Full Dental Extractions Fully Anticoagulated?

[Ross]

Well group do I do this fully anticoagulated or do I bridge? This seems to be the question that is holding up the show.

http://webteach.mc.uky.edu/ODM830/PPT_0607/Anticoagulant and Antiplatelet Drugs.ppt#1

 

[geebee]

This jumped out at me:

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.​

I had a molar extracted while fully anticoagulated and, although the dentist had to work at the bleeding, I survived. Now, I realize that is not the same as you but......will they be cutting the gums or just pulling?

 

[Ross]

I imagine they will cut the gums. Don't know what they do for Alveoplasty.

'Many of these
cases involved full-mouth
extractions and alveoplasties,
and many were performed while
patients’ anticoagulation levels
were higher than currently recommended
therapeutic levels.'

 

[Lisa in Katy]

I had one molar extracted and the dentist said I didn't bleed any more than normal. He put some kind of "skin" on the hole and stitched it. It seeped for a while, but that is also normal. Of course you have more teeth to deal with. If it was me, I would feel safer anticoagulated, possibly on the lower side of the range, if possible. Like we've heard before, bleeds are easier to reverse than clots.

 

[njean]

Well group do I do this fully anticoagulated or do I bridge? This seems to be the question that is holding up the show.

http://webteach.mc.uky.edu/ODM830/PPT_0607/Anticoagulant and Antiplatelet Drugs.ppt#1

This is a tough one though Ross. I've had one or two extractions fully anticoagulated but it was just one tooth both times. I had no complications at all.

But, how many teeth are they going to do at one time? This would definitely be something I would talk to my cardio about & then base my decision on what he/she recommends. One tooth vs 5 or 6 or more in one sitting presents a more delicate situation I think!

 

[Ross]

Studies show that as long as person is within range, they should remain anticoagulated even for dental surgery which is what mine is. 31 teeth to come out and ready the jaws for dentures. I guess my cardiologist is holding up the show now. Seems the dental clinic is afraid of little old me and bleeding.

 

[EVELYN]

Hi Rossman
Do they have to do it all at one time? Can't they take 1/4 or 1/2 at one shot and then the same later? That way there would be less bleeding and might be easier on you.

Just a thought.

Ev

 

[Ross]

Hi Rossman
Do they have to do it all at one time? Can't they take 1/4 or 1/2 at one shot and then the same later? That way there would be less bleeding and might be easier on you.

Just a thought.

Ev

No way, can't afford to do it twice. It has to be done in one shot.

 

[KristyW]

Ross,

I agree wholeheartedly with this article (as you knew I would )

I think the risks are far to great to withdraw anti-coag therapy. If your Drs balk it maybe a compromise to try to get between 2.0 and 2.5 and see if they'd do it then. If I'm reading this right, this paper is saying that as long as you're below 4.0...go for it. The risks of stopping are much greater than the bleeding.

Alveloplasty is the reshaping of the bone structure (removing sharp edges and such) after the extractions to encourage smooth healing of the tissue.

There are several points in the article that are just plain common sense. There are NO major blood vessels at tooth level...you just are NOT going to bleed enough to cause life threatening/life altering problems from being fully anticoagulated and having these extractions and bone shaping done. Sure it's going to be inconvenient...you will probably have a little more bleeding than one who is not on anticoagulants. BUT with this type of dental surgery, there WILL be stitches (I'm almost sure).

However, withdrawing AC therapy all together is way too dangerous....sure, maybe nothing will happen, but if it does...it's definitely life altering and maybe life threatening! I see no reason for bridging either...lovenox is expensive - warfarin is cheap - you'll be in the hospital (right?). If so, testing your INR is easy...the lab's right there. (Not that it's a problem). Eat lots of brussells and spearguts LOL!

Of course, this is just my lay person's opinion.

 

[Eva]

When I asked my dentist last time I saw him before the surgery about the next visits, he said he might ask me to skip a dose or two before I see him but will let me know after the surgery depending on what is normal range for me! I am not sure how helpful my answer is.

 

[Cris N]

I'd go for the bottom of your range. When I had mine pulled there wasn't all that much bleeding - though I didn't have the restructuring issue. So when I consider the minimal bleeding at INR of approx. 1.0 - this was before my OHS - and then consider the 'twice the amount of time to stop bleeding' - no problem. Also, when I had my colonoscopy and hemorroidectomy my dr said he was comfortable with 2.0 (did have a little bit of trouble with bleeding but manageable)

 

[tobagotwo]

I'm with KristyW and ChrisM. Go to the low end of your range and go for it. I believe that stopping ACT, even with bridging, is more dangerous that the possibility of a longer bleed.

I will tell you this, the more they linger on the decision, and the more people that get involved, the less likely this is to happen at all. Adding more opinions never, ever helps to get things done. It tends to lead to lousy compromises for the wrong reasons.

Very best wishes,

 

[aussigal]

Just curious Ross...will you be getting dentures immediately or are you going to be sporting the "gummy" look for a short while?

I had 5 teeth pulled pre-warfarin and I had gauze packed into the holes, tasted like cr@p but seemed to help clots form etc.

 

[Ross]

Just curious Ross...will you be getting dentures immediately or are you going to be sporting the "gummy" look for a short while?

I had 5 teeth pulled pre-warfarin and I had gauze packed into the holes, tasted like cr@p but seemed to help clots form etc.

Nope can't afford temporary's. I'll be toothless for 6 months.

 

[Bina]

When I asked my dentist last time I saw him before the surgery about the next visits, he said he might ask me to skip a dose or two before I see him but will let me know after the surgery depending on what is normal range for me! I am not sure how helpful my answer is.

Eva, most of us go to the dentist for cleanings, fillings, etc. while fully anticoagulated. There is no problem. I usually try to have my INR at around 2.7 but I would NEVER hold a dose for dentist visits.
I do take the antibs. (clindamycine) one hour before.

 

[zipper2]

Nope can't afford temporary's. I'll be toothless for 6 months.

Ross Remember what you told Feddie and i no posts complete
without pictures
Come i'll even throw my whole bruised leg in for a picture

OHHHHHH i wish you all the best,it will be alright.


zipper2 (DEB)

 

[tobagotwo]

Well, while they're making up their minds, we're pushing ahead, Ross. We've chosen your new nickname for the next six months or so:

Gummy Bear!

Best wishes,

 

[catwoman]

Ross:

Did I read that correctly -- that you'll be toothless for 6 months?
After having had my jaw surgically broken years ago and "eating" a liquid diet for 6 weeks, I empathize with your situation. I remember the frustration very well, 40-plus years later.
You have my sympathy.

 

[bvdr]

Ross, I fully agree. Lower your INR to the lower end of your range and go for it. I had about a 3 inch long bony shelf (tori) removed from my mouth on my lower jaw several months ago and I didn't come off coumadin at all. My oral surgeon said there was no bleeding "emergency " in a mouth that he wasn't fully equipped to handle. I know how frustrated you must be!

 

[Ross]

Ross:

Did I read that correctly -- that you'll be toothless for 6 months?
After having had my jaw surgically broken years ago and "eating" a liquid diet for 6 weeks, I empathize with your situation. I remember the frustration very well, 40-plus years later.
You have my sympathy.

Yes I'm searching out pureed food recipes. Some people have told me that they were surprised at what they could eat without teeth. Hope I find it the same. It'll about kill me. I'm a steak, pizza, seafood man. Fish I don't expect to have trouble with, but my shrimps and such will be a chore.