Dental Implant

[Newbie]

Before my AVR (mechanical), I extracted a tooth in preparation for an implant. I did not predict the AVR before the implant.

I just called my dentist to book the implant procedure. I informed the assistant that I was on warfarin. She simply told me to stop taking it 5 to days before the procedure.
Hello ? Bells went off in my head...
Is she nuts ? Is she right ?

I will talk to my cardiologist about it but thought I would get advice here too.

Joe

 

[tobagotwo]

In my book, she's underinformed. Here's a repeat of a post I made earlier...

More info for discussions with your dentist regarding being on ACT for dental procedures...

From the Journal of the American Dental Association: http://jada.ada.org/cgi/content/full/131/1/77 MYTHS OF DENTAL SURGERY IN PATIENTS RECEIVING ANTICOAGULANT THERAPY MICHAEL J. WAHL, D.D.S.

Results. Of more than 950 patients receiving continuous anticoagulant therapy (including many whose anticoagulation levels were well above currently recommended therapeutic levels) who underwent more than 2,400 surgical procedures, only 12 (< 1.3 percent) required more than local measures to control hemorrhage. Only three of these patients (< 0.31 percent) had anticoagulation levels within or below currently recommended therapeutic levels. Of 526 patients who experienced 575 interruptions of continuous anticoagulant therapy, five (0.95 percent) suffered serious embolic complications; four of these patients died.

Conclusions. Serious embolic complications, including death, were three times more likely to occur in patients whose anticoagulant therapy was interrupted than were bleeding complications in patients whose anticoagulant therapy was continued (and whose anticoagulation levels were within or below therapeutic levels). Interrupting therapeutic levels of continuous anticoagulation for dental surgery is not based on scientific fact, but seems to be based on its own mythology.

But there's more in the article, including a list of the five "MYTHS OF DENTAL SURGERY IN PATIENTS RECEIVING ANTICOAGULANT THERAPY." This is the type of article that can help you make a point, if you wish to, or provide subject matter information for a realistic discussion with your dental practitioner.

I wish you good luck in convincing the practice to let you stay on warfarin. They are generally resistant (spelled c-h-i-c-k-e-n). However, they should consider believing their own Journal (JADA = Journal of the American Dental Association). You risk a stroke off of warfarin (1%), and at worst only a non-fatal bleed if you stay on it (1.3%). Are they willing to risk your brain for their convenience and to avoid possible (barely possible) embarrassment at needing external assistance in stopping minor bleeding after? No point in a dental implant if you can't chew anymore.

Best wishes,

 

[Cris N]

Do not, I repeat, do not stop your warfarin for 5 days. That's absolutely not necessary. Bob H gave you good info. You should be able to make a deal with the dentist. You'll get down to the low end of your range... probably 2.0? At that point the bleeding would only take twice as long as a person with regular coagulation. In other words, if it takes 20 seconds for the bleeding to stop in a regular person it may take you 40 seconds. And then ask, how much bleeding normally occurs. Maybe a couple of teaspoons... Keep in mind that blood donors lose a PINT when they donate. Arrgghhhh.... these people just don't get it.

Good luck - stay safe!

 

[Protimenow]

No, these people DON'T get it.

I had an extraction a few years ago -- I don't know what my INR was, but I think I stopped warfarin the day before the extraction - and the area where my tooth was seeped for a couple hours -- annoying, but certainly nowhere near life-threatening.

I had some dental work a few days ago and took my INR immediately before seeing the dentist. This was fairly routine stuff, and my dentist was unconcerned. He explained that the amount of blood lost from the hole made when he injected novocaine was almost zero, and the work he did caused no bleeding. If it was oral surgery, the bleed may have been more (as Cris N said, maybe twice what it would normally be), but certainly neither life-threating nor especially annoying. It certainly would be less risky than a stroke that may result from NO anticoagulation.

As others have said, if you have a meter, and can go in with a 2.0, you shouldn't be too concerned (although, I guess, if it was dental implants, your oral surgeon may consider working in an area that bleeds less because (s)he gets a better view of the operative site.)

 

[Protimenow]

There's one thing you should be somewhat concerned about. It's not about your INR level - it may be about your antibiotic level. When oral surgery is performed, some protocols call for Gentamycin (which could cause deafness) or other antibiotics to battle the bacteria that exist in the mouth, and keep it from damaging your heart valves. This is probably something you should ask your cardiologist about before getting major dental work.

 

[ctyguy]

I had a dental implant started about 6 months ago. Tooth extraction and the packed with bone material. I have to go back in within another month or two to get the post put in and then the crown. I 1/2 dosed my Coumadin for 2 days prior and as a precaution they decided I needed a Lovenox bridge as well. Bleeding was an absolute non-issue. The biggest issue I had was the ache of the tooth and the time it took to heal up. The only real issue I've found in being on Coumadin is that I seem to heal slower.

The assistant in your dentists office is obviously un-informed. Don't stop your Coumadin, have your Cardio call and give his/her recommendation to the dentist. They will run with whatever your cardio says.

 

[Newbie]

Thanks all for your comments and advice. I'll be speaking to my cardio and the dentist.

 

[olefin]

I had an old root canal go bad on a molar and required removing the root tip below gum line. My Endodntics said stop warfarin for 5 days before. I said I couldn't do that but I would lower my INR to 2.5 to 2.0 on the day of the procedure. Then he said OK. Took three stitches to close my gum but he commented there was no more blood than someone not on warfarin.
Since this same tooth may have to be removed at a later date I asked my Cardiologist. He said NOT to stop warfarin but do as I did in the past and get the INR down to 2.5 to 2.0. I have that in writing for the local oral surgeon refuses to do an extraction while on warfarin unless the Cardiologist approves.

Good luck!