Picking an oral surgeon:

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Dennis S

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Jun 28, 2005
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Northern New Mexico
Well, I didn't plan it this way, but it looks like I will have some first hand information to share with Gina about a tooth extraction, as I am scheduled for November 9th.

As i was trying to pick an oral surgeon, I ran headlong into the plague of Warfarin ignorance that so many have previously described. I contacted several of the highly regarded (and older) oral surgeons around here, and they kept telling me to go off warfarin for a few days before they would do the surgery. They were not interested in reviewing the wealth of information I had accumulated about the relative dangers stroke/bled.

I was going nowhere until I got down to a younger guy who had graduated in the last few years. When I told him I self-tested he said take a reading the day of surgery and bring the unit in. He wants to see for himself that the INR reading is less than 3. If less than 3 we do the surgery. If more than three we re-schedule. I told him about my previous problems getting a surgeon, and he said the newest traing for oral surgeons is to proceed at an INR level of 3 or below. He also said they have many good ways to stop any bleeding. I wasn't looking for the newest kid on the block, but this is going to be my guy. I guess I am making the choice to take proper training ahead of more experience, and I feel pretty good about that right now. I will let you know more later.
 
Dennis,

Almost the exact things my dentist told me. He wants me to "crank the INR down a little" and also that they have lots of good ways to stop bleeding these days.

I think some of the dentists out there are more up on coumadin info than many MDs.

My extraction has been rescheduled for the 14th. Love to hear how yours went so I can either panic or calm down.:eek: ;) :D
 
Great Result: And Thanks to Al & Ross!

Great Result: And Thanks to Al & Ross!

Dear Geebee and others: I just finished a letter of appreciation to my oral surgeon. I tell you truly, I thought he was getting started when he told me we were through. With some great help from Ross & Al, I was able to wake up this morning with an INR of 1.9. For my particular valve, in the aorta position, I was pleased with this reading. I didn't experience any bleeding to speak of, and it appears the hardest part for me will be remembering limitations on eating and strenuous exercise for tomorrow.

They have some great equipment these days which allowed the tooth to come out without putting any stress on my jaw. He did say he put in a few more stitches than usual, in an attempt to avoid any possible bleeding problems.

I talked some with him about his training regarding warfarin. He finished his residency in Oregon four years ago. He said that while in Dental School they were taught not to work on anti-coagulated patients, but things changed during his residency. As I mentioned before, he says they were taught that it was safe to go ahead with an INR of 3 or less.

In fact, he mentioned he is thinking about getting a coagucheck for the office. I think some of the older oral surgeons in town are viewing him as a guy to refer patients to when coagulation is an issue. Hopefully some of them will do some current research and quit giving bad advice to their own patients. The first three oral surgeons I contacted turned me down when I refused to go off warfarin for 2 or 3 days prior to the extraction. Personally, I look at this as my good fortune. I ended up with a guy versed in the latest research/techniques, as well as some an office full of new and superior equipment.

All in all, a very good day!
 
Great to know. I am stressing a little about my coming extraction.:eek: :(

With my cardio's blessing, I am taking my INR down to 2.5 or so which will give me enough protection and won't be too dangerous for a couple of days. He is having me taper down rather than dropping rapidly. Don't know if that really matters but I trust him so.....

5 days to go.:eek: :(
 
I had a tooth extraction on October 30th with an INR of 3.2 with no problems whatsoever. I had filled in the form with all my medications and medical history and made sure I had pre-medicated and informed them that I had pre-medicated but did not bring up the warfarin issue and they didn't either. I didn't say anything about my INR since they didn't ask and I really wanted to get it over with. I had brought along the JADA continuing education abstract about continuing anticoagulation therapy during certain dental procedures and knew my INR was within the guidelines presented.

When it was all over and I was being told my post extraction care I asked if I needed to do anything different since I was on warfarin. She said I should expect more bleeding.:)

I had no problems of any kind other than the site oozed for several hours. I did not develop a dry socket or even take anything for pain.
 
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