Warfarin and The Dentist
hughtwalker
Posts: 2,213 Member
I am a Dental Surgeon in General Dental Practice in UK (for 40 years).
I also have direct experience of Warfarin from the patient's perspective from January until July 2012 (for bilateral pulmonary emboli). My target INR (International Normalised Ratio) was 2.5 to 3.
Years ago patients were told to stop their Warfarin before any dental procedure (e.g. extraction, periodontal surgery or even just a scale and polish) , some doctors still advise stopping for a few days. This is unnecessary and in some cases unwise. Warfarin isn't a big deal for the visit to the dentist these days
All I need is for the patient to have a recent INR less than 3.5. Higher than that then we must reschedule and contact the General Medical Practitioner (GMP) to adjust dosage until INR is balanced - unless the patient has one of the rare conditions that have a permanent target INR higher than 3.5 which will preclude extractions in the dental surgery.
("recent" is a moveable feast - no more than 2 weeks before and ideally that day)
Antibiotics are the main problem as they have varying levels of interaction and your dentist will have these listed in The British National Formulary (can't speak for other countries outside UK but I imagine something similar is available)
Liaison with the patient's General Medical Practitioner will usually overcome these difficulties.
For a patient with an INR of 3.5 or lower, stopping the Warfarin could be potentially harmful.
Even an extraction can be performed without hazard with some simple precautions, such as:
1. Suturing (sewing) the socket and getting the patient to bite on a gauze swab until the socket stops bleeding
2. Giving the patient a supply of gauze swabs with instructions to bite on the swab for at least 20 minutes, in the event of bleeding starting again when they have left the surgery
3. Warning the patient that they may get some bruising of the face that may last a few days
4. Giving the patient clear, written post-extraction instructions, including the telephone number(s) to call if bleeding won't stop both within and outside normal surgery hours.
The most important thing is to reassure the patient that they are not alone, there is a plan in place and all reasonable precautions are being taken.
For more than two extractions that cannot be scheduled separately, the patient should be referred to hospital.
I hope this is helpful and will not alarm anyone. Please feel free to send me a message if you have any questions that you prefer to ask in a less public environment.
I also have direct experience of Warfarin from the patient's perspective from January until July 2012 (for bilateral pulmonary emboli). My target INR (International Normalised Ratio) was 2.5 to 3.
Years ago patients were told to stop their Warfarin before any dental procedure (e.g. extraction, periodontal surgery or even just a scale and polish) , some doctors still advise stopping for a few days. This is unnecessary and in some cases unwise. Warfarin isn't a big deal for the visit to the dentist these days
All I need is for the patient to have a recent INR less than 3.5. Higher than that then we must reschedule and contact the General Medical Practitioner (GMP) to adjust dosage until INR is balanced - unless the patient has one of the rare conditions that have a permanent target INR higher than 3.5 which will preclude extractions in the dental surgery.
("recent" is a moveable feast - no more than 2 weeks before and ideally that day)
Antibiotics are the main problem as they have varying levels of interaction and your dentist will have these listed in The British National Formulary (can't speak for other countries outside UK but I imagine something similar is available)
Liaison with the patient's General Medical Practitioner will usually overcome these difficulties.
For a patient with an INR of 3.5 or lower, stopping the Warfarin could be potentially harmful.
Even an extraction can be performed without hazard with some simple precautions, such as:
1. Suturing (sewing) the socket and getting the patient to bite on a gauze swab until the socket stops bleeding
2. Giving the patient a supply of gauze swabs with instructions to bite on the swab for at least 20 minutes, in the event of bleeding starting again when they have left the surgery
3. Warning the patient that they may get some bruising of the face that may last a few days
4. Giving the patient clear, written post-extraction instructions, including the telephone number(s) to call if bleeding won't stop both within and outside normal surgery hours.
The most important thing is to reassure the patient that they are not alone, there is a plan in place and all reasonable precautions are being taken.
For more than two extractions that cannot be scheduled separately, the patient should be referred to hospital.
I hope this is helpful and will not alarm anyone. Please feel free to send me a message if you have any questions that you prefer to ask in a less public environment.
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