Dental procedures and anticoagulation revisited

[Georgia]

Went to the dentist last week - he wants to do some scaling on a portion of my gums. I reminded him about the coumadin. He said he'd do it with an inr of 2.5 - he'd just call the doctor and the doctor would adjust my meds to get it at that reading.

I told him that (a) it's not that easy and my veins are just not up to the number of tests to try to get it down; and (b) I'm not willing to drop my inr so much for an essentially optional procedure (my range is 3 - 4 and I've managed to keep it at @3.5 for a year).

Do you suppose that dentists don't know what's involved in getting an inr into range and keeping it there? Comments?

 

[Ross]

Do you suppose that dentists don't know what's involved in getting an inr into range and keeping it there? Comments?

What do you think the answer to this will be? There is so little difference between a 2.5 and a 3.5 that it shouldn't make any difference in the outcome. When is this block headed stuff going to stop in the medical community?

 

[Georgia]

Frankly, I think he won't come around and either the gums will get better or I'll eventually lose a tooth.

Unfortunately, the difference for the poor coumadin user between a 2.5 and 3.5 is huge if they're going to get the inr swinging wildly trying to get it down. And I KNOW that's what'll happen - it's not like there's a magic button to push. Bringing that down will get it swinging for months and weekly bloodwork for just as long.

ARGH!

 

[Karlynn]

Dentist "Georgie, so your INR is now 2.5?"

Georgie "Why of course it is Dr."

 

[LUVMyBirman]

Overkill and wild swings!

Overkill and wild swings!

May be the reason I am still riding low after holding my Coumadin for one day. It's been three weeks too!My "dental" issue ended up being a hole in my jaw that needed fusing. This was after they had me on antibiotics for three weeks because they "thought" I had an infection! This entire thing start to finish has been going on since mid April. Come on people!

My oral surgeon did not want to touch me with an INR of 2.2 the day of surgery. He was making such a HUGE deal out of it to his nurse. He said. hummmmm her INR is really high today, lol. After he finished sewing me up I asked his nurse if I was bleeding more than the average patient?? She rolled her eyes and said no! I know that role of the eyes was in my favor, lol. He also instructed me to hold my Coumadin that night! Yeah, ok buddy I will get right on it! Coumadin nurse instructed 9MG to get it up. So I did so. And BTW I did not bleed one drop after surgery or in the days after.

There are dentists out there that will handle most of our issues on Coumadin. Just need to find them! For a scaling......I would not go any lower than 3.0 if I could get away with it.

 

[tommy]

Georgia,

Sorry about your frustration. I know how you feel about the INR roller coaster that (too often) follows procedures. I've been there several times. In fact, I'm coming up very slowly after colonoscopy. 2.0 for 2 days in a row. I'm sitting on the phone "on hold" with the coumadin clinic for my next instructions/negociations.

These variables make doing these procedures discouraging, but please don't let that stop you from doing what is necessary. Find a way. My concern is that if the consequences of doing nothing will result in a pulled tooth, that could be worse. Yuchhhh!

My experience is that doing a procedure like this while on coumadin may cause some inconvenience for the dentist because of bleeding time, and you may bruise more. They aren't "show-stoppers" for me.

Can you get the cardio to talk directly with your dentist? I'll bet they can come to some agreement that you can live with. That has worked for me several times.

Can you get access to a finger stick test to give your veins a break? I've been testing daily, alternating four fingers. Works well.

I wish you the best outcome possible.

 

[Granbonny]

My Dental problems..after surgery..I had been very Lax..about dental cleanings, ect...before surgery..Just brushed..no problems, moved to different state, remodeled house, ect. Just pearly whites. THEN..2 months after surgery..I would notice blood on my mouth when I awoke. One day, about 3 months post-surgery..was at pool..Noticed my mouth bleeding..Went to ER..scared to death. They ran the tests, ect..Nothing..then I went to a dentist...She cleaned my teeth and recommend..that I see an Oral doctor next door in 3 months for a deeper cleaning..I was given Amox..4 500 mg. an hour before cleaning. I was so scared..NO bleeding from her scaling...And did not stop coumadin..Went back to the regular dentist later. Was told..I need to have 2 teeth extracted in back. Old and doing me no good..but he wanted me off coumadin for 2 days...Consulted with my Cardio..and he said..same thing. My appointment was for an early Monday morning. skipped my 5 mg. on Sat. and my 1/2 dose on Sunday..Extractions done early Monday a.m. NO bleeding. I waited for 3 days and took my INR. 2.0..It only took a week to get back up to 2.5 with my eeking a tad a day. ...I went last week..for oral cleaning again..(Been going every 3 months but missed this last time. It was 6 months. Still no bleeding from her scaling.And she (Oral dentist) never question my INR.Just. Did you pre-medicate. ..She refilled my Amox...30 pills....Will probably go 6 months now before I go back..Love her (Oral dentist) Bonnie

 

[Granbonny]

P.s.

P.s.

I figure the bleeding was due to my taking coumadin..and gums were bad..due to NOT having my teeth cleaned for several years. Bonnie

 

[tommy]

Bonnie,

Good point. Comadin has made me more more diligent about brushing and flossing.

Don't forget the antibiotic.