Coumadin & Dental Procedures

[KristyW]

Hi everyone,

I just started working as patient coordinator for my dentist. (Pretty scary for someone who avoided dentists like the plague until 2 years ago.) He gave me a chart to use when I'm dealing with patients who are on coumadin since I am familiar with the drug. I thought that this chart would be useful for all of us here.

Safety of outpatient dental treatment for patients receiving warfarin therapy.

This is a document that the ADA gives dentists, but please check with your Dr./Cardiologist and your Dental professional before any procedure. Different protocols are used by many. (Example: My cardiologist says that for a simple extraction I should hold my warfarin for, get this, 4 DAYS!!!) My dentist and I have agreed to do otherwise.

Hope this helps.

 

[Kim]

I had a wisdom tooth extracted several months ago and did not hold Coumadin at all. My dentist agreed to this. Of course, I wouldn't have done it any other way! I don't know what amount of bleeding is normal for an extraction, but I bled slightly for about 36 hours. I kept guaze packed on the site for probably 24 hours. The tooth had broken thorough the gum, so no "digging into the gums" so to speak, was required.

It was a piece of cake!

 

[LUVMyBirman]

Hi Kim,

That's certainly surprising. Glad you are ok.

I had mine out a few years back, non impacted. They took me off the Coumadin. I think you will find the risk of an uncontrolled bleed is much higher than being down on you Coumadin for a few days. Was on the now controversial Lovenox.

As I understand it.....you should form a clot within 6 hours and should not bleed at all after 12. Sounds like you had a bit more going on. I would double check with your MD if there is a next time.

 

[Guest]

Kim,

You procedure was done according to American Dental Association guidelines. In an article in 2001 they cite a number of patient deaths when taken off warfarin for simple procedures such as one extraction. The inconvenience of bleeding for 36 hours is nothing compared to this.

I consulted on a malpractice case where the dentist had the patient stop warfarin for one extraction. The patient had a stroke in the dental chair. We were able to get the case dropped because it happened just before this guideline was published. Today stopping warfarin for a one tooth extraction would be indefensible in court if the patient had a stroke.

Please look at my web page http://www.warfarinfo.com/dental-procedures.htm for a discussion of this. It includes an e-mail exchange with a dental school professor who agreed with my position and allowed me to publish her e-mail and her name.

 

[LUVMyBirman]

Hi Al.

All I can say is WOW! So you are saying you can't loose a lot of blood or become anemic from a tooth extraction? I will defiantly be inquiring about this one at my next visit! Not that I plan on having any more teeth pulled

Back to the Lovenox. Can't tell you how many times I have been on it with no adverse affects.

 

[Kim]

The bleeding after the extraction was not excessive and more of a nusiance. It was inconvenient that's for sure, but like Al said, I would rather put up with the bleeding than a clot and stroke! I would do it again the same way. Still have one more wisdom tooth that hasn't made it's appearance!

 

[Guest]

Gina,

Did you read my new webpage http://www.warfarinfo.com/bridgetherapy.htm

I sent an e-mail that I had posted to my friend James Groce one of the authors. He wrote back that we are going to address this issue at our professional society meeting in May.

You are right that being on Lovenox when necessary is probably right for almost everyone with a valve.

I had a patient who was fairly angry with me after I recommended that she not stop warfarin for a simple one tooth extraction. She complained bitterly that she was up all night with oozing. I said something like, "So how long would you have been out of action if you had ruined a valve or had a stroke?" Then she decided to go to our cross-town rivals. She was a real pain in the opposite end of the spinal cord from the neck so I felt like our rivals loss was our gain!!!

 

[LUVMyBirman]

Hi Al.

Yes....thank you very much for the information and the link. I will print it off for my cardioligist.

Was informed they do not want patients using Lovenox. I don't agree, but respect his professional opinion unless proven otherwise. Most of it is CYA. And it appears he does not want to risk it.

 

[Zipper]

Gina,

I have worked in and around medicine most of my adult life....you are right..SOOOO much is about CYA...This is why a forum like this is soooooo beneficial. We, as patients, consulting with one another and offering wisdom of our own experiences and questions is so invaluable. No matter how trivial our offerings may seem....they are helpful.

Zipper *~*

 

[ALCapshaw]

Kim,

You procedure was done according to American Dental Association guidelines. In an article in 2001 they cite a number of patient deaths when taken off warfarin for simple procedures such as one extraction. The inconvenience of bleeding for 36 hours is nothing compared to this.

I consulted on a malpractice case where the dentist had the patient stop warfarin for one extraction. The patient had a stroke in the dental chair. We were able to get the case dropped because it happened just before this guideline was published. Today stopping warfarin for a one tooth extraction would be indefensible in court if the patient had a stroke.

Please look at my web page http://www.warfarinfo.com/dental-procedures.htm for a discussion of this. It includes an e-mail exchange with a dental school professor who agreed with my position and allowed me to publish her e-mail and her name.

 

[ALCapshaw]

SO, what do we do if we need to undergo an Endoscopy or Colonoscopy?

'AL'

 

[Granbonny]

Or Skin cancer

Or Skin cancer

I've had several basel cell lesions cut out and think I may see another one on forehead..Pearl looking. Bonnie

 

[Guest]

AL,

MATXR had a good discussion of colonoscopies not too long ago. Perhaps he can direct you to the discussion.

Bonnie,
If you want to ask your question of a hematologist go to www.fvleiden.org and go to their questions section. Dr. Stephan Moll answers their questions. He is a The University of North Carolina in Chapel Hill. I was actually in his office when I heard of this problem with Lovenox and valves for the first time.