Extractions after a Stroke

November 19, 2007 by ·

Question:  I had a toothache the other day and the dentist I saw said I need to have some teeth pulled since I haven’t been to visit a dentist in a long time.  After my stroke a couple of years ago my doctor placed me on blood thinners.   I am confused whether I need to stop using my blood thinners because the doctors are recommending different things.  My doctor says I need to stay on the thinners and this dentist I saw said I should stop taking them.  What should I do?

Answer:  I agree with your physician and would do what he recommends.

For maximum patient safety a blood test is needed before dental treatment is done to make sure prolonged bleeding won’t be a problem.  The INR readings need to be from 2-3 to safely treat the patient. 

            Assuming the INR readings are from 2-3;

  1. There is NO need to take patients off of their blood thinner medications for routine extractions, gum surgery, deep periodontal cleanings and regular cleanings. 
  2. For some invasive treatments it may be necessary to take patients off of coumadin.  If so, they need to be taken off of the medication 4 days before the procedure and then have injections of heparin until the invasive dental treatment is performed.  All of this is monitored by their cardiologist or specialty department at the hospital.  Potential life threatening problems exist if patients are taken off of the coumadin and then restarted without special medications used.
  3. The dentist can use local agents such as thrombin gauze and sutures to enhance bleeding in areas where teeth are extracted.

This information is new and should be followed to treat patients most safely, preventing potential future strokes and heart attacks (thrombosis).

Filed Under: Dental Emergencies, Drug Concerns, General Dentistry, Oral Conditions Tagged With: , ,

FDA warning on Toothpastes

October 1, 2007 by ·

  
I ran across this consumer alert from the FDA and thought it would be good for you the consumer to be aware of this:

  The U.S. Food and Drug Administration on June 1 issued a warning to consumers to avoid using tubes of toothpaste labeled as made in China. The agency issued an import alert to prevent toothpaste containing the poisonous chemical diethylene glycol (DEG) from entering the country. DEG is used in antifreeze and as a solvent. The toothpastes that  have the ADA seal of approval are.  Cooldent Fluoride; Cooldent Spearmint; Cooldent ICE; Dr. Cool, Everfresh Toothpaste; Superdent Toothpaste; Clean Rite Toothpaste; Oralmax Extreme; Oral Bright Fresh Spearmint Flavor; Bright Max Peppermint Flavor; ShiR Fresh Mint Fluoride Paste; DentaPro; DentaKleen; and DentaKleen Junior. Manufacturers of these products are: Goldcredit International Enterprises Limited; Goldcredit International Trading Company Limited; and Suzhou City Jinmao Daily Chemicals Company Limited. The products typically are sold at low-cost, “bargain” retail outlets.
Please submit your questions or comments to me  DrAntolak@TheGentleDentist.com. call us at 586-247-3500 or stop in or office located at 15055 22 Mile #2 Shelby Twp. MI 48315
  
Filed Under: Drug Concerns, General Dentistry, Nutrition, Oral Conditions Tagged With:

Fosamax update

May 22, 2007 by ·

Fosamax update:  ( As it relates to dental surgery and necrotic jaw.)

 

For more information on this topic please visit our web site at www.TheGentleDentist.com and click “In the News” tab.  Under the “drug concerns” section you will find archived articles written on this subject.  Because we had an overwhelming response for more information when the articles were first written, I felt it was important to add as current information became available. 

 

I just attended an advanced implant grafting course in South Carolina a couple of weeks ago and some very current information was presented for patients who have been on medications to increase bone density secondary to osteoporosis and cancer therapy. 

The body naturally deposits new bone (osteoblasts) and eats away old bone (osteoclasts) in regular healthy bone metabolism.  The bisphosphonate medications actually make bone more dense, but at the expense of decreasing vascularity (blood supply) and inactivation of the bone cells called osteoclasts which are responsible to eat away the dead bone cells.    Jaw bones are more susceptible to bone death after tooth extraction or other invasive dental procedure because jaw bone has the highest metabolism. Other bones in the body do not change over nearly as fast as the jaw bone does.

 

We now know that the bisphosphonate medications used intravenously to strengthen bones after breast cancer, prostate cancer and multiple mylenoma therapy affect the jaw bones the most.  These are commonly known as aredia and zometa.  Oral medications used to treat osteoporosis such as fosamax don’t affect the bones to the extent the intravenous medications do.  The key seems to be the duration of usage.   If these medications are used for less than a 3 year duration the prognosis is good that they won’t have a problem.  If it’s use is greater than 3 years there is more of a concern that jaw bone death could take place after dental surgery.

 

There are blood tests called CTX that can be performed to assess the relative safety of  surgical procedures in patients who have been using the bisphosphonate drugs.  When using this information and bone density tests we can now assess the likeliness of potential future complications. 

 

Of course the best way to prevent these major problems is to be proactive and inform your physician that you need a dental assessment before the treatment is started.  It is much more prudent to remove teeth, place implants, or have oral surgery accomplished 4-8 weeks before you go on these medications.  For more information on the current protocol please call us at 586-247-3500

Filed Under: Drug Concerns, General Dentistry, Mouth pain
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