Wisdom Teeth Extraction

[Cork]

I was wondering if anyone here on Coumadin has needed to have their Wisdom Teeth extracted?

I've been to several oral surgeons...

one told me to live with the teeth problem and it's not worth the risk unless the symptoms are unbearable

one told me that I would need to be in the hospital for a week to be deregulated and reregulated using Heperan and Lovenox; but he doesn't practice at the same hospital as my cardio and says that he doesn't regulate INR. So I can't find someone there to regulate my INR.

and one told me that I just go off the blood thinners for four days and have it done in the office. I'm on 10mg a day and don't feel that to be a viable option.

Has anyone else had this much difficulty and what has your experience been? Any advise would be greatly appreciated.

 

[dick0236]

I would ask my cardio for a reference to an oral surgeon who is comfortable with working with anti-coagulated patients. I certainly would not go off warfarin for four days without bridging under medical supervision.

 

[Protimenow]

It's kind of surprising that you have received such a broad range of opinions. HOSPITALZATION FOR DAYS???? Personally, I don't think I'd be too concerned about not taking my warfarin for two or three days -- the effect of Warfarin diminishes with time, and in two or three days, the INR is probably close to 1.0 - and will be in a place where most oral surgeons will probably not have too much problem with bleeding. Immediately restarting warfarin - or possibly bridging for one day after the extractions - may be a good way to go. I'm not sure that a low INR for just a day or two would substantially increase the risk of clots - from what I've seen it takes closer to a week with a low INR to be at significant risk of clotting. (Of course, this assumes that you're at least 3 months post-op).

Of course, you should speak to your cardiologist, and should fine an oral surgeon who is actually familiar with wisdom tooth extraction in patients who are on warfarin. (I don't now your situation, but am aware that some dentists routinely prescribe wisdom tooth extractions - needed or not - so the earlier suggestion to wait until you REALLY NEED IT (if ever) is a good one to consider).

 

[Herb M]

I had a wisdom tooth extracted. The dentist said he would not do it unless my INR was 2.0 or less. I did not think that I needed any change in my INR, but I did get to 2.0. There was hardly any bleeding.

 

[Bina]

Hi Cork, you've been hiding
How many teeth do they want to take out?
Last month I asked my dentist if he would pull a molar that i had broken and he said "No, not on Coumadin." Fortunately he was able to rebuild it so all is fine for now but I'm sure the same
question will come up in the future.
We've had the discussion here on Vr before, and with the same results. You can ask 4 docs and get 4 different answers. Do your research and go with what you are comfortable with.
Lowering the INR near 2.0 or even 2.5 would sound reasonable to me.
Going off and bridging can be a pain in the ass with Lovenox causing more bleeding if started very soon after the procedure.
Are the molars cutting you or can they wait a while?

 

[Cork]

Thanks for all the advice everyone.

Dick, that's a good idea. I don't know why I hadn't asked my cardio.

Protimenow, my INR falls into the high 1's if I miss one dose. I had my surgery 8 years ago and have two mechanical valves. Aortic and Mitral. I'm currently on 10mg a day and that barely keeps me in the high 2's. Unfortunately, waiting much longer I don't feel is an option.

Herb, thanks for the personal account of your experience. Did you have it done right in the oral surgeons office? How did you get your INR to 2? I could probably cut back to 2.5 mg or 5 mg and still hold my INR in the high 1's. You've given me something to think about.

Bina, Always lovely to hear from you. They want to take all four out. There are multiple impactions and they used other words I don't remember. Basically, the teeth pain isn't causing me sever problems, however one of the teeth are facing a bad direction and has started pushing on things it shouldn't. The oral surgeons seem to think that they could be causing the daily headaches I've been having along with some balance issues and an overwhelming ringing in my right ear and a numbness that I can't explain. In short they have affected my life negatively for too long and they gotta go. I never got my wisdom teeth when I was a teenager. They never came in and are still in the gums and pointing and pushing in crazy directions. I seem to agree about the bridging.

Thanks again everyone.

 

[Protimenow]

Four teeth at the same time, even if you're not anticoagulated sounds like a lot to put on anybody. If your INR falls into the high 1s after you miss a dose, maybe you should schedule the extractions, then miss a dose (if you know how long it takes for the INR to drop after a missed dose).

Bridging may not be necessary if your INR is below 2 for a day or two. But, of course, you should check with your cardiologist to see how long your INR should be below 2, and if she (or he) thinks that you should bridge.

 

[m11_9]

Reading up on this is suggested. From my search a few weeks ago, I found that current best practice is not to modify warfarin at all, but many older dentists have not caught up yet.

When I asked my cardiologist about holding for 3 days he was seriously concerned and suggested if doing that go to a big city where they can monitor for a stroke well and deal with emergent problems. He said you don't want to be far from a major center if that happens. He lightened up only a little when he realized I didn't have a mechanical MV. Apparently mechanical MV should never, ever go off for 3 days like that, all the better reason to keep searching for answers on this.

On the other hand, virtually any dentist can handle tooth pulling if you stay in your regular range. Its not that big of a deal in the end, might not even need an oral surgeon.

So in the end, even though I only have a mech AV, I asked the dentist to deal with it, and he was fine with that.

 

[Protimenow]

I had an extraction, with an INR of around 2. It took a while for the bleeding to stop (maybe an hour or so), and was just a minor annoyance. Others on this forum reported that chewing on a piece of gauze stopped the bleeding - until they removed the gauze and it started again.

I wouldn't be surprised if the oral surgeon who takes out the wisdom teeth doesn't put a stitch or two in the incision -- this should help with bleeding.