Tooth extraction - help please.

[Nancy]

I don't have any experience with Coumadin, but have had a few extractions. One thing you want to avoid is a "dry socket" which is when the soft clot which forms after the extraction, washes out of the extraction cavity. That leaves the nerves or whatever totally exposed and it is very painful. I have had two of those, and I don't recommend them. It's then painful until the area heals and closes enough to cover whatever is hurting.

Ask your dentist how to avoid them.

 

[Lisa in Katy]

I'm revitalizing this old thread because my dentist referred me to an Endodontist for "significant bone loss" in my #3 molar (Upper 6-year molar) and possible root canal. I saw the Endodontist today and he said, "You don't need a root canal because the root is healthy. The bone loss is caused by a fracture in the tooth. You need a bridge or implant." I asked him about a simple extraction, leaving a hole and he told me that my upper teeth would shift over time, leaving spaces, and that it could cause even more bone loss.

So, I'm looking at either a simple extraction with possible negative effects or some signficant work and money.

Does anyone know about Warfarin for an implant? I assume both procedures would involve an extraction. Gina and Betty, what did they do for your long ago procedures?

 

[KristyW]

Find a good periodontist

Find a good periodontist

Lisa,

I work in a dental office & I understand the procedures involved. I would say that the coumadin issue shouldn't be an issue. From what your endodontist said, you may need a bone graft prior to implant placement. A periodontist is your best bet rather than an oral surgeon.

Bleeding is sometimes an issue...more from the viewpoint of the professional because it can obscure the area being worked on. I wouldn't let them talk you into anything crazy like witholding for 5 days...a slight reduction wouldn't be amiss if your valve is aortic. If you have a mechanical mitral...make sure that the specialist listens to the advice of your anticoagulation manager.

Don't hesitate to PM me if you have any more questions.

 

[geebee]

Lisa,

I just never had the "hole" filled. I have a gap but it is lower back and not visible. I have not notice any teeth shifting and it has been 18 months. I just couldn't afford the dental work to replace the tooth. Everything has healed well.

I did drop my coumadin to 2.8 (lower end of range) but no sure if it really mattered. The dentist packed the cavity well with some type of material so bleeding was minimal.

 

[Kathleen]

Hi Gina
I like you can get pretty freaked by dentists. I had a tooth pulled in February. I knew the afib was going to be an issue and did take a half of a Xanax 20 minutes before I went to the dentist. I brought my INR to 2.0 which I felt was a good number. I have a real problem with the chair being back so the dentist had to squat down and raise the chair as high as he could. I did not use gas just the carbocane (sp). I stayed in the chair with pressure on the site while they would come in an check and it went to so very well. We talked about the dry socket so I knew what to watch for. I took my normal amount of coumadin that night and knew it would pop up quickly with the antibiotics and it did. I will be watching for your positive outcome since I feel you will breeze through this one. Good luck
Kathy

 

[bvdr]

Lisa,
I recently had some oral surgery and didn't have to do anything about my Warfarin. I had to have extra bone removed. I made sure my INR was not over my range but the endodontist/oral surgeon just said that there was no bleeding that would occur that he wasn't well equipped to handle. I had fractured a tooth and had to have it removed (I think that was several months ago) and stayed on Warfarin for that as well. I had a tooth added to an existing bridge so I wouldn't have an empty space. It was pricey though.

Years ago I fractured a tooth walking into a sliding glass door. It developed an absess and that was a mess. I made the rounds and needed surgery to get it drained and healed. I lost that tooth too and had that one replaced with an implant. It was years before I was diagnosed with heart problems so there were no added issues there. The only problem I had was that the implant seems to have entered the floor of one of my sinuses and I have had some sinus problems since that time. It was just one of those things.

I hate having dental work and feel for you. Kathleen mentioned having a problem with a-fib.... I've had SVT when I had the novacaine with epi in it but again that was years ago. I didn't tell anyone at the time because I decided to wait it out since I knew the epi clears the system pretty fast and the SVT didn't last but a few minutes.

 

[ALCapshaw2]

I 'believe' that Carbocaine does NOT have epinephrine in it (but is shorter acting than other local anesthetics).

I also recall one dentist telling me that some of the other local anesthetics come in forms with and without epinephrine. My medical dictionary indicates it is added to local anesthetics to prolong their effect.

Epinephrine is the usual 'trigger' for Heart Arrhythmias following dental procedures (and/or stress!).

'AL Capshaw'

 

[geebee]

I 'believe' that Carbocaine does NOT have epinephrine in it (but is shorter acting than other local anesthetics).

I also recall one dentist telling me that some of the other local anesthetics come in forms with and without epinephrine.

Epinephrine is the usual 'trigger' for Heart Arrhythmias following dental procedures (or stress!). My medical dictionary indicates it is added to local anesthetics to prolong their effect.

'AL Capshaw'

You are correct and Carbocaine is the anesthetic I always have. However, since it only lasts about half as long as the Epi ones, so much is needed that I always end up with "brain fog" - feeling like my brain is numb too. Better than making my a-fib worse than it already is. Crummy options but at least there are options.

 

[Lisa in Katy]

Thanks everyone. I guess I will see how comfortable the Periodontist is with Warfarin. I don't want to do the Lovenox thing if at all possible.