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Thread: Dental Procedures while on Coumadin

  1. #1
    Perrster Guest

    Default Dental Procedures while on Coumadin

    I'm a bit confused (and quite scared!) with a "stay-on Coumadin" or "go-off Coumadin" possibility for some upcoming dental work.

    My family doc says the dentist has the best answer (he does have a heart-transplant patient and understands Coumadin therapy). My cardiologist said I may have to go off Coumadin for a few days depending on how much the dentist expects to make me bleed? Not sure what the dentist thinks yet as he hasn't even started excavating yet. I got a tooth that may not be saveable via root canal and it may have to go bye-bye-ouch! To top that off, he may even have to send me to an oral surgeon if the work is beyond his capability. Yikes!

    Any experience here? Who should I depend on for the best answer?

    I've done the cleaning thing with a ton of antibiotics so I understand that part.

    Thank you.

  2. #2
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    Default

    Hi Perry

    Been in those similar shoes before. Wisdom teeth removal.

    Just remember everything will turn our just fine if you have the proper DDS handling it, i.e. works with patients on Coumadin.

    If you need an extraction go see and oral surgeon. You will defiantly need to come off your Coumadin for that. Ask whomever is regulating your Coumadin about Lovenox.... it is a sub Q heparin type injectable that will cover you while your levels are down and until they resume.

    They have me hold back the injections 12 hours before the procedure and resume them a few hours after with the Coumadin until I become therapeutic again. This is how I am handled for invasive procedures.

    Depending upon the experience your DDS holds he should be able to handle your other dental needs on your Coumadin. I have had filings replaced as well a crown. The small risk lies while they administer the novicane. It's a lot lower than the risk of getting a clot or worse.

    Just remember to premeditate with your antibiotics.

    Keep us posted
    Last edited by LUVMyBirman; August 13th, 2001 at 11:57 AM.
    All the best,
    LuvMyBirman :)
    MVR, 3/99

  3. #3
    Join Date
    Jun 2001
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    McLean, VA
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    1,584

    Default Big time dental work while on Coumadin?

    I'd be interested in knowing how Al Lodwick would answer this question. I personally had a root canal without going off Coumadin. For bigtime oral surgery extraction etc. I'd stop two days before and start up again the evening of or the next day after.
    Marty
    Mitral valve replacement
    September 17, 1998
    Mechanical St. Jude
    Inova Fairfax, Falls Church VA
    Dr. Ed Lefrak

  4. #4
    Join Date
    Aug 2001
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    Honolulu Hawaii
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    925

    Question great question!

    Perry, Please keep us posted on how your dental work ends up!!!!!!!! I have some work coming up and I need to know if I have to come off coumadin or not! How about for fillings? Anybody???
    Joy E. Paulson
    rhuematic heart disease
    mitral valvuplasty 01/09/01- Dr. Doug Stewart UWMC
    MVR 08/27/01-Dr. Edward Verrier UWMC

    "Remember the good times, don't worry about the bad times, and take each day with stride...

  5. #5
    Join Date
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    upstate New York
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    Default

    For regular dental work, you will not be off coumadin, but will have to take antibiotics prior to treatment. Your cardiologist or primary will prescribe those for you. Most everyone takes Amoxicillan (spelling?), but in Joe's case now that he's developed a reaction to penicillin type meds., he'll use Clindamycin.

  6. #6
    Tammy Guest

    Default Dental Work

    Perry -

    I can relate. I am finally having a crown done next month. I have been putting it off for almost a year. I really, really don't like the dentist office!!!!!!
    For a Crown I can stay on the coumadin but for an extraction it is my understanding you should come off the coumadin temporarily.
    Keep us posted. My appt is Sept 7. Ughhhh.

  7. #7
    Perrster Guest

    Default Thank You All for Your Support

    I will indeed let you know how it all comes out! Actual timing looks like sometime thereafter the Reunion.

    Thanks again.

    PerryA

  8. #8
    Join Date
    Jul 2001
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    Pueblo, Colorado
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    Default

    I'm the one Marty wrote about.

    I am not a valve patient but a pharmacist who has managed warfarin full-time for the past 4 years.

    I was just corresponding with a dental school professor last week about this. I have also been a consultant to a lawsuit where a person had a stroke in the dentist's chair.

    My recommendations are on my website at http://www.warfarinfo.com/dental-procedures.htm

  9. #9
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    upstate New York
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    Lightbulb That explains a lot Al

    Hi Al-

    Husband Joe has 2 valve replacements, one 24 years old (aortic), and one 2 years old (mitral)

    Joe had gone to a dentist for many, many years and surprisingly had few procedures done. He and the dentist were friends and he always had a good report. After his dentist finally retired, Joe began having terrible problems with his teeth. He ended up with a massive infection which spread throughout his mouth. He saw a fine oral surgeon who admitted him to the hospital for oral surgery and had multiple extractions. He lost most of his teeth.

    I am sure his old dentist was scared stiff of doing anything in Joe's mouth.

    I used to think it was just bad luck, but your article puts a whole new light on it.

    In everyone's best interest, you should make sure your dentist is of the enlightened variety.

    It's a miracle that this infection didn't damage Joe's heart more than it already was. But then again, we'll never know what effect it had on the need for a mitral valve replacement.

    Valve replacement people have to be extremely vigilant.

  10. #10
    JBriau Guest

    Default

    Hi Perry

    For any dentist appointments I attend even a
    checkup. My dentist has me go off my coumadin
    for two days prior. I had three teeth pulled at one time
    and had no problems at all.
    Also Perry make sure you take antibiotics before
    any appointment with the dentist. Even for a check up
    any amount of bleeding may cause bacteria to enter
    the blood system. This can cause a life threatening
    disease called endocarditis. I got endocarditis after
    a dental appointment this is the reason I have a
    mechanical valve.

    Jbriau

  11. #11
    ticktock Guest

    Default Yikes!

    You guys are scaring me, I think I will quit brushing. Now THAT is really scary! I go for the Lovenox shots myself, painful and my tummy looked like an eggplant, but hey, I had no problems.

    Im due for cleaning, in fact, 2 years PAST due. The last question I had for Dr. Cooley was "when can I have my teeth cleaned", and he said "never". His father was a dentist! So, what does that really mean???? Gum disease would have to be worse than having them cleaned. He gave me just the excuse I needed. Well, I give up. Im going to make an appt. this week.

  12. #12
    Perrster Guest

    Default Not as Scared as I was!

    I can't say that I look forward to any type of dental work, however I followed the pre-med procedure with Ammoxicyllin (sp?) for dental round one -a good cleaning. (I bled more than I'd like afterwards and felt like an ol' tobacco-chewin' farmer with a spittoon at his side). Nevertheless, my teeth and mouth felt great a few days later and I am scheduled for round-two for a final cleaning and polish session on Sept. 4.

    After that, the doc will work with me on the extractions that I can't avoid. He is a good dentist and has a heart transplant patient and a few other patients on Coumadin. So, I guess it's comforting knowing that.

    All of the information and replies in this forum have been incredible and it's so reassuring to know that an army of experience is behind you! Everything I've learned here will have a role in my dental battleplan. I have CRS and will actually print these replies and use them in my dentist's consultations. I consolidate them as notes right along with allodwick's web page information.

    Thanks again!

    Sincerely,

    PerryA

  13. #13
    Join Date
    Jul 2001
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    Pueblo, Colorado
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    Default

    Going off warfarin for two days for a dental checkup is putting you at an unnecessary risk.

    Why risk ruining your valve or a stroke just for a checkup?

    There are several articles in the dental literature saying that this is malpractice.

  14. #14
    Perrster Guest

    Default Absolutely Not!

    Thanks for the reminder. I am NOT altering my Coumadin for any dental work so far plus doing the recommended antibitotics for all cleanings and exams.

    I have printed the warfarininfo.com pages for reference when I see the dentist to review my case. It is my HOPE that I don't go off Coumadin for anything! It's going too good for me right now to screw-it-up and cause problems.

    I understand what you mean about myth vs. fact, so I think what you are suggesting is DO NOT change any Coumadin intake, have my INR checked, just do it (extraction) and be prepared with lots of gauze?

    At this time, I actually trust the dentist more than my regular doctor and Cardiologist. I think the dentist doesn't believe I should have to go off Coumadin. My doc gets off the hook and refers me to the advice of the dentist. My Cardiologist has suggested going off Coumadin since I mentioned dental work to him and suggests either 2 or 4 days, depending on how much the dentist says I'm likely to bleed.

    Should I start looking for a new Cardiologist? I respect the man and his profession, but he talks too fast and always seems rushed for time. No wonder my BP is high when I see him-I'm too afraid I'll forget something and not be able to get an answer for another 6 months.

    Thanks again, allodwick for your valuable time and information.

    PerryA

  15. #15
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    Default

    You should never have an extraction on your Coumadin. Sounds like you need to find yourself a new dentist if this is what he is suggesting.

    Review my post above about using Lovenox injections while off your Coumadin. They can handle routine dental work on your Coumadin, cleaning, filllings, crowns. Extraction's DO NOT fall under routine for us coumarians.
    All the best,
    LuvMyBirman :)
    MVR, 3/99

  16. #16
    Perrster Guest

    Default Thanks again

    Gina, thanks for the lecture. I mean it, sometimes one needs to be conked on the head!

    I'd much prefer eating conk, I think it's conch...hey, I wonder if conch affects Coumadin? I may go back to Jamaica someday-they're trying to legalize you know what down there!? Nah, better stay away, the heart rate coudn't take it anyway.

    I WILL be careful. Everything is so darn complicated.

    I'm looking forwad to meeting you in Nashville.

    Sincerely,

    PerryA

  17. #17
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    Happy to help Perry.

    And, above all do not want you to bleed unnecessarily.

    When I had my wisdom teeth removed we used the Lovenox while I was off the coumadin. This only leaves you uncovered for a few hours vs. a few days. You resume the Coumadin along with the Lovenox until your levels come up. Just like the Heparin/Coumadin combo.

    Back to the wisdom removal. Was back on the Coumadin and Lovenox. Two days later I started to bleed. Not bad. But that is not normal.... so they packed the site with a gauze that contained a clotting agent. Problem solved. Could not imagine what would have happened with a normal INR!

    Play it safe Perry. We all care about our family here.

    Take care
    All the best,
    LuvMyBirman :)
    MVR, 3/99

  18. #18
    Join Date
    Jun 2001
    Location
    Texas
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    186

    Default to Gina

    Gina, some do perform extractions with the patient on Coumadin. It is rare but not unheard of.

    I am fixing to have a tooth pulled and my cardiologist does not want me off Coumadin for the procedure so after the Cardiologist and my dentist, who is related to me, discussed it, they elected to keep me on it. Ben said he has done it before but not that often. There is apparently some type of foam he plans to use to seal the hole after the tooth is pulled.

    I have to take two types of antibiotics before the procedure and both plus some kick-ass pain killers for afterwards. I'll keep you posted.
    DickV
    AVR-Graft
    SJ Mechanical

  19. #19
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    Default

    A simple extraction can be done while the INR is in the therapeutic range. I have had patients who had a little oozing that lasted overnight. Not bad when you consider the damage that a clot could do.

    The product is Gelfoam. It is like a gauze pad but has materials to assist in clotting.

  20. #20
    Join Date
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    Default

    Guess I should specify that the extraction's I had were wisdom teeth.... notably deeper extractions than a regular tooth.

    Suppose this is the reason I was off my Coumadin.

    In any case, my oral surgeon and cardiologist placed the orders. Using the Lovenox covered me just fine. Would never consider stopping the Coumadin cold turkey without the Lovenox!
    All the best,
    LuvMyBirman :)
    MVR, 3/99

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