Tooth extraction

[sue943]

Can this be done on warfarin or is it a hospital job? My INR needs to be between 3.0 and 4.0, the tooth involved is a wisdom tooth, it hurts. I am going to the dentist today and as I have already had five absesses I am worried that this is yet another.

 

[sue943]

I checked with dentist and for antibiotics I have to take 3 grams an hour before I see him 'just in case'. I will keep my fingers crossed that I don't need the tooth out today.

 

[Ross]

For one extraction, no you shouldnt, but if they decide to do them all, more then likely yes.

 

[sue943]

I guess I am also nervous about getting another bout of endocarditis, as well as the bleeding problem. The only times I get tooth pain I have tended to have an absess, I said five but I have re-counted and it is six so far! Only two of the teeth were saved with root canal filling but I think one of those hit the dust with the last two absesses, on my 51st birthday - not a recommended way to spend the day, with pain and two extractions.

My INR is 4.0 at present, I just got my book back today telling me to skip tonight's dose (range 3.0 - 4.0) and to be honest I was only going to reduce it but now I have to take 3 grams of antibiotic I will do as they want as it will obviously rise with that.

I am prepared for anything, I have stocked up on cat food, got English money from the bank, paid bills and packed a suitcase - with all those precautions nothing will go wrong and I won't have an absess or any other major problem.

 

[Ross]

Don't feel alone. I have one that doesn't hurt yet, but lost a huge filling and I'm not sure it can be repaired, but have to wait 2 more weeks to see the dentist. I have a feeling it's coming out. I must have bit the endoscope pretty good while in the hospital. I broke a filling in another tooth also along with losing one out of the wisdom tooth.

 

[Guest]

There is a chart about dental procedures at various INRs on my website
http://warfarinfo.com/dentalprocedures.htm

 

[sue943]

Two weeks? Wow, I telephoned this morning and said I needed to see a dental surgeon TODAY. My own isn't available so I am seeing his partner. Mine says if you are in pain, phone him, he will come out at midnight Christmas Eve if necessary, that we ought not put up with pain - he will charge for it mind you.

 

[sue943]

Oh dear, it looks as if 4.0 could be a problem then. That is the top of my normal range.

Trust it to be a weekend, if I need to be admitted to hospital for an extraction that is not helpful although at least it would give my warfarin time to work out of my system and for them to keep me on heparin.

Hopefully I will only require a filling but as my back teeth are crowned I think that unlikely.

 

[Ross]

If you skip tonight and depending on what antibiotic they give you, you might just squeak by.

 

[sue943]

Looks as if I was lucky. Turned out to be an infection under a gold crown. He took the crown off, cleaned it all out and packed the tooth with antibiotic. He will see what it is like in a few days and if necessary it might have to be root filled but he hopes not. He said we only need worry about the INR if it is extraction, not root filling. He has given my his home telephone number just in case I get any bad pain over the weekend, but he doesn't think it will happen. A lucky escape. His face was a picture when I told him that my INR was 4.0!

 

[Ross]

I think I need to see your Doc. Mine seems to think it's fine to let people walk around for months with broken fillings and teeth until he can see them. Sorry, but with this mechanical valve, I'm deeply worried about infections.

 

[sue943]

I am delighted to say that the pain has gone without any pain killers. The thought of a possible infection really had me worried. Now all I need face is the prospect of paying for the treatment which will include a new crown!

 

[aussigal]

Gee Sue...you have done well...luck is o your side this time...must be all that pre-planning you did...I must keep that in mind . I was cringing at the thought of what could have happened with your sore tooth .

 

[sue943]

I am a firm believer in planning for the worst case scenario, then it won't happen. Before my surgery I gave my daughter the money to pay for her wedding and made her promise to go through with it regardless of what happened, wrote a letter to my ex-husband who is still my executor telling him where everything is, will, bank accounts etc, arranged with my sister that she would have my funeral from her home - all good insurance. Here I am, alive and kicking although it was a very close call.

 

[Herb M]

A few months ago I had an extraction of one of my wisdom teeth. Everything I read on this forum abd other sources indicated that if I was in my normal INR range, I need not stop taking coumadin. The dentist wouldn't listen and said he would not do the extraction unless my INR is less than 2.0 on the day of the extraction.

 

[Guest]

So he would rather that you were paralyzed for the rest of your life than you had to stay awake one night holding a piece of gauze on the socket.

 

[doyo]

I posed the same question to both my wife's cardio and also her PCP about the tooth extractoin.

The cardio said, stop warfarin, go onto Lovenox.
The PCP said, for a simple extraction, keep taking warfarin.
The PCP said he got into many arguments with his patients' dentists over this issue. It seems dentists would rather have you end up with stroke than a little bleeding.

What the PCP said agrees with what I read elsewhere.
What the cardio said seems a bit extreme for a simple extraction.

EJ

 

[Ross]

I posed the same question to both my wife's cardio and also her PCP about the tooth extractoin.

The cardio said, stop warfarin, go onto Lovenox.
The PCP said, for a simple extraction, keep taking warfarin.
The PCP said he got into many arguments with his patients' dentists over this issue. It seems dentists would rather have you end up with stroke than a little bleeding.

What the PCP said agrees with what I read elsewhere.
What the cardio said seems a bit extreme for a simple extraction.

EJ

From Al Lodwicks treasure chest of info:

Do you need to stop warfarin before a dental procedure? The January 2000 edition of the Journal of The American Dental Association published a study of 950 people who had 2,400 dental procedures done. None of these people stopped their warfarin. There were only 12 incidents (about 1% of the time) where anything more than holding a pad with slight pressure was required to stop bleeding. In these 12 incidents, only 3 times was the INR at or below the therapeutic level. The author also studied 526 people who stopped their warfarin for 575 dental procedures. There were 5 serious complications (about 1% of the time). However, 4 of these 5 patients died.

The conclusions drawn from the study:

Serious complications, including death, were 3 times more likely to occur if warfarin was stopped than if it was continued.

Stopping warfarin for dental surgery is not based on scientific fact, but is a myth.

The author recommends:

Continuing warfarin at therapeutic levels for dental procedures.

Having the patient's INR checked before dental procedures.

What should you do?

Be certain that your dentist is aware of this important information before having a dental procedure.

Question the need for stopping warfarin if you INR is in your goal range.

Show this to your dentist, it contains the reference the dentist will need to find and read the entire article.

Reference: Wahl MJ. Myths of Dental Surgery in Patients Receiving Anticoagulant Therapy. J Am Dental Assoc 2000 Jan;131(1):77-81. See Also