Tooth extraction and warfarin

[sue943]

I have just come from the hospital dental surgeon who was cleaning my teeth me and during his check of my teeth he said (again) about probably removing one of my back teeth, I am not sure if it a wisdom tooth or a molar, probably a molar.

After my scaling he said that he wants to remove the tooth so I said my therapeutic range was 3.0 to 4.0 so was he suggesting me coming off warfarin and being bridged or what? He said that he will be writing to my cardiologist for his input but his own gut feeling was to not touch the warfarin, to just get my INR checked immediately prior to the extraction then to pack it after extraction and put in a stitch.

How does this sound to the experts - Ross? Antibiotic cover is a given, he knows I will have nothing done without it.

 

[Ross]

I've gotten tons of documentation saying he is wrong. From my own experience, Lovenox provides a much greater bleeding risk then Coumadin. If you'd like, I can find my links and post them for you. I'd recommend coming down in INR to 2 or 2.5 temporarily.

My Dental clinic Doc is an ex Coumadin user that had trouble with Coumadin, so naturally, he wants you off of it despite what every study says to the contrary. The bleeding can be controlled in a variety of ways. It's been shown that just as many serious bleeds happen with normal patients as does those that remain on Coumadin. The key is as to how good of a job he does sealing the socket up.

Here is one to get you started:
http://www.valvereplacement.com/forums/attachment.php?attachmentid=6310&d=1223065492

http://www.bcshguidelines.com/pdf/WarfarinandOralSurgery26407.pdf

http://www.dentistrytoday.com/ME2/d...91&tier=4&id=2A2B237A73C44B15BEDF57C575E4C248

http://www.med.umich.edu/cvc/services/site_anticoag/Warfarin_UMHS.pdf

Hundreds more:

http://www.google.com/search?q=coum...-us&ie=UTF-8&oe=UTF-8&startIndex=&startPage=1

Also just so you know, I had all of mine removed and the bleeding complication was from a lousy stitching job on one of the sockets. Had it been done properly the first time and second time around, there would have been no further complication. We proved that it was not the anticoagulants fault by 2 units of fresh frozen plasma and repeated testing of INR and PTT for Lovenox. They were both at normal values and I was still bleeding badly.

 

[KristyW]

Sue,

If you can convince him, stay on your warfarin! If you bridge it will be much worse...ask Ross. Remind the dentist that you're not going to bleed to death from one tooth socket. I've had my upper wisdom teeth taken out with absolutely no problem and still been on my warfarin with an INR of 3.4 at that time.

It did ooze a bit longer, but if you bite on the gauze as they tell you to, you'll clot up just fine in a couple of hours.

BTW, I work in a dentist's office.

 

[sue943]

Perhaps I didn't make it clear, he wants me to take my warfarin as normal and for him to just control any bleeding in his surgery. When I said 'not to touch' I meant not to alter my dosage at all.

It is only if the cardiologist wants me to come off warfarin will I be admitted to hospital.

 

[Herb M]

My dentist kept telling me to have my molars removed. They weren't causing any problem, but he though they serve no purpose. I declined but after 20 years I had one molar removed because it was causing a problem.

When I went to the dentist he recommended for removal, that dentist told me he would not remove my tooth unless my INR was no greater than 2.0 on the day of extraction. I told him it was not necessary, but he retorted that he has a lot of experience and he will stick to the 2.0 requirement. I went along with it, since getting to 2.0 was not a problem or much of a risk.

 

[Ross]

Perhaps I didn't make it clear, he wants me to take my warfarin as normal and for him to just control any bleeding in his surgery. When I said 'not to touch' I meant not to alter my dosage at all.

It is only if the cardiologist wants me to come off warfarin will I be admitted to hospital.

Fair enough. He is correct then. If you cardio wants you off, then your cardio is wrong. Not sure how it works for you over there, but you shouldn't need hosptialization, just bridge with Lovenox injections at home, but like I said, Lovenox will cause more bleeding, by far, then Coumadin ever would.

 

[sue943]

If there is any bridging to be done it would most likely to be in hospital. Heck, I even have to go to the dental department at least an hour before my appointment so that someone can witness me taking my antibiotics and make a note in my records! In fact yesterday the woman who witnessed put 13.45 instead of 12.45 and the dental surgeon wouldn't accept my word for it, he made her come into the room and confirm the actual time I took them.

I am quite happy that they are extra careful with me, it is all free and as I don't work or have anyone living with me it isn't really a problem to spend more time there.

 

[Elcarim]

It depends on the dentist... some don't see a big deal in whipping a tooth out for no real reason, INR notwithstanding. I am lucky my dentist is more cautious, especially since I am terrified by the thought of extractions.

 

[sue943]

This dentist is a hospital one so works hand in glove with the other doctors in the hospital. He is writing to my cardiologist who is in the building across the road who will then write back to him. It is all a slow process but what the heck, it is free.

 

[Ross]

I'm Gumby damn it!