Dental implants on warfarin

[Annaelizabeth]

I am having two dental implants next week. The dentist knows no adrenalin and is happy with an INR of 2.0. However my range is 2.5 - 3.5, I usually jolly along in the 3's, I would be happier on 2.5 for the treatment - would be very grateful for consensus of opinion please.

[Bagrat]

My dentist is happy with INR below 4 but I have not had implants only crowns

[BobD Volunteer]

Is your range that due to other considerations such as artificial valve rather than just AF? You would still have plenty of protection at the lower number but how you accomplish that without having INR tests for a few day before is difficult to see. Maybe reduce your dose a little for two or three days before you go. As an example in my own case, I dropped out of range (1.8) due to my own stupidity (I won't bore you) on a daily does of 4.5. Raising to 5 took it back up to 2.3 in a week.

[PeterWh]

Look up NICE guidelines for dentistry to see if their statement about dentistry being ok if INR is below 4.0 applies to root implants. Over a year ago I saw an article which showed relative bleeding times and it wasn't much difference between 2.0 and 3.0.

I would try and speak to the dentist directly if possible and re-emphasise that your cardiac consultant has set INR range as 2.5 to 3.5 in your case specifically because of assessment of you / your case since for the vast majority it is 2.0 to 3.0 range.

[Annaelizabeth]

Thank you for your replies. Range is dictated by artificial heart valve and AF......although after third ablation in April, I am going through a peaceful stage. 11mgs achieves a steady INR of 3.00 give or take. I self medicate with the help of coaguchek and am quite capable of achieving 2.5 over the three days before appointment. I will, though, double check with the dentist.

[PeterWh in reply to Annaelizabeth]

That makes much easier as you are self testing and also on a higher dose of warfarin.

Personally I would aim for 2.6 or 2.7 as tiger is a 0.1 margin of error anyway.

[Annaelizabeth in reply to PeterWh]

Yup agree, and thank you for your input, hugely appreciated.

[dedeottie]

I had two implants last year. My I.N.R. was in the high twos for both. I self tested so knew the exact I.N.R. on the day. My dentist was happy with that and all was fine. Incidentally, my dentists practice employs alot of excellent young dentists( they look about 12 on average ) and they all know more about A.F. and anticoagulation than my G.P.s surgery! X

[ILowe]

Any INR less than 4 should do. I once had to have a collapsed tooth cut out. The roots had fused with the jawbone. The surgeon (in outpatients) insisted on an INR the day of the intervention, which was fair enough. Then he used special techniques to reduce the bleeding. These techniques meant more pain later, but at least there was no bleeding. So, if they can do surgery involving cutting the gums with an INR as high as 3.9, an implant should be a doddle.