Surgery
Extractions
Most surgery that we carry out is for the extraction of teeth. Fortunately, this is gradually becoming much less common, as we are now keeping our teeth for longer and have successful techniques to save even badly damaged teeth. All extractions performed in practice are done under local anaesthetic. In the rare event that a general anaesthetic is deemed appropriate, a referral to hospital would be required. In exceptional circumstances, we may offer oral sedation with Diazepam.
Drugs
As always, a comprehensive medical history is required before any surgery is carried out.
Of particular importance are the following drugs:
- Warfarin In fairly common use, used to thin the blood. Patients taking this drug will have a booklet recording their INR scores, which they should show us. Patients taking warfarin who need an extraction, should not stop taking the drug or alter their dose unless advised to do so. It will be necessary to have a blood test as normal, within 24 hours of the extraction appointment. As long as the INR is low enough, the extraction may proceed as normal.
- Other blood thinning drugs These may include drugs such as Dabigatran, Apixaban and Clopidogrel. Special care is required for surgery in patients taking these drugs, however with careful management there should be no barriers to receiving the treatment you require. The drug should not be stopped or dose altered prior to treatment without specific advice.
- Bisphosphonates. These drugs are used for osteoporosis and have many different names. They are sometimes taken weekly and taken whilst sitting or standing. They are also given by injection. Their effects can persist even after stopping the drug. In patients taking these drugs, there is a risk that extraction sites may have prolonged and difficult healing. In such cases, every effort is taken to avoid an extraction, but if it is inevitable, special measures may be necessary. Each case is assessed individually.
