gum surgery and coumadin

[mld]

Hi, I am new to this wonderful forum. I have read many of the posts and received so much information which have been very helpful to me. I have a question regarding gum surgery and coumadin. I am on coumadin because I had a mitral valve replacement 6 years ago. The Periodontist says I need to be off coumadin for three days. I am very concerned about being off coumadin. My cardiologist said I can use lovenox (injections) while I am off coumadin. I got some information from the internet which said that if you have an artifical valve you should not take lovenox. I am really concerned about this. I was wondering if I could still be on coumadin and have gum surgery, or if I had to stop taking it maybe just stop for one day. I don't know much about lovenox. I just don't know what to do, but I do know that I need to have gum surgery. Is there anyone who has had gum surgery while on coumadin. Please let me know how you handled it. Thanks.

 

[Karlynn]

Welcome!

There are many here who have mechanical (artificial) valves that have used Lovenox. My cardiologist has told me that she would have me use it if I had any procedures that require going off of Coumadin.

As far as your gum surgery, I'm sure Al (our resident warfarin/Coumadin expert) and others will be along to give you information on that issue.

 

[ALCapshaw2]

Hello MLD,

I suggest you call your Cardiologist's office, ask to speak to his nurse, tell her about the need for gum surgery and that you need his (the cardiologist's) guidance on "Bridge Therapy" in going off coumadin for this gum surgery.

Also ask that the cardiologist contact your periodontist to coordinate the Bridge Therapy.

Typically you take Lovenox up until X hours before the surgery and then resume Lovenox X hours after the surgery until your INR comes back into range. You really do want the cardiologist to be guiding this transition.

The alternative to Lovenox injections is a Heparin Drip but this MUST be done in a Hospital and typically lasts for 3 days before and 3 days after surgery. Not a fun time.

Good luck with your cardiologist!

'AL'

 

[Guest]

I doubt that anyone has ever died from the bleeding of gum surgery. They had died, had strokes and wrecked valves from going off warfarin. It comes down to how much bleeding are you willing to tolerate. Would you stay up all night holding compression pads on your gums. If so, then you are stopping it for the convenience of the dental surgeon. You are the one who will suffer the consequences. You can lose about 2 pints (1 quart of blood) before you get into trouble. Here is my test. Throw a quart of milk on your floor. If you think that you will bleed more than that, then stop the warfarin. If you think that you will bleed less, find a dental surgoen who will fo the procedure while you are on warfarin.

One of the wondrous things about the internet if that out-of-fate things still hang around as if they were today's latest knowledge. A few years ago, the FDA overreacted to a report of pregnant women with mechanical valves dying while on Lovenox. As a result, they put out a statement that nobody with mechanical valves use warfarin. About a year ago, the FDA corrected this mistake, but the internet with its forever lasting memory keeps these incorrect pages circulating.

 

[mld]

thanks for your responses

thanks for your responses

I just wanted to thank you all for responding to my question regarding gum surgery and coumadin. The Periodontist said I shouldn't wait too long before scheduling an appt. so I need to make a decision soon. Again thanks, I appreciate your help.

 

[JimL]

Thanks, Al, for saying it well!

I had to look around quite a bit to locate a surgeon who would remove a cyst while I remained on coumadin, but I did find one, and the procedure has gone well twice now. The second time I was awake, and he cauterized the wound so that I had no bleeding from it at all.

I encourage you to look for a periodontist who will let you remain on the coumadin.

 

[Guest]

MLD,
I have a chart on my website at http://www.warfarinfo.com/dentalprocedures.htm
showing what procedures can be performed at what INR level. Please discuss the with periodontist before making a decision.

 

[mbalfour]

Had flap surgery while on Coumadin

Had flap surgery while on Coumadin

I just wanted to thank you all for responding to my question regarding gum surgery and coumadin. The Periodontist said I shouldn't wait too long before scheduling an appt. so I need to make a decision soon. Again thanks, I appreciate your help.

I recently finished four quadrants of flap surgery. I am on Coumadin and 81 mg Aspirin. My Periodontist was willing to do the surgery under the following conditions: INR lowered to 2.0 and NOT stop the Aspirin. He said there was minimal bleeding during the surgery and I experienced no signinficant bleeding (other than slight oozing for a couple of hours) after the surgery. We did this four separate times with great success. What made it easy to do is the fact that I use a Pro-Time machine to home monitor so we could nail the INR exactly before the surgery. Normal INR is 3.5 to 4.0. Two days with no dose dropped it to approximately 2.0.

 

[Guest]

The world needs more professionals like this. Your risk for both bleeding and clotting was minimal with this process.

 

[mbalfour]

The world needs more professionals like this. Your risk for both bleeding and clotting was minimal with this process.

Al:
The cudos really go to my PCP whohas been "the power behind" these negotiations. I've also undergone two melanoma excisions (successful) with the same procedure and the same good results. I might add that I have a cardiac sensitivity to epinephrine so the Docs did not even have the benefit of using that with the novocaine to forestall bleedng. Where there's a will there's a way.

 

[mld]

thanks for the additional responses

thanks for the additional responses

You all have been very helpful. I will speak to the periodontist about having gum surgery with the INR lowered, this way coumadin will still be in my system. The only thing is that I don't have a home monitor to check my INR, I have it done at my doctor's office. I am pretty sure that can be worked out. I just want to do this gum surgery and get it over with, well I really don't want to do it but I really need to. Thanks again.

Oh yes Al thanks for your website with the chart for the different dental procedures. There is alot of information there.

 

[Guest]

Having your INR checked the afternoon before or the morning of the procedure will be acceptable.

Thanks for the nice comments, it helps keep me doing this.

 

[ALCapshaw2]

Manny,

My dentist uses Carbocaine to desensitize my teeth and gums without triggering my heartrate. It is a shorter acting and may require a second dose for LONG procedures such as a double root canal.

Works for me!

'AL'

 

[Blanche]

I certainly do agree with Manny,Al Lodwick, and Al Capshaw. My Albert, who has a mitral valve replacement and is on Coumadin, had had extensive dental work without ever going off of his anticoagulant. Last April he needed periodontal work and the periodontist said that he should go off Coumadin for 3 days. I gave him a bunch of articles, and low and behold, the periodontist did some research of his own. He did the work without taking Al off Coumadin. And, Al had no problems with bleeding during the long procedure, nor did he have any bleeding problems after it. Here is the article, "Periodontal Management of Patients with Cardiovascular Diseases," that the Periodontist found that changed his mind.

http://www.perio.org/resources-products/pdf/23-Cardiovascular.pdf

This article is also located in the reference section of this board. Why not run off a copy of the article for your doctor and for your periodontist. If you would like, email me and I will give you our periodontist's phone number. He's been in practice for 30 years and prior to this he also had his patients go off Coumadin. No more.

Kind regards,

Blanche

 

[Granbonny]

Mld

Mld

I hate to be the bearer of bad news... but, you will have pain after gum surgery, too. Lots of pain..and will need pain meds to get you thru a few days. I had gum surgery..10 years ago..before my valve surgery...Meds didn't help..so, you will need to watch your INR if you are taking pain meds, too... Good luck..Bonnie

 

[mbalfour]

Pain after perio surgery

Pain after perio surgery

I hate to be the bearer of bad news... but, you will have pain after gum surgery, too. Lots of pain..and will need pain meds to get you thru a few days. I had gum surgery..10 years ago..before my valve surgery...Meds didn't help..so, you will need to watch your INR if you are taking pain meds, too... Good luck..Bonnie

Bonnie:

Not for everyone. It is an individual thing and has a lot to do with pain tolerance. I went through four procedures and never needed anything beyond an occassional Tylenol.

 

[Granbonny]

Manny

Manny

I'm glad you had not much pain..but you had 4 different gum surgery appointments..where I only had 2. Top gums done all at the same time then I had to wait for the next year..( few months) due to only having $1,500..a year..Cost that much 10 years ago..Then had the entire bottom ones done. .. Maybe things have changed in 10 years..but I suffered something awful. I remember crying from the pain and upsetting my children. But, it was worth it..Saved my pearly whites...Now, I go to my regular dentist every 3 months and my peridondist every other .3 months (for the deeper cleaning..I still hurt for several days after my peridontist visit.but I know, she has to get down deep... The beauty of it all. I can brush hard and have NO bleeding.When you reach my age..64..they decide which teeth are worth saving. I had 2 back ones taken out several months back. Came off coumadin for 1 day..dropped to 2.1 but tweaked a little and it was back in range soon ( INR)..I always keep Anbesol on hand..I think a tooth ache is as bad as child-birthing. Can hurt your ears too... Bonnie

 

[mld]

still trying to decide about gum surgery

still trying to decide about gum surgery

Hi everyone,

When I had gum surgery about 10 years ago (wasn't on coumadin) I didn't have a bad experience. I had 4 quads done at separate appointments. I remember the Periodontist giving me a prescription for pain medication but I didn't have to use it. My gum surgery was not bad at that time. Each time may be different, but I pray that I won't be in pain this time. I saw my Cardiologist today and asked him about having my INR lowered and having gum surgery. He told me that I need to come off coumadin for three days and be on lovenox so I will have protection.

So here I am, gum surgery should be done within the next two week and I am still not 100% sure what I should do. I guess this shouldn't be such a big deal, but it is a big deal for me. Well thank you all for listening.

 

[Guest]

This is a very good way to manage your anticoagulation for this type of procedure.

The last e-mail that I answered was from someone whose doctor told her to stop warfarin for 9 days to have one tooth extracted. I told her that this was one of the most ridiculous pieces of advice that I had every heard of anyone being given. To top it off, it was less than three months ago that she had a blood clot in her lung.

 

[ALCapshaw2]

MLD -

Did you show or tell your Cardiologist and your Periodontist about the Latest Protocols for Dental work while on Coumadin?

Just because someone is a Doctor doesn't mean that they are up to date on the latest accepted procedures, which allows for doing many types of dental surgery while still on Coumadin but a a lower INR (typically around 2.0).

Print out a copy of the referenced dental standards and then ask for their opinion. OR, find a periodontist who is already familiar and EXPERIENCED with doing surgery on an anti-coagulated patient.

OR, go the Lovenox route as your cardio recommended if that is acceptable to you. It is YOUR choice.

'AL'