Coumadin & Oral Surgery

[Susie Q]

I will be scheduling oral surgery within the next week or so. It will involve removing the 2nd molar on the upper right side. I THINK the dr. said it would leave a hole in the sinus cavity that usually heals on its own. In a few cases a 2nd procedure is required to close the cavity.

My question is: Should I stop taking my coumadin prior to or on day of surgery? The surgeon said he'd check with the Coumadin Clinic, cardiologist, and internist. I told him I'd read on this site that it would be better to bleed a little more than to suffer a stroke. He seemed to be up to date, but I wanted to know what any of you have experienced in this area. I presently take 12 mg of coumadin every day.

Susie Q
ATS Mechanical Aortic Valve
11/08/05

 

[Ross]

For the removal of one, you shouldn't stop coumadin at all. He's an oral surgeon, so he should be able to control a little bleeding.

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.

 

[Susie Q]

Thank you, Ross, for your wisdom & knowledge. I'm printing your reply so I can hand it to the surgeon. I will be curious to see what information he comes up with. At least I'll be armed & ready thanks to you.

 

[Lisa in Katy]

I had the same exact molar removed on May 18. I did not stop taking Warfarin. Actually, my dentist was more comfortable with this than my Cardiologist, but I had done plenty of research and found the same information that Ross quoted. Bleeding complications are much easier to fix than clotting complications. I had my blood checked that afternoon and it was 3.7. I had no problems with bleeding. They told me it would ooze for a couple of days and they were right. It also bled when I brushed my teeth for quite awhile, which they also warned me about. These are the same expectations as for people who aren't on Warfarin. The doctor said that I didn't bleed any more during the procedure than anyone else.

Good luck! Buy plenty of soup. I had 2 crowns and a filling on the same day, so I didn't expect to be eating steak, but the missing/sore tooth made it difficult to chew or bite into things like sandwiches for about a week. Even mashed potatoes were difficult because they had a tendency to get trapped in the sensitive gap.

 

[Ross]

Thank you, Ross, for your wisdom & knowledge. I'm printing your reply so I can hand it to the surgeon. I will be curious to see what information he comes up with. At least I'll be armed & ready thanks to you.

Download the attached PDF file to my post and print it for him.

 

[RobThatsMe]

Hi Susie,

There is one additional thing that I did not see mentioned in the posts.

You must also protect yourself from infection. Dentists should give a patient, that is on Coumadin, an antibiodic 1 hour prior to the dental work being performed. This includes all dental work, even teeth cleaning. Usually they will write you a prescription that you fill and take the pills 1 hour prior to your appointment.

If you are on Coumadin, and have a tendency to bleed, then the mouth, which has all sorts of bacteria in it, can cause infection through any open wounds. Taking an antibiodic will help prevent Endiocardisis. (sp)

I am allergic to penicillin, so they give me a prescription for Clindamycin. I take 4 capsules 1 hour prior to my appointment.

I have had to do this ever since my open-heart surgery. Also, this has been required by several different dentists that I have used.

You may want to inquire with your doctor about this.

Good luck with your dental surgery,

Rob

 

[csutherland]

The abcessed eye tooth that Jerry thought was going to require a root canal re-do turns out needs to be extracted. (See prior posts concerning this). The root is cracked. Guess we'll have the same old argument with the oral surgeons about warfarin. This is the 3rd time we've had this issue. We usually just fudge and pretend he's gone off the warfarin to make them happy. This past week his INR was 2.6 so he should be fine.

We agree, it would be a lot easier to stop minor bleeding than recover from a stroke.

 

[Susie Q]

Coumadin & Oral Surgery

Thank you for the replies. Ross, I downloaded the attached PDF file & have printed it out for not only the oral surgeon, but also for the coumadin clinic that monitors my levels.

Lisa, it was nice to hear from someone who had already experienced the extraction of the same molar. I do realize that no 2 people are exactly the same, but it does add to my confidence. I already have soups on hand.

Rob, both my dentist & the oral surgeon prescribe antibiotics 1 hour prior to procedures. Thanks for the reminder.

Celia, this molar is also a tooth on which a root canal was (SUPPOSEDLY)performed many years ago. Funny thing, part of the root was left. If he can, this surgeon said he'd try to remove the rest of the root. However, if it was embedded, he'd leave it alone. Sounds good to me.

Susie Q
ATS Mechanical Aortic Valve
Mitral Annuloplasty Ring
11/08/05

 

[Sunshine susan]

Ouch & Och

Ouch & Och

Susie Q--I am another Susie Q planning to have 2 wisdom teeth removed which will be a minor surgical procedure which I hope can be done on an out-patient basis. I will be anxious to hear how you do. I have been putting this off now for 2-3 years because of the warfarin/coumadin issue. I hope I won't have to stop the warfarin...I don't want to have to deal with the Lovenox! Good luck!

 

[geebee]

I had the secod molar on the bottom left removed over a year ago. I did not stop coumadin. There is packing material that can be used - very absorbent and works very well. I did not have any more bleeding after than others I talked to who went through it. I think the dentist had to deal with a bit more bleeding than others but he did just fine.