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Wednesday, January 9, 2013

It's ok to pull that tooth Doc, I already stopped my Blood thinners!

Doc, it is OK to pull that tooth, I have already stopped my blood thinners!


Alot of patients coming into the office, are on blood thinners and have a lot of questions.  Some patients come into the office and are on blood thinners and already have the answers.

Most people who are taking blood thinners are taking them to prevent blood clots in their blood vessels that could end up moving and blocking major vessels or structures.  The ensuing loss of oxygen to the blocked structures could have major consequences for the patient, including death.

This is a concern in dentistry since almost every procedure we do may cause bleeding.  From fillings, to cleanings, to extractions, to periodontal surgery, to root canals and so on.  In dealing with the thousands of patients that we have here in our office we must always be careful with those patients who have bleeding tendencies. 

Bleeding tendencies can be subidivided into those patients who have natural bleeding disorders and those patients whose bleeding is caused by medication that they are taking to "thin" the blood.  In this blog I am talking about those patients taking blood thinners as those are the majority we see.
 Many patients are taking Warfarin type medications and many are taking Aspirin.  Those patients taking Warfarin medications can have a largely increased clotting time.  Those patients on Warfarin have a test done called INR (international normalized ratio).  This INR is a target goal for coagulation depending on the underlying condition so that a patients' dosage is adjusted to the target goal.  In most situations a dentist can still work without having the patient stop his medication.  This will depend on the patient specific factors such as the INR, patients overall health, expected bleeding and the length of the procedure.
Many patients are on low dose Aspirin.  This usually does not represent a problem and most dental procedures can go ahead without any change.
Patients on Heparin are usually in a hospital setting so that is really not an issue but today there is is LMWHs (low molecular weight heparin) which allows the use of Heparin type medication outside the hospital setting and this may require stopping a patients medication.

After all this, the question really is what should you the patient be doing?  The answer is very simple.  Speak to your dentist, he will have the answers and if he doesn't he will be in touch with your physicians to dicuss the proper treatment for your specific situation.  In most cases you will not have to ask your dentist as your dentist will be discussing it with you.  In consultation with your physician he will tell you wether you need to stop medication or continue.  Most important never do anything on your own. Stopping your medication even for a short time on your own may have a very negative affect.  No matter what you read on the internet or heard on Oprah.  Speak to your dentist, because every situation is different and there are no cookie cutter solutions.

All the best

Dr. Ron Barzilay

enjoying dentistry in Hamilton, Ontario Canada


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    1. Hi Dick,
      Be careful of dental emergency kits. A simple mouth mirror and explorer may help you visualize the area better but if you don't know what you are doing or what it is that you are actually seeing you may just make the problem worse. If you have some food stuck between your teeth you can try to pick it out. If you try to recement a crown with some glue you can create a new problem or cause the crown to be unfixable. Most dental offices have policies regarding emergencies. Ask when you start with a new dentist. Our policy is that we generally try to see you the same day at least to find out what the problem is. We leave an emergency number on our phone for late night dental and weekends so you are always covered even when we go on vacation.
      All the best!
      Dr. Ron Barzilay