What to do with this tooth

[Kathleen]

A question for those of you who have had to make a tooth decision. I have a thrid from the back tooth that needs attention last week. I have two choices as far as I can tell. My dentist will do a root canal, medicated packing and a crown which will cost me 1200.00. That is after insurance pays their part. I can have it pulled for a cost to me of 120.00. Right now it hurts like heck and the filling is leaking. I feel having it pulled is the best bet. I don't have 1200 bucks and can't see it is going to appear anytime soon. I realize I will have to drop the INR level. I have two mechanicals that are 22 years old and have had a previous stroke and heck a ton of other issues including an ICD which I don't want getting full of bacteria. I know how to adjust the levels but worry about bleeding after the removal. Seems to me that I have to decide if it is worth a grand to risk another stroke or bleed. I hate teeth.
Kathleen

 

[Ross]

Pull it. The bleeding won't be any worse then any other tooth and you shouldn't need to come off Coumadin for it either. I'm looking at a whole mouth full of extractions, care to trade places?

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



http://warfarinfo.com/dental-procedures.htm

 

[geebee]

Kathleen,

Sorry to hear of this addition to everything else.

I had a molar pulled about a year ago (lower left, second from back) and did not go off coumadin. The dentist did have to deal with more bleeding than "normal" but he did mention he had a couple patients not on coumadin who bled almost as much. He used some special packing to stop the bleeding that was removed when the stitches were removed. I have not done anything with the "hole" which has healed nicely and is not easily visible. So far, my other teeth have not moved so I am not sure I will ever have a bridge since it is so expensive.

Be sure and take your antibiotics (although I hear even that is being questioned these days) and do all the follow up care, like rinsing properly. You should be fine.

 

[njean]

I'd have it pulled in a heart beat! (no pun intended!)

I had a tooth extracted 2 years ago & I was not taken off of coumadin either. The bleeding took a little longer but all went well & I didn't have that awful ache anymore!

Just make sure to pre-med before; I'm sure you'll do well! Good luck!