Anyone had Apicoectomy surgery while staying on warfarin?

[olefin]

While getting my teeth cleaned last July the girl found a red bump on the gum above a #2 molar that had an old root canal. I wasn't feeling any pain but my dentist sent me to see the Endodontics.

Since then I've been seeing the endodontics almost monthly. On the first visit he drilled through the crown, the odor was terrible. He cleaned it out, soaked it for hours with antibiotics. He thought he could save the tooth with more treatments. After the last treatment the first of December we thought the tooth was going to be OK. But after Christmas it began bothering me. He now says he will have to do apical surgery for exploring and may lead to extraction. He first said I'd have to come off warfarin. I said I didn't like that... he then agreed he could handle it with me being on warfarin.

 

[EireCara]

I have a red bump on my gum above a front tooth. Its a tooth I had a root canal treatment on about 5 years ago. It is sore all of the time and often becomes painful and pus comes out of it every few weeks. I went to a dentist about 2 years ago, he did an x-ray and said there is a pocket of infection in the root, but that it was ok so long as it is draining down and out through the red bump....still there right now ??????????

 

[olefin]

Jacqui, that's very interesting. Sounds just like mine, only now I don't have the bump. But I recently completed 10 days of penicillin. I don't have what I call pain, just a feeling that something is wrong. I think the bump thing had also happen in the past. But I never paid any attention to it other than feeling it with my tongue. The tooth wouldn't feel normal for a few days but then get ok. That had been happening for years. The dentist said it had probably been draining though the bump. Mine doesn't show anything on x-ray. But having an infection all the time with a mechanical valve bothers me?

 

[Eva]

Good luck, Dayton. let us know how it goes.

 

[catwoman]

Dayton:

Perhaps KristyW will drop in in the next day or two -- she works for a dentist.

 

[Ross]

I would go for lower end of my INR and stay on it. Coming off and being bridged is actually more bloody then just doing it while on Coumadin.

 

[AgilityDog]

Based on that article Ross (or someone) posted a few days ago, even the dental association agrees they should do the procedures while we are anticoagulated.

Ross, that article ought to be a sticky, if it's not already!

I vote with Ross, drop your INR to lower part of your range, and take that article to your dentist/endodontist.

You're not going to die from losing 3 tablespoons of blood (if you'd even lose that much). And I agree a constant infection can't be good for you/your valve.

 

[olefin]

The warfarin site relating to apicoectomy and not stopping warfarin..... "Insufficient Research" or "Not Advised".

From one of the other sites mentioning specifically apicoectomy.

d. Procedures involved moderate-high risk of bleeding:
• Examples:
o Gingivectomy
o Apicoectomy
o Minor periodontal flap surgery
o Placement of single implant
• Safety profile based on INR:
o Not sufficient scientific data to draw a conclusion for any INR values.
o Not advised to do procedures. Need to refer to physician for adjustment of warfarin therapy

http://stanfordhospital.org/PDF/anticoagulation/dentalProcedure.pdf

Based on that article Ross (or someone) posted a few days ago, even the dental association agrees they should do the procedures while we are anticoagulated.

Ross's article does not specifically mention apicoectomy.
I faxed a copy of that article to my dentist last week.
If it was a simple extraction, I'd have no question.
I'm most sure what my cardiologist will say.

 

[tobagotwo]

These types of constant infections (and others, like constant sinus infections) represent a real risk for infective endocarditis.

I would strongly urge you to go to someone who will aggressively treat the infection, rather than someone who feels it's all right to let it go. In the case of tooth infections, that infected material is present every time you brush, and you can brush it into any tear in the gums, or you can inject it with anything that might accidentally cut your gums (even something like a sharp potato chip). And stopping brushing would be even worse.

Please consider getting these treated to complete extinguishment of the infection.

Best wishes,

 

[Ross]

I really don't think it's going to make much of a difference. If your going to have a bleeding problem, your going to have it whether or not your anticoagulated and they'll still have to treat it the same way. I can only speak of my experience from full dental extractions. I did the bridge thing and bled like crazy. They failed to get one area sutured correctly and it let loose 2 weeks later. Most of the that time, I was not anticoagulated and I was still bleeding. I think you catch my meaning here.

 

[olefin]

Thanks Ross and Bob.

For those like myself that hadn't heard of apicoectomy until two weeks ago... here's a site all about it.

 

[Nancy]

I've had that procedure done twice. Same tooth on different sides. Can't figure that one out, maybe some flaw in the tooth structure. In both cases, they tried to do a normal root canal, but it didn't work and just kept reinfecting. So an apico was done. Not any worse than a regular root canal, if I remember right, since it's all numbed up anyway. I had novacaine injections.

 

[olefin]

Nancy, but were you on warfarin during the apicoectomy?
Oops... maybe you don't take warfarin?
Sorry.
But thanks for the info!

 

[Nancy]

Nope, only referring to the comfort level. Others will talk about Warfarin.

 

[olefin]

Nancy, good to hear that's no more than a root canal. I've had a couple of those and there was no pain. Also be getting novacaine injections. From what I read about apicoectomy there is some discomfort and swelling while the incision heals. Watched a video of the procedure and I can understand why it takes a while to heal.

 

[KristyW]

Dayton:

Perhaps KristyW will drop in in the next day or two -- she works for a dentist.

That's out of my realm Marsha. It's a question for an endodontist. But I agree with the others, there's more danger from the infection than there is of bleeding while anticoagulated.

Get the INR in the bottom of your range and go for it.

 

[olefin]

Thanks,
I fully agree, I'm using an endodontist. I've been on antibiotics a big part of the time for the last 6 months. My INR range is 2.5 to 3.5, I plan to be at 2.5 on surgery day.

Also if I was Jacqui, I would be finding me a endodontist, fast.

 

[tobagotwo]

I don't take warfarin, so I have no skin in the game. You need to determine your own path, based on your personal comfort zone.

However, just some content from the article on warfarin use during dental procedures...

- there are no major blood vessels in the gums
- experientially from the studies, there is a 1% increased danger of a stroke, if warfarin is stopped
- there is up to a 3% chance of needing help to stop bleeding if warfarin is not stopped (this percentage does include people who were well above their ACT INR range at the time of the procedure)
- there was no study in which anyone bled to death from a dental procedure
- the article said there were no non-study cases extant where a patient bled to death from a dental procedure (I have scanned for, but cannot find any either)

As always, you should do what you believe is right for you.

Best wishes,