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).

Extractions after a Stroke Explained by Michigan Dentist

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Extractions after a Stroke Explained by Michigan Dentist