I’ve just been told that I need a tooth extracted and am supposed to be flying on Saturday. My dentist is getting very wound up about me being on anticoagulation (currently Enoxaparin). The British Dental Society guidelines say no need to stop (this is a relatively easy extraction of a tooth with a very shallow root). I’m trying to link them with my anti coag clinic, but not getting there yet.
Does anyone have any experience of managing dental work?
I had to have an extraction of a deep rooted back tooth a couple of years ago - I offered to Bridge myself, as I am on heparin, clopidogrel and aspirin daily. My dentist was the opposite - 'no worries, you're be fine'!I decided to drop the aspirin, took the others a bit earlier the previous day. I was nervous of bleeding - but the dentist was right, I was fine.
You have the opposite, your dentist is worried, you are right in getting them linked to Dental assn and doing your research. Do you bleed much when you cut yourself? Maybe bridging plan would appease them? Follow your instincts- you know yourself, our medication has a risk for bleeding but on the whole it's to make our blood 'normal'.
Hope you get sorted as you don't need extra stress. x
Thanks Holly, That’s what my research shows, don’t stress about it too much. On bleeds, I haven’t cut myself since I started treatment. Blood draws are a variable, mostly no problems at all, very occasionally it can last a while - normally when they’ve had to poke around quite a bit (I’m a difficult stick 😟 with tiny veins apparently)
the only thing I would add ( I’m also on enoxaparin every 12 hours) is to have the extraction first thing - as early in the morning as possible, before your morning dose. ( even if you delay your dose by a bit ? Reduce it (?) to adjust for the fact you are an hour late with it so as to not interfere with the normal evening dose time? )
Your hematologist will have the correct advice here.
I have a lot to still Learn about enoxaparin.
I'm just about to go to hospital today to have 2 molars out. Having this done under GA as one of the teeth is unrepairable and the other has had a temporary filling for about a year now. (which could last another year or fall out tomorrow) Haem advised off aspirin and Clexane for 48 hours before procedure and start immediately after. I am doing a long haul flight (26 hours) in 4 weeks time so I needed to have this done ASAP so everything is healed and anticoags in place before I go.
I'm not *too* worried as I do have help close by - I'm more worried about being cannulated and pricked multiple times as I'm fasting and a bit dehydrated and in general have hard to find veins!
See you on the other side, Gilly and I'll let you know how I went today.
Wishing you all the best, thankfully mine is nothing like as serious, will probably take under 5 minutes.
After a lot of too and fro with our occupational health department, we’ve agreed that I can fly back to Nigeria at the weekend, but will have to come back to the U.K. for the extraction. There’s a brilliant dentist we use out there, and being on LMWH makes it all easier, so I’m finding this all a bit OTT. Everyone else seems more worried than me, but at least I get back to work.
I hope all goes well for you, esp the cannulation (my most recent one took 6 stabs). Hopefully the flight is taking you somewhere lovely.
I'm just resurfacing today (I think it's Monday) after some of the most exquisite pain I have ever felt . As usual things never go to plan with APS starting with cannula. Anaesthetist couldn't find a vein so he called for U/S machine. The best vein he could find was too close to an artery and possibly thrombosed so he said easiest way was to do a gas induction and put the cannula in when I was asleep. He must still have had problems 'cos I woke up with cannula in my foot. My mouth felt like it was stuffed with cotton wool and completely numb from tongue down. The surgeon said it was a little (?) more difficult than he thought but all went well (????) I have no wrinkles as both cheeks are swollen as though blowing up a balloon. Was sent home with antibiotics and some heavenly pain killers that woke me every 5-6 hours when they wore off. Still on a fluid only diet with lukewarm water-also painful because I must have bitten my upper lip quite hard while all was still very numb. I can't smoke or drink alcohol for two weeks-so luckily I don't do either!! Going back to bed................zzzz while the painkillers take effect.
I ve bern through all that too. Same meds. Bridging my dental surgeon insisted was 5 days . I was surprised after deep molar surgery how little bleeding there was . Good Surgeon? I noticed in hospital after regular surgery , even after stopping 5 days before , cannula and surgery , I bled lije a fountain , BUT my heamatologist said this was likely due the drugs given in injections for the surgery . Pain blockers etc etc . So don’t worry about the cannula anyway ? . My Dental Surgeon and Haematologist state 5 days stop before , should be normal blood by then . Popped up with lots of drugs in surgery . Can cause bleeding . 🤫
I had a tooth extracted about five years ago. INR was above 3.00 when checked on a coacucheck prior to procedure. All abosultely fine. However about 3-5 days later I started to bleed and got a lift to dentist. I heard the receptionist saying, "it's pouring out of her". The Dentist immediately wanted me to go to Hospital, luckily a friend could speedily take me there. Transexamic acid was applied to wound and I came home with some of the same liquid.
All bleeding stopped on application of this liquid. Needless to say I need another extraction and have pressed for procedure to take in Hospital,
I am on warfarin. I just need to get INR to 3 and dentist then willing to extract tooth.Tooth extracted then I passed out😄
Hi Gilly, you have my sympathies. I had a back upper tooth extracted by the hospital (I have more health conditions than just APS so dentist thought it safer). You do not need to come off warfarin. You need to be in range and have a good record of having your tests done. I have a range of 3 to 4 and was about in the middle I think. You are more likely to have problems from a low INR than you are to bleed to death from a tooth extraction. I didn’t bleed very much. She packed the hole and put a couple of stitches in although the packing fell out the first night making the stitches too loose to be of any value.
I don’t think I could have coped with flying the next day. Dental work gives me a flare. Also, you may need help if you bleed too long or if your INR goes down out of range it might not be safe, but it depends on length of flight how important that is.
Hope this helps, although might be too late.
Those ‘flares’ target all my weak Immune spots . I just go to bed . Take anti allergy homeopathics, mild pain killer , frozen yoghurt SLEEP.
I take warfarin and I bridge to and from injectables. Not hard at all. I just stop warfarin 3 days prior to procedure, give myself a couple of no-big-deal shots near my belly button for a couple of days, , then odd to the dentist. Then resume warfarin and another 2days of shots while the warfarin kicks in.
I just had two teeth extracted a few weeks ago without changes to my blood thinner. Absolutely no problems. They just put a hemostatic med on the extraction site and stitch it up! Actually less bleeding than when I wasn't on a blood thinner!
YES , for shallow easy extraction my Dentist said no need stop blood thinners . Also my Haematologist agreed. However when I had dental surgery , full cutting out of deep wisdom tooth . MY dental Surgeon ( not just dentist ) said stop 5 days before , my Haematologist agreed with this . There was very little bleeding anyway . The dentists are very weary knowledgable of blood thinners . Oh also I’m not on Warfarin, no INR readings . Rivaroxaban 20 mg reduced to 10 mg luckily . It depends on the original condition . Follow your haematologists orders .
I had a nervous dentist a couple years ago before an extraction. He wanted me to stop my warferin 2 days before and not start it again for a day and I refused. I got my gp to write him a letter and that worked. They put a pad on it for a day or so after it came out and no issues.
I don't have personal experience, however maybe you could get in touch with the main dental surgeon, by asking for their PA to ring you, then, ask for an email address, and write an email marked urgent to the relevant parties including your dentist, this may bring about them talking to each other, I regularly do this if I can't get a reply from the overstretched local NHS, in terms of consultants. MaryF
Thanks Mary, struggling with this, they don’t seem to be talking to each other and won’t talk to me. I’m only the patient…..
I was told yesterday by heme that I have to have it done in hospital 😟
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