There may be many reasons that a tooth is planned for extraction. These can include deep or extensive decay, badly broken or cracked teeth, teeth that are loose due to gum problems, appearance and non functioning teeth. As discussed in our previous blogs the decision to remove teeth is not taken lightly and it is imperative that the patient’s overall wellbeing is considered.
We are living in an aging society, people are living longer and retaining more of their teeth. There is an increasing demand for maintenance of good oral health. There are many considerations including social and financial limitations as well as the rise in number of people who have comorbid medical conditions and are on multiple medications because of heart problems, diabetes or arthritis as some examples.
Some of these conditions and medications can affect dental extractions treatments and require treatment modifications. These modifications can include different approaches in the removal of the tooth and various haemostatic measures to reduce the wound size and decrease any post operative discomfort that can arise.
Antiplatelet and anticoagulant drugs are taken for the management of many conditions including heart and blood vessel problems, cerebrovascular disorders, atrial fibrillation and venous thromboembolic disease.
The following medications are important to note. Bisphosphonates are routinely prescribed for a range of medical conditions involving bone. Bisphosphonates affect the turnover of bone including our jaw bones. Aspirin can be used as a painkiller or in the prevention of stroke or myocardial ischaemia in some people. The complications of aspirin can include post operative bruising. Warfarin is routinely prescribe for those who have had a heart attack, pulmonary embolism, artificial heart valves or atrial fibrillation. It acts as a blood thinner and may cause prolonged bleeding time in patients whohave undergone oral surgery/ dental extraction. As part of the treatment planning process the dentist will refer the patient to their general practitioner to obtain a blood test for their INR level. The acceptable level is a range from 2.2 to 4.0. Once this is known an appointment can be planned for the removal of that tooth.
In treating individuals with these medical concerns it is important we find a good balance between the risks of bleeding and bruising from a surgical extraction and the risk of having a stroke or other medical emergency prevented by taking the medication. With diligent planning and liason with your general practitioner the treating dentist will be able to safely and routinely perform the dental extraction for you. In a lot of cases it is not neccessary to cease your anticoagulant or antiplatelet drug but rather some modification may be required.
Once the tooth has been removed the dentist can suture the area and use local haemostatic measures. You will be given post operative instructions to reduce the time required for the area to heal.
It is vital that if there are any changes to your health or medications that you inform your dentist as early as possible.
At Parramatta and Cabramatta Dental Studios the dentists always endeavour to make your experience as comfortable as possible.