pellicle
Professional Dingbat, Guru and Merkintologist
should be less of a bleeding issue there because the nerve is already dead and gone.
Still fingers crossed its not distressful.
Tooth Extraction
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Still fingers crossed its not distressful.
ATHENS1964
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An issue in a tooth extraction and in any dental surgery besides bleeding is the anesthetic. There are anesthetics with adrenaline - articaine, etc. that are used in the healthy population. In pregnant women and heart patients, they must use anesthesia with mepivacaine hydrochloride or something equivalent, and this is important.
https://jcda.ca/article/a36
https://jcda.ca/article/a36
pellicle
Professional Dingbat, Guru and Merkintologist
actually this prompts me to ask about bleeding and local anaesthetic. I was under the impression that the injection of local anaesthetic also worked to reduce bleeding. Perhaps as that wears off any effect may result in a return of bleeding.
Myself I've not had any extractions while I was on warfarin (although before that I had 4 wisdom teeth taken out, which was no fun at all).
On a related (but different) question, can I ask the forum about dental sedation?
With my recent severe AS (Aortic Stenosis), and a dental extraction coming up, my cardio says I cannot have “IV sedation” at the dentist. My dentist has been unable to get any clear answers on if I can have Nitrous and/or Triazolam.
Anyone got any info or experience to share on this question?
With my recent severe AS (Aortic Stenosis), and a dental extraction coming up, my cardio says I cannot have “IV sedation” at the dentist. My dentist has been unable to get any clear answers on if I can have Nitrous and/or Triazolam.
Anyone got any info or experience to share on this question?
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I had a tooth extraction about 5 years ago. At the time, I did not have severe stenosis. But, I will say that it was done with only local anesthetic- no IV sedation, no nitrous ect. The local anesthetic was fine- it was not painful.
I've had 4 teeth removed with local anesthetic. I've never needed nitrous or an IV sedation. Are you sure it's required?
ATHENS1964
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carolinemc
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It depends on the individual. Many need extra to relax during a dental procedure.
Hey thanks for the Sedation Link! It’s interesting, but doesn’t directly answer my concern.
In about 3 weeks I have my Cardio visit and I will ask him directly what type of sedation I could use (if any)?
In about 3 weeks I have my Cardio visit and I will ask him directly what type of sedation I could use (if any)?
Hi All! I wanted to thank you for your input on the tooth extraction. It went very smoothly on July 6th. I took a week of antibiotics before the procedure and 5 days following. The oral surgeon was able to place an implant the same day, which thrilled me since I didn't want to return. This is my 4th implant so I'm very familiar with the procedure. My INR was 1.4 before the procedure. I didn't miss a dose, but the clinic I go to has new employees and I told the pharmacist that they usually keep me at 2.5, but she let it go so I dropped lower. I'm still in the processs of getting my own device so this sort of thing doesn't happen again. No need to go to a clinic when you can check your INR at home. The dosage of antibiotics was mainly because the tooth was cracked into the gum tissue and the Endo didn't want any bacteria seepage into the area after the blood infection I had last year. This August it will be one year with the second OHS. So far, so good 
thomas999
Well-known member
I think surgery would be more of a cocnern. I have had knee, ankle, and shoulder surgery since getting my aortic valve prosthesis (st jude).
I agree! I will need a hip replacement at some point. The Dr said, wait as long as you can.
bicuspidrek
Member
I was wishing I didn't have to post following my wisdom tooth extraction last week 19/02/2024. Recovery alas has not been smooth.
I had 2 teeth taken out, left upper, and left lower, under local anaesthesia. 2g Amoxycillin one hour prior to extraction. INR was 2.2 on day of extraction. Swoll up stupidly. Doctor brought me in the next day and I could hardly open my mouth. He was content to just irrigate and sent me back with more gauze.
Pharmacist taught me how to crush the tranexamic acid tablets in water and use the gauze to soak them up and bite on them. Light reading educated me that this helped in local coagulation of blood. I was not given anymore antibiotics, but had a hexidine mouthwash to help with bacteria. And yes paracetoml & codeine pills for pain.
I probably was healing pretty good for the next 2-3 days. Over the weekend on 24/02 and 25/02 though, I developed liver clots (https://pubmed.ncbi.nlm.nih.gov/23059585/) and this was probably due to one of the stitches coming loose. It's not fun having these liver clots - they are generally painless clots. But they prevent you from biting down or opening fully when top/bottom combine.
The taste of iron + hemoglobin is horrible and sleeping at night without codeine is quite tricky. I've pulled away the liver clot a number of times but the bleeding on the site doesn't stop and even biting on tranexamic soaked gauze isn't doing the trick. Tried biting on black tea bag once too, but it didn't work either.
I've got some gory photos of my complication but the Internet is a vast place so I guess I'm not required to share them here.
@Protimenow - you mentioned you had some bleeding issues post-extraction, care to share how you got through them?
I am slated for another follow-up tomorrow 27/02 and for once, I am looking forward to it so that I get some relief from bad breath + iron taste in mouth.
Hopefully the doctor can assist in resolving this by removing the initial clot, and resuturing the site. Fingers are crossed.
I had 2 teeth taken out, left upper, and left lower, under local anaesthesia. 2g Amoxycillin one hour prior to extraction. INR was 2.2 on day of extraction. Swoll up stupidly. Doctor brought me in the next day and I could hardly open my mouth. He was content to just irrigate and sent me back with more gauze.
Pharmacist taught me how to crush the tranexamic acid tablets in water and use the gauze to soak them up and bite on them. Light reading educated me that this helped in local coagulation of blood. I was not given anymore antibiotics, but had a hexidine mouthwash to help with bacteria. And yes paracetoml & codeine pills for pain.
I probably was healing pretty good for the next 2-3 days. Over the weekend on 24/02 and 25/02 though, I developed liver clots (https://pubmed.ncbi.nlm.nih.gov/23059585/) and this was probably due to one of the stitches coming loose. It's not fun having these liver clots - they are generally painless clots. But they prevent you from biting down or opening fully when top/bottom combine.
The taste of iron + hemoglobin is horrible and sleeping at night without codeine is quite tricky. I've pulled away the liver clot a number of times but the bleeding on the site doesn't stop and even biting on tranexamic soaked gauze isn't doing the trick. Tried biting on black tea bag once too, but it didn't work either.
I've got some gory photos of my complication but the Internet is a vast place so I guess I'm not required to share them here.
@Protimenow - you mentioned you had some bleeding issues post-extraction, care to share how you got through them?
I am slated for another follow-up tomorrow 27/02 and for once, I am looking forward to it so that I get some relief from bad breath + iron taste in mouth.
Hopefully the doctor can assist in resolving this by removing the initial clot, and resuturing the site. Fingers are crossed.
pellicle
Professional Dingbat, Guru and Merkintologist
My wife had a gum procedure a few years back and experienced liver clots as well. Her INR was 2.5 for the day of the procedure (as suggested) and she went a few days afterwards without any bleeding. Then, as with you, it started bleeding a couple of days later and formed liver clots. The dentist thinks it was because the stitches moved around a bit when the tissue was healing (which is normal).
The problem was exacerbated by the dentist keeping her on antibiotics for 1 week after the procedure which drove her INR up between 4 and 5 and delayed the healing process. She then got sick from swallowing the blood. It was a long ordeal but what saved her was renting a portable fluid suction device (like what they use in the dentist office) from a medical supply company. It took a good week or two for the bleeding and liver clots to subside once her INR got temporarily down between 2.0 and 2.5 (normal range for her is 2.5-3.5).
The problem with having bleeding in the mouth is that you can't apply a tourniquet or pressure on it for too long (you grow tired of holding or bitting on a compress for too long).
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Sorry to hear about your dental complications and thanks for sharing your experience so that others may learn.
Have you had your INR tested since the procedure? I know that you were 2.2 on the morning of your procedure, but with all of the meds that they had you on, it would not surprise me if there was one or more of them interfering with warfarin clearance. You could easily be over 3.0 at this point.
Maybe talk to your cardiologist to see what he thinks of bringing your INR down to around 1.8 for a couple of days until the bleeding is resolved. Staying in that zone briefly might not be much of an issue- just make sure to discuss it with him and get his blessing.
I'm actually going in for dental work myself today. It is just for a replacement of a crown, so not much concern with bleeding and I have not taken any steps to lower my INR for the procedure. I will be taking my 2,000mg of amoxicillin an hour prior. Personally, if I was getting teeth extracted, I would get my cardiologist's blessing to go in with an INR about 1.7 to 1.8, at least for the day of the procedure. My normal range is 2.0 to 3.0, BTW.
Have you had your INR tested since the procedure? I know that you were 2.2 on the morning of your procedure, but with all of the meds that they had you on, it would not surprise me if there was one or more of them interfering with warfarin clearance. You could easily be over 3.0 at this point.
Maybe talk to your cardiologist to see what he thinks of bringing your INR down to around 1.8 for a couple of days until the bleeding is resolved. Staying in that zone briefly might not be much of an issue- just make sure to discuss it with him and get his blessing.
I'm actually going in for dental work myself today. It is just for a replacement of a crown, so not much concern with bleeding and I have not taken any steps to lower my INR for the procedure. I will be taking my 2,000mg of amoxicillin an hour prior. Personally, if I was getting teeth extracted, I would get my cardiologist's blessing to go in with an INR about 1.7 to 1.8, at least for the day of the procedure. My normal range is 2.0 to 3.0, BTW.
Your dentist (oral surgeon?) took out TWO wisdom teeth at the same appointment? That's crazy.
Were they extracted by a dentist or an oral surgeon? (The oral surgeon would probably have known better).
In my case, I had a tooth (not a wisdom tooth) extracted. Gauze didn't seem to help much, plus, when the blood seemed to have clotted, when I removed the gauze, the bleeding started again.
IIRC, I just had to continue with the gauze for many hours, and eventually a strong enough seal formed that I could remove the gauze without the bleeding starting up again.
It was no fun -- but NOTHING like what you're suffering through. (And, for future reference, get your INR down to 1.7 or so - or even lower (it takes about three days back on your usual dose of warfarin for the INR to get back in range) before a procedure like this. You might speed up the process of dropping your INR by taking something with Vitamin K1 - green leafy vegetables probably won't do it quickly - so that you can get the procedure without waiting too long.
IF/WHEN? I have to get stuff done in my mouth, I'd go closer to 1 - and then boost INR back up with daily dosing (I HATE bridging, and this shouldn't be necessary).
Were they extracted by a dentist or an oral surgeon? (The oral surgeon would probably have known better).
In my case, I had a tooth (not a wisdom tooth) extracted. Gauze didn't seem to help much, plus, when the blood seemed to have clotted, when I removed the gauze, the bleeding started again.
IIRC, I just had to continue with the gauze for many hours, and eventually a strong enough seal formed that I could remove the gauze without the bleeding starting up again.
It was no fun -- but NOTHING like what you're suffering through. (And, for future reference, get your INR down to 1.7 or so - or even lower (it takes about three days back on your usual dose of warfarin for the INR to get back in range) before a procedure like this. You might speed up the process of dropping your INR by taking something with Vitamin K1 - green leafy vegetables probably won't do it quickly - so that you can get the procedure without waiting too long.
IF/WHEN? I have to get stuff done in my mouth, I'd go closer to 1 - and then boost INR back up with daily dosing (I HATE bridging, and this shouldn't be necessary).
ATHENS1964
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Management of Dental Extractions in Patients taking Warfarin as Anticoagulant Treatment: A Systematic Review
https://jcda.ca/article/f20ATHENS1964
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Extraction in Patients on Oral Anticoagulant Therapy With and without Stopping the Drug: A Comparative Study
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795646/
pellicle
Professional Dingbat, Guru and Merkintologist
Good study. But the evidence seems to suggest otherwise.
Proper scientific control and test case can only be done if he gets another wisdom tooth pulled and goes for INR < 2
