Having dental treatment whilst on warfarin

[Grizedale]

I am 78, male and take warfarin for atrial fibrillation. I have to have a wisdom tooth extracted and a gum deep clean because of gum disease.

I will need to take warfarin as usual but am worried about the possibility of heavy and uncontrollable bleeding and also because the NHS dentist wants to perform both procedures in one 30-minute session, which seems a bit rushed.

I would be very interested to hear of the experiences of anyone who has had similar dental treatments whilst on warfarin and whether the work was done on the NHS or privately.

Thanks in advance for any replies.

[jeanjeannie50]

My dentist is very understanding of AF as his wife has it. I had a back tooth extracted while on Warfarin and had no problems, though it may have oozed blood a little longer than normal. I was sent home afterwards with some pads to bite on if it bled again. I'm not one to suffer in silence, so did go back to him a few hours later because of the very minor blood seepage, but all was fine.

Jean

[Hidden]

Hi, I've not had an extraction, but, have had a deep clean on Warfarin. I'm on it for mechanical valves but, also have AFib.

Warfarin shouldn't be a problem, but the Dentist always ensures I have my INR taken within 48 hours of the appt. He goes as far as asking for my book to prove it. If I recall correctly the max is 4.0 otherwise they shouldnt proceed with treatment.

[Mentdent]

I was a dentist and did minor oral surgery as a speciality for referrals. Warfarin isn’t a problem. At one time we used to mess around with vitamin K injections and even stopping the drugs pre surgery but it was realised many years ago that this is completely unnecessary. It’s quite easy for us to stop post op bleeding. The only slight risk is a small amount of extra bruising and/or swelling. If you were taking enough warfarin to make it a problem you’d probably already be in serious trouble from internal haemorrhage.

I think you may find the odd dentist who uses it as a cop out to avoid doing a job they don’t fancy. I‘ve seen that happen.

[Jetcat]

I haven’t had a gum clean for years now and I never will again.! I ended up with a bad infection that needed lots of antibiotics.

It’s not normal to have your gums prised away from your teeth and cause them to bleed or leave them open to infection.?

2 separate GPs told me the bacteria that live on our teeth and gums can in some cases damage the heart and valves if it gets into the blood stream.!! Once I heard that then it was a no brainier for me.!!!

And Iv still got full set of pearly whites and good strong teeth for my age.

[HenningLob in reply to Jetcat]

My husband is on warfarin for mechanical valve and had to have two teeth extracted in the past month. Each time he had to have INR check 48 hours prior to the extractions. The first extraction went fine. After the second extraction he had a lot of bleeding that would not stop even after two days so he went back and had a stitch put in where the last tooth was extracted and was told to go to A and E if the bleeding did not stop. Unfortunately the bleeding did not stop so he did have to go to A and E. in A and E the Dr/Dentist put pads on where the extraction had been and miraculoulsy managed to stop the bleeding. I think they may have also given him an adrenalin injection. There was talk of it but my husband does not remember if he actually did have this injection. My husband said she pressed extremely hard with the pad and it was rather painful but it did the trick. He was also told to make very very sure not to aggravate where the tooth had been and to not have hot drinks and leave the area well alone (ie don't poke at it or put your tongue in it!). A week later all is fine!

[Jetcat in reply to HenningLob]

Glad it all ended up ok.

[Warm-heart]

Hi - that seems a bit rushed to me, I see a private dentist and she would probably book an hour for both at least. Also my cardiologist advises before dentist or hygienist to come off my blood thinner 24hrs beforehand and restart after the procedure. That ensures bleeding can clot. And I have to take an antibiotic - just one dose - before every treatment at the dentist to prevent bacteria settling on the heart valve. Can you check with your cardiologist or GP?

[ILowe]

I have had what amounted to jaw surgery, all with an INR of 3.5. The surgeon accepted an INR of less than four. He had to slit the gum to get at the roots which had joined to the jaw (as happens with root canals) then cut out the roots.The dressings stopped the bleeding afterwards.

I used hydrogen peroxide mouthwash which attacks food particles caught in the stitches.

The main problem with antibleeding methods is the greater risk of pain afterwards. What kept me going was the knowledge that it would pass.

[Qualipop]

I have a friend in eh same situation. He spoke to his dentist who has referred him on to the hospital dental department to have it done.

[Anon2023]

Hi. I’m having problems with my dentist at present. I’m an nhs patient (I pay the nhs rate) but I get the feeling they are trying to ditch nhs patients. I was due a filling and a scale and polish and she didn’t ask for inr despite me making it clear I was on warfarin. They should ask for inr to be taken no less than 48 hours before treatment. I cancelled my appointment due to a dispute about prophylactic antibiotics which she said she would give me but then changed her mind. I’m high risk of endocarditis. I’m now looking for a new dentist.

[Warm-heart in reply to Anon2023]

Sounds like a good thing to find a new dentist Anon2023. I think you need to be able to trust your dentist, our oral health and heart are too important not to be taken seriously by the dentist & dental hygienist.

[Anon2023 in reply to Warm-heart]

Hi. Thanks for your reply. I’ve lost confidence in her and don’t trust her. As soon as I can find a dentist elsewhere I’ll be moving.

[Lhasaone]

I've been on warfarin for over 20 years as have AF. Last year my local hospital removed two lower teeth. They asked me to reduce my warfarin so that it would be around 1.5 INR. They did a super job, stitched up, took normal dose of warfarin that same evening. No blood, no problem. I can't see if you reduce your warfarin you'll have any problems. Go for it, Im in my 70's.

[npchsw]

I too am on warfarin and needed an extraction earlier this year after a tooth abscess. I’m on a higher target INR due to previous intracardiac thrombus and multiple emboli from my AF, so the dentist asked me for an INR 2 days before, the skip the warfarin the night before and restart on the evening after the procedure. No bleeding, but the worry about thrombus kept me awake until I was back to normal INR the following week. Stressful, but no bleeding!