Tooth extraction....

[Woodbutcher]

I have a back tooth which my dentist was going to do a root filling in but now thinks that because it's cracked right through the length of it that I should have it removed. Not too happy about that but hey ho... Anyway he says that because I'm using Warfarin I need to go on a two month waiting list and have it done in hospital ! I argued this point, told him not to be such a baby and just pull the thing out ! Then he said maybe he could but I'd have to come off Warfarin for two days prior to surgery, to which I replied, that's crazy it's only a bit of blood that I'll lose which I'd much rather do than put myself at risk of a clot and or stroke ! My inr is usually between 2.5 and 3 hich isn't very high anyway ? Now he's said to me that if I go and see a GP first and he's ok with it all then he'll do it .
So now it depends which GP I see, because just like dentists they all have differing views and understanding of Warfarin. Do any of you out there have experience of tooth pulling on Warfarin ?
Thanks...

 

[AgilityDog]

Oh Ross, where are you??? I KNOW you have comments (some unprintable) about this subject.


Woodbutcher, there's a link to a dental research paper somewhere in stickies, I believe, which addresses this very issue. You should print it and take it to your dentist AND your GP if you go that route.

 

[sue943]

I had a molar out a few months ago, my INR was checked in the morning, extraction in the afternoon and my INR was 3.4. There was no bleeding, the dentist packed and stitched the gum. He said there was no need to come off warfarin or even to reduce it, he did give me antibiotic cover. My dentist is one of the consultants at the dental department at the hospital and if he says it is ok then it is ok.

 

[kpearse]

I had a molar out, didn't come off my meds. No big deal.

 

[Ross]

For a single extraction, NO. Ask him if it's going to bleed more then a gunshot wound?

For full mouth extractions like I had, YES, one single tooth, NOPE. I'll have to find the link to the article if you don't have it already.

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]

Thank you all so much for your time. Some interesting points there. I'll let you know what my doctor says tomorrow.

 

[Ross]

Doctors are doctors. We have to educate them!

 

[Maryka]

Hi, Woodbutcher! (An Alfie Moon message at bottom)

I had a sort of emergency wisdom tooth extraction last year. (I had had one molar and two wisdome teeth extracted decades ago before Coumadin, with no problems but a bit of bleeding after the fact.) The young dentist seemed a bit nervous, but the more experienced dentist was there and gave guidance. I was on full-strength anticoagulation. The extraction went well. It was suppertime so I sort of drank soup for the meal, keeping the cotton wad pressed on the hole in my gums. I did not seem to bleed more than I had with my other three extractions years before. (I always figure you "keep" your blood, because you swallow it into your own digestive system again.)

Alfie Moon: In the ancient EastEnders they show us here in Washington, DC, Alfie Moon just got together with Kat Slater. What a great series of shows! No wonder Alfie Moon is considered one of the most popular characters ever on EastEnders! I hope your little dog, Alfie, is doing well!

 

[Woodbutcher]

Well, thanks again everyone. I visited my Doctor this morning and he agreed that I shouldn't be taken off Warfarin to have a tooth pulled but thought I should be bridged on Heparin (?) . I told him that that's crazy, it's only a tooth and I'm pretty stable with my inr and dont want to mess about with my dose ! At that point he admitted he really didn't know what to recommend but he does has a couple of mates who are dentists and he'd make a few calls and get back to me tomorrow ! It's one continuous circle of confusion and pain killer popping for me !! I'll be wrenching it out myself soon !
Maryka, it's funny that you're watching those old reruns of East Enders, Yes Alfie was a great character and he was indeed named after my dog after the executive producer at the time, Louise Berridge met him (my dog) and me whilst on holiday down here in Cornwall, must have been about 2002 cos Alfie Moon was a puppy and very cute and scruffy, she loved his name and the rest is history ! I've read that Alfie is returning to the show soon too !
Ps. I was going to add a picture then but is says enter URL of your image and I've absolutely no idea what that means !!

 

[Lily]

Just a thought, but I think painkillers could cause your INR to possibly be a little more unstable.

 

[Kathy McCain]

My daugther LOVED East enders when she was in high school years ago! Hope ol Alfie is doing well. I also hope you get your tooth problem resolved Justin!

 

[Ross]

If they pull you off Coumadin and put you on Lovenox or Heparin, your going to bleed 100 times worse then if they'd of just left you on Coumadin. Copy that article and give it to them.

 

[Woodbutcher]

Thank you Lily, Cathy and Ross... Dont know what I'd do without this place ... Well, I'd just muddle along and be none the wiser I suppose... Anyway it's great to be part of Vr and to be able to tap into it's wealth of knowledge and encouragement !
Visited the Doctor yesterday as I mentioned before. He called me this morning having spoken to some specialists and his dentist friend and basically advised exactly what I'd thought way back at the beginning of the problem.... I'd befine to have the tooth extracted whilst on Warfarin as long as my inr is below 4.0 ! Sadly that was only my theory and not the official one. However now the official line is just that too !! So it was a quick trip to see the nurse this morning for inr test (3.0) and off to visit the dentist 9am tomorrow for the extraction .... Eeeek.... Most of you will be sleeping as I dig my finger nails deep into the dentists chair and wince as he heaves at my tooth with his pliers !!

 

[halleyg]

Yes, well this time, accept the pain killer! Glad it all worked out, gives me some hope!!

 

[Ross]

gives me some hope!!

What? You have doubts?

 

[halleyg]

What? You have doubts?

I am in a similar situation, not my tooth, but trying to find a dr. who won't make me bridge.

 

[Ross]

Some day, probably around the year 3026, all physicians will be on the same page.

 

[Freddie]

Don't forget to take your antibiotics one hour before you leave for your appointment.

Good Luck

 

[Woodbutcher]

Thanks Freddie, I've decided not to bother with the Antibiotics, I've read loads and considered view points and it would seem that there's zero evidence to suggest Antibiotic cover has ever prevented Endocarditis after dental treatment. If that were the case then we'd need to take it before eating crunchy toast or even flossing our teeth or vigorously cleaning them ?
Thanks for your wishes anyway.

 

[Woodbutcher]

Any other thoughts on that ? I do actually have a sachet that I've saved in my first aid kit ! You've got me thinking now !