Sticky Blood-Hughes Syndrome Support
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Tooth extraction with INR of 4

Morning all,

I have a broken tooth which needs to be extracted. My dentist says she will do it at her clinic with an INR of upto 4, whereas my friend who used to be a dental nurse said her practice wouldn't touch me with a barge pole, and my anti-coag dept say that I need to have it done at the hospital.

What makes it worse is that I am PETRIFIED of the dentist and have only just overcome my fear of fillings with my new dentist and now I have got to have an extraction which i can see me putting off at least 6 times until it hurts !

What's the norm for this kind of procedure anyone?

Have a good day all of you.

12 Replies

I am having a wisdom tooth out on Thursday - it's the third extraction whilst on Heparin, and it's caused by my teeth getting loose because my gums kept bleeding when I was on Warfarin.

My own experience is that my dentist (an NHS dentist that we have been with for over 20 years) is the health professional in my life with the most knowledge and understanding of my APS and the various medication associated with it - far more than my GP, haemo or even rheumatologist.

She puts me in her colleagues surgery on the colleagues day off, and I am the first patient of the day. I do not take my injection that morning, delaying it from 8am until about 4pm. (I then graduate the times of my injections over the next few days until I am back at 8am again.) She performs the extraction, and then I am left to lie in the chair for about 40 minutes. She goes off upstairs to her surgery room and starts the other patients and one of the nurses pops in every 15 minutes or so to check that there is no excessive bleeding, and that I haven't passed out!!

I presumed she had several patients with APS because she knows what to do and has always been interested as my symptoms changed and developed, but no, I am the only one. She has done her own research with other dentists as to what she needed to do. Lovely lady!


My dentist said if I needed an extraction she would refer me to the dental hospital. Fillings and cleaning she does as long as the INR is less than 4.

The problem with an extraction at 4 would be the possibility of too much bleeding or the hole getting infected.

It depends on the individual dentist really also if they are Dental Surgeons or not. Some of them aren't.

When I had my wisdom teeth out I went to the dental hospital (when I was in Wales).


went through the same thing a couple of months ago. I have aps and von wilkebrands plus heart problems. I have to have all my teeth pulled, a few at atime, due to bone loss. Same here, no one would touch me. My hematologist recommended one next to the hospital. He was confident, knowledgeable and painless! they were pulled, no anesthesia just novocaine. I wish you all the best. Feel better


I have recently had to change dentist so am afraid I can't offer any pearls of wisdom. That said I am also terrified of the dentist so dread any forms of treatment. The new dentist is allegedly one of the gentlest in the area and no2 (the one I worry about going down the same pagh as me) has had four white fillings in the last month due to his enamel not calcifying (?) as a small child apparently due to the high levels of antibiotics he had to take as a baby and toddler. Anyway he said his treatment was much better than our previous dental experiences so there is hope out there.

Good luck! :)


I had a tooth out a month ago, my Dentist wouldn't take it out as I'm on warfarin so I was referred to the local hospital. Unfortunately the first time I went my INR was too high at 4, they wanted me at the lower part of my range which is 2-3. When I went back the 2nd time my INR was low enough and I saw a dentist who had experience of patients on warfarin, she made sure the tooth was packed to prevent a dry socket and it was stitched (Which she said was normal procedure) Like you I hate going to the dentist but they were really good and the socket healed very quickly. Good luck


Some dentists will offer hypnotherapy or anxiety management, be sure to discuss your fear before sinning up with a dentist, to find one which offers this.


Herb, I think you are right, if I am honest with myself I think it is just my overwhelming fear of the dentist and I am just looking for excuses to have the tooth out. !!!!

I keep telling myself that I will wait for toothache before I have it out, but then I don't want to turn up for them not to do it as my inr is too high etc


I also have APS etcand last month had a tooth extracted in hospital because my dentist would not carry out the procedure because I was on high dosewarfarin. Yes, my Haematologist and the Dental surgeon at the hospital bothsaid that my INR wouldhave to be below 4 the day before t he procedure, so I had my blood staken the day before and I was within range.

My tooth was perfectly normal, no fillings or anything just a woblbly tooth because I have a tendency to grind my teeth and tense my jaw , mainly during the night but also during the day, so I always wake up with jaw ache, unless I wear my Gum guard at night, which is what Rugby players wear. Are having loose teeth common with APS? I just wondered. I buy Colgate Sensitive Pro relief and I have less blood on my gums.

When I had my tooth abstracted it was paclked and I had four stitches .


Hi duttyjean,

I have always put my poor teeth down to my lupus and sjogrens, I have no idea whether it can be related to APS too, hopefully someone will be able to help us



Hi Tired mum,

The school holidays are looming soI hope you have some support if you are so tired because your symptoms will only get worse over the holidays , won't they? Sorry.,I am not a mother so I am just thinking about my friends who are and do not have your health problems.

Take care of yourself tiredmum!


I used to be just the same with dentists, many teeth went rotten because I just wouldn't go after a dreadful experience as a child. Eventually had to and the new guy changed my attitude completely- also the kit is so much better these days. That said, all the dentists I have subsequently known won't touch me with an INR over 3- and I won't drop below 3 so its been off to the hospital for extractions.

On one occasion, instead of being an inpatient for three days as used to happen, the hospital guy was trialling some new drug that was meant to deal with the bleeding. I was slow to stop bleeding but did, went home and started bleeding again though not to a worrying degree. Arranged to go back next morning and, as I was stood at reception, the receptionist spotted the doc tor and called out "Dr , its that bleeder from yesterday" I knew what she meant but I'm not sure the waiting patients did! I was his only failure!

Last time around had three out prior to a heart op, dentist used an old coaguchek just before procedure and I was about 3.4. No problems, no need for any of the precautionary facilities they have at hospital dental services.

I have never thought that the occasional problems that do come along are to do with Hughes though I developed Sjogrens and an appallingly dry mouth.I reckon the problems stem from not seeing a dentist for decades. The inability to produce saliva can lead to problems with teeth and gums and I see my dentist every three months and she is sending me off to see a dentist at Guys who specialises in dry mouth and Sjogrens.

Good luck with whichever way you go.


I too avoided the dentist for a while after being diagnosed with APS in 2005. A crown fell out a few months ago so I went back. My dentist was fairly knowledgable and gave me a thorough education of proper brushing of teeth. I'd been using a softer toothbrush to avoid bleeding and he said to do the opposite - when the teeth are bad bacteria and plaque free they won't bleed in the first place. I had a couple fillings to have, a change in brushing, now also using bottle brushes and tape each day and with a hard electric brush just after a month there is no gum bleeding with brushing. But it was a horrible month to start with. Also for the fillings my INR was 3.0 and I bled a lot.

So my advice is now see the hygienist regularly, 10 minutes brushing a day, use bottle brushes and tape. Also avoid grazing between meals (including sugary drinks) as that also builds up plaque. I've not enjoyed the process but hopefully it will save extractions later in life. I'm almost in my mid 40s....


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