Really Worried, Tooth Extraction

[Blake777]

Hello gang, I made it back from vacation, it was great! But when I got back I got a fever blister, for some reason I get these every time I go on vacation. I really think it's from stress and trying to do too much while on vacation. But anyway, was running fever with it and got a nasty infection on my lips also. Doctor finally decided to put me on antibiotics. Then at the same time I have a tooth that is really bad and may also have infection, so that was another reason for the antibiotics.

So called my dentist who called one of my assistant heart doctors who I report to for my coumadin because I'm on the ONX valve study for coumadin. He asked him if he could take me off coumadin for 3 days before he pulled my tooth. Well when the dentist called me back he said that my doctor told him that I would have to be down to like 1.5 before he pulled the tooth, so he wants me to go off my coumadin to get to 1.5. I am so worried about this and when I asked the dentist isn't that just a little too risky and isn't it possible I could have a stroke with it that low? All he could say was it is a possibility but we have to take care of the tooth. I was just shocked, what else do we have to go through with this coumadin! So worried though, should I be?

 

[Cris N]

Hang in there... A number of people will probably ring in with their tooth extractions while FULLY anti-coagulated. Your dentist & doctor probably need a bit of education. One of the members should be able to supply you some good ammunition.

 

[kfay]

You need to do a search on Woodbutcher...he just had a massive tooth pulled last week. He had to convince his dentist to do while he was still on coumadin and finally it was indeed done that way. I don't think he had any problems at all with bleeding. I think in that thread, there is a link to an article about safely pulling teeth while on coumadin. If that's the way you want it done and this dentist won't agree, I'd find another dentist.

 

[Blake777]

Thank you all for your comments. I am seriously thinking about getting a second opinion from my primary doctor, but he is old fashion and I probably already know what he will say. So maybe I will find another dentist. I just can't believe they want me down so low on the coumadin.

Thanks again

 

[tobagotwo]

I offer this:

http://www.valvereplacement.org/for...e-ACT-and-Your-Dentist-Talk&highlight=Journal

Best wishes,

 

[Philip B]

Testing your On-X

Testing your On-X

Well dropping your INR to 1.5 for a tooth extraction might be a good way to test your On-X. Lots of people choose the On-X because it may prove to be the valve which requires no anti-coagulation at some future date. Okay, okay, I know you don't want to be known on the forum as the guy with the On-X who stroked-out after a tooth extraction.

On a more serious note, as others have commented, many of the folks here have done the tooth extraction thing without messing with their INR. I can't imagine that you'd lose much more blood with a properly done tooth extraction than I've experienced with some of my more profuse, 4-5 hour nose bleeds. Keep in mind, a good dentist will probably do a good pack job at the extraction site to reduce bleeding, but you'd be best advised to seek professional advice.

-Philip

 

[Blake777]

Thanks Bob! I read the 5 myths also.

 

[Maryka]

All of this was covered in the recent Woodbutcher postings, but let me say again that a few months ago I had a wisdom tooth extracted on the same day the tooth broke in half. I did take my dental anti-biotic before I went into the dentist (which my dentists usually advise against, but were happy I had done it that day). I had the extraction, using only novacaine. After the extraction it was supper time, so I got some soup which I slurped up while holding a cotton piece in place between my clenched jaws. I did not bleed excessively (compared to other office extractions I had had before going on coumadin). All was well!

 

[Lynlw]

Hello gang, I made it back from vacation, it was great! But when I got back I got a fever blister, for some reason I get these every time I go on vacation. I really think it's from stress and trying to do too much while on vacation. But anyway, was running fever with it and got a nasty infection on my lips also. Doctor finally decided to put me on antibiotics. Then at the same time I have a tooth that is really bad and may also have infection, so that was another reason for the antibiotics.

I don't know if this helps with the fever blister/vacation problem,butwere you outdoors in the sun alot more than normally? I sed to get a fever blister after going on vacation or to the shore for a couple days and realized it was probably related to the sun somehow. So I started making sure I used a chapstick type product with sunscreen and made sure I kept reaplying it pretty often thru out the day. Now I rarely get feverblisters and my lips don't get as dry and chapped as they used to when I spent days in the sun. (sumer or winter in the snow)

I hope your dentist situation gets worked out as stessfreeas possible, I'm sure that stress doesn't help either

 

[Ross]

There is absolutely no reason to come off of Coumadin for a single extraction. That is old school myth. Ask this dentist if your going to bleed more then a gunshot wound. If he's going to cause that much bleeding, then you better get a new dentist.

 

[daveguy14]

I would seek a professional opinion. Even if some people here have done it with no problem, everyone's situation is different. I find some of the anti-doctor sentiment here a bit troublesome.

 

[Woodbutcher]

Hey Blake, as a few have mentioned, I went through all this myself last week. The only problem you'll have with regards this tooth extraction will be finding a dentist to do it without a worry. I had an INR of 3.0, a huge tooth with deep roots and virtually no blood and no stitch needed. The dentist said that if anything there was less blood than he'd expect from a "normal" patient having a tooth extraction. Tooth extraction on Warfarin, unless your INR is 4.0 or above really is nothing to worry about and anybody wanting to alter your meds of bridge you isn't worth listening to.

 

[Ross]

I would seek a professional opinion. Even if some people here have done it with no problem, everyone's situation is different. I find some of the anti-doctor sentiment here a bit troublesome.

Dave read that article from the ADA and you'll know why there is an anti doctor sentiment. When it comes to anticoagulation, most doctors are operating under old school myths and have not stayed up to date with current trends. Sorry to say, but asking your professional may be more dangerous then taking matters into your own hands. Those of us that are on anticoagulation see this everyday and everywhere. You'd think they'd be on the same page after 50 years, but it has not happened yet.

http://jada.ada.org/cgi/content/full/131/1/77

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.

 

[Woodbutcher]

That's all well and good Daveguy, trouble is the "professional" opinion isn't on a level playing field. Some will say absolutely dont do it without being in hospital and bridged and some will say if your INR is below 4.0 you've nothing to worry about. This really is one area where the professionals have hugely differing views. Most probably based on fear of litigation rather than pragmatism.

 

[catwoman]

I would seek a professional opinion. Even if some people here have done it with no problem, everyone's situation is different. I find some of the anti-doctor sentiment here a bit troublesome.

Many of us here have found that we have to stay on top of our own medical needs and we have read online a lot of the latest findings that effect our situations (JAMA, AHA Circulation, other publications). Not all medical professionals have read the latest articles on everything, and some may use the old "go off warfarin for 3 days" routine order. That may work OK for someone on warfarin for a-fib, but for someone with a mechanical valve, that could prove troubling.
My own family doctor has encouraged me to read as much as I can about warfarin and anticoagulation therapy. His reasoning: He has many patients with varying medical conditions to keep up with, but I have only one person to keep up with -- myself. It's easier to stay on top of things for one person, than many.

When the occasion is appropriate, I have told medical professionals one of our mantras here: You can replace blood cells, but you can't replace brain cells.
My family doctor has agreed with me on more than one occasion, that he would rather bleed a little, rather than have a stroke.

 

[catwoman]

Blake:

Talk to your doctor about an Rx for the antiviral drug acyclovir (generic Zovirax) for your fever blisters.

I get fever blisters several times a year. Once I mentioned this to my family doctor and he said he has the same problem. He takes several capsules of acyclovir at the first symptom of a fever blister and then repeats it about 6 hours later. He said that nips it in the bud.
He wrote me an Rx for acyclovir, 200mg X 100 capsules (100 of 400mg caps are about $25 @ Costco). It has worked really well. The prescribing information he gave was to "use as directed."
I take 4 caps of it at the first symptom, then another 2-4 about 6-8 hours later. I've never needed an additional dosage.

I would certainly ask a doctor about acyclovir and what his/her opinion is on dosage.

I read in one place online that the usual dosage is 400mg about 5 times a day for 2 days, I think. Taking 4 of the 200mg capsules all at once and several more about 6-8 hours later is less than what I had read.

 

[Blake777]

Well it gets even worse.
Just had my appt. today with the dentist. Well now he wants to pull all my upper teeth that are left and put in dentures. I have too big of a space to put in one partial where the tooth will come out (front tooth). He also says since I have gum disease I am loosing bone around the teeth and gum disease also causes heart problems so it will be in my best interest to go ahead and remove the 7 teeth I let him put in dentures and partials on the bottom.

Now when I told him I have a lot of trouble and pain with tooth extraction and ankle swelling when my teeth are pulled he suggested being hospitalized. That way my INR can be monitored also. He is still wanting to take me down to 1.3 INR as well as my doctor. Wondering what else will come up with my health in the next coming days, it's always something. So now I'm just sitting here in a daze, lol.

Thanks for all the replies!

 

[nngbwh]

Sorry to hear that. Hope things get better.

 

[Ross]

Well it gets even worse.
Just had my appt. today with the dentist. Well now he wants to pull all my upper teeth that are left and put in dentures. I have too big of a space to put in one partial where the tooth will come out (front tooth). He also says since I have gum disease I am loosing bone around the teeth and gum disease also causes heart problems so it will be in my best interest to go ahead and remove the 7 teeth I let him put in dentures and partials on the bottom.

Now when I told him I have a lot of trouble and pain with tooth extraction and ankle swelling when my teeth are pulled he suggested being hospitalized. That way my INR can be monitored also. He is still wanting to take me down to 1.3 INR as well as my doctor. Wondering what else will come up with my health in the next coming days, it's always something. So now I'm just sitting here in a daze, lol.

Thanks for all the replies!

I've been there my friend. I had to have all of mine removed for the same reasons, only I had 4 infected teeth when it finally got done a year after I put the wheels in motion to have it done.
Most definately DON'T DO IT in an office. The hospital is the place to be. If they stitch you up properly, you'll be fine. Mine didn't and made me come off of Coumadin and bridge with Lovenox. It turned into a complete nightmare.

 

[jimbo]

Off cumadin

Off cumadin

I, like Ross, had a nightmare a year ago having my wisdom teeth pulled. On the day of my extraction, I was told to get back on coumadin and to give myself the the Lovenox injection. We'll, 2-3 days later when the coumadin kicked in with the Lovenox, my gums turned to mush and I ended up in the hospital with massive bleeding. The oral surgeon was furious. He said I should have stayed off the coumadin for a couple more days and I would have been fine. Two weeks ago, I had surgery to have one of my broken sternum wires removed. The surgeon, told me to stop the coumadin 2 days prior. My level dropped to 1.4 and they did the surgery without a problem with local anesthetic. I got right back onto to the coumadin and within 4 days I was very close ( 2.1) to the normal range ( 2.5-3.5).