warfarin, a recent INR result is usually needed before a procedure that causes bleeding.
Extractions are still possible with planning. In a 2018 study from Duke University of 32 people with an LVAD who had teeth removed, published in the Journal of Oral and Maxillofacial Surgery, Suresh and colleagues found that bleeding problems were uncommon: one person needed a blood transfusion and none needed a second operation for bleeding. All of those extractions were done in a hospital operating room, and gums were stitched closed afterwards. Local measures help a clot form, such as packing the socket, stitches, firm pressure and sometimes a tranexamic acid mouthwash.
Your cardiology team decides about antibiotics
Some heart conditions call for a dose of antibiotic before certain dental procedures to reduce the risk of infection spreading to the heart. In Australia, dentists follow the Therapeutic Guidelines on this, and the list of conditions that need it is much shorter than it used to be. An LVAD is a specialised device, so the need for antibiotic cover is a decision for your cardiologist or VAD team, based on your history and the procedure planned. A dentist should not guess.
The simplest approach is a short letter from your VAD team that you bring to each new dental practice. It can set out your device, your blood thinner and target INR, any need for antibiotic cover and for which procedures, and who to call with questions.
Keeping the mouth healthy is part of protecting the device
Gum infection and decayed teeth are a source of bacteria. For that reason, VAD teams often ask for a dental check before implantation and regular preventive care afterwards. Twice-daily brushing with fluoride toothpaste, cleaning between the teeth, and regular check-ups and cleans with a dentist or OHT all lower the chance of needing an extraction or other invasive treatment later. If gums keep bleeding after 3 to 4 days of good brushing and flossing, let your dentist know, and mention that you take a blood thinner.
Practical details for the appointment
Some people with an LVAD find lying flat uncomfortable. Dental chairs can be kept partly upright, and shorter appointments can help. Mention this when you book so the team can plan.
Bring spare batteries and anything else your VAD team asks you to carry, and tell the practice if you need room for equipment or would like a companion with you. Ask your VAD team if your particular device has any precautions around electrical dental equipment, such as ultrasonic scalers, and pass that on to the dentist.
When a hospital dental service is the better place
Routine preventive care is usually fine in a general practice for someone whose LVAD care is stable. More involved treatment, such as multiple extractions or surgery, and treatment soon after the device is implanted, may be better done in a hospital dental service with direct access to your cardiology team. Your VAD coordinator can advise which setting suits your situation.
Questions people with an LVAD ask
Can I have a scale and clean?
Usually, yes. Let the dentist or OHT know about your LVAD and blood thinner first. Ask your VAD team whether they want antibiotic cover for cleaning below the gum line.
What should I do in a dental emergency?
Call your dental practice, say that you have an LVAD, and have your VAD team's details ready. If you have facial swelling, fever or bleeding that will not stop, contact your VAD team or go to hospital.
Should I tell my VAD team about every dental visit?
For check-ups, a note in your records may be enough. For anything that causes bleeding, such as extractions, deep cleaning or gum surgery, tell them beforehand.
Similar planning applies to other devices. Our posts on pacemakers and ICDs, insulin pumps and continuous glucose monitors cover what to tell the dental team, and our guide to sedation options for anxious adults may help if nerves are part of the picture.
If you have an LVAD or another complex medical device, the team at Lumi Dental can talk through how we would coordinate with your medical team before any treatment, and you will usually receive a written treatment plan, often by email. Visit the general dentist page to get in touch, or see our current deals.
