title: Dental treatment in the cardiothoracic intensive care unit for patients with ventricular assist devices awaiting heart transplant: a case series.
abstract: OBJECTIVE
  This report aims to describe the dental protocol for treating in the intensive care unit patients with end-stage heart failure who have had ventricular assist devices (VADs) emergently implanted as a bridge to heart transplant. This protocol permitted the rendering of safe and effective dental care in this setting and did not result in near-term (1-30 days) excessive hemorrhage, local and systemic infection, or contamination of the VAD.
  
  
  METHODS
  This descriptive cross-sectional study by the University of California, Los Angeles, Hospital Dental Service examined the dental care of 9 patients (mean age, 50 ± 12.9 years) with class IV stage D heart failure.
  
  
  RESULTS
  Nine patients, 22 days (mean) after VAD placement, received dental treatment after intravenous prophylactic antibiotics and maintenance of prior anticoagulation, antiplatelet, or antithrombin regimen. Eight patients had extractions (mean, 4; range, 1-12), and one of them also required scaling and root planing (SRP) of the remaining teeth. A ninth individual only required SRP of 4 quadrants. No adverse outcomes developed.
  
  
  CONCLUSIONS
  Emergent removal of active dental disease in patients with VAD awaiting heart transplant can be safely accomplished using established protocols with extended vigilance.
authors.affiliation: Professor of Clinical Dentistry and Vice Chair, Division of Advanced Prosthodontics; Director of the General Practice Residency/Hospital Dentistry Program, School of Dentistry, University of California, Los Angeles, CA, USA. Electronic address: esung@dentistry.ucla.edu.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Sung
authors.affiliation: Student, School of Dentistry, University of California, Los Angeles, CA, USA.
authors.forename: Loveleen K
authors.initials: LK
authors.lastname: Brar
authors.affiliation: Clinical Associate Professor, Division of Advanced Prosthodontics; Clinical Director, General Practice Residency/Hospital Dentistry Program, School of Dentistry, University of California, Los Angeles, CA, USA.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Chung
authors.affiliation: Professor of Clinical Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Bernard
authors.initials: B
authors.lastname: Kubak
authors.affiliation: Associate Clinical Professor, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Margrit
authors.initials: M
authors.lastname: Carlson
authors.affiliation: Professor of Medicine; Director of the Advanced Heart Failure/Mechanical Support/Heart Transplant Program, Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Deng
authors.affiliation: Associate Chief of Staff and Director of Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System; Director of Quality Assurance, Hospital Dental Service, UCLA Medical Center; Professor of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA.
authors.forename: Arthur H
authors.initials: AH
authors.lastname: Friedlander
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D000925:Anticoagulants / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D017742:Dental Care for Chronically Ill; D006333:Heart Failure / Q000150:complications* / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants