Drugs to avoid before tooth extraction. / Medications and supplements that may cause complications with pulling your tooth.

Your dentist will need to identify all medications and supplements that may unfavorably impact your extraction procedure or postoperative healing.

Your “meds list.”

Before your dentist can even consider pulling your tooth, they’ll first need to be aware of your meds list, which needs to include all medications, vitamins, dietary supplements, and herbal compounds that you take.

This includes both prescription and over-the-counter (OTC) items. And it must include all of the compounds you take, no matter which ones you think are important or not.

Your dentist being aware of your meds list prior to removing your tooth is of utmost importance because some types of compounds have the potential to cause complications during a person’s extraction procedure and/or the healing process that then follows. In extreme cases, the complications that develop might be life-threatening.

Presenting a complete list to your dentist is both vital and your responsibility.

Beware – It may be a compound’s side effects that are the issue of concern.

While you’re probably familiar with the therapeutic benefits of the drugs and supplements you take, you’re probably not so knowledgeable about all of the different side effects and potential drug interactions they may pose.

In many cases, it’s these side effects and interactions that are your dentist’s primary concern when performing your extraction. So be complete, just using your own judgment isn’t always good enough. Report everything you take so nothing gets overlooked and your procedure is performed safely.

Types of medications and supplements that may unfavorably impact your extraction process and/or extraction site healing.

The remainder of this page discusses classes of compounds that are usually of most concern to a dentist when planning their patient’s extraction. We also discuss circumstances where it may or may not be possible to avoid the use of that type of medication or supplement before having your tooth pulled.

(Keep in mind, no list should ever be considered all-inclusive. So when formulating your meds list, don’t be swayed by what we’ve chosen to mention. You still need to report everything you take to your dentist.)

Here are the groups of compounds we discuss –

• Prescription blood thinners.
• OTC NSAID pain relievers/anti-inflammatories.
• Prescription NSAID pain relievers/anti-inflammatories.
• Nutritional and herbal supplements.
• Antibiotics.
• Chemotherapy drugs.
• Corticosteroids.
• Immunosuppressive drugs.
• Bisphosphonates.
• Drug interactions.

1) Prescription anticoagulants / blood thinners.

This class of medication is taken specifically for its inhibitory effect on the blood clotting process. And for obvious reasons, its use needs to be avoided or managed prior to having a tooth extracted.

Being able to control bleeding following extractions is vital.

a) Prescription blood thinners –

b) Prescription antiplatelet drugs –

Examples include: clopidogrel (Plavix), ticlopidine (Ticlid), abciximab (ReoPro), eptifibatide (Integrilin).

How prescription medications that have a blood-thinning effect may be managed prior to having oral surgery.

Depending on the type of hematological therapy you require, two different approaches are frequently used.

• If pausing the use of the drug is possible, your dentist will provide instructions where you discontinue taking the medication for a few days to a week or more prior to your extraction appointment. You’ll then resume its use following your procedure.
• In cases where the continued use of the drug is needed without interruption …

  1) Your case may be treatment planned in a fashion where fewer teeth are pulled per appointment. Doing so is a way of limiting the extent of the wound that’s created which makes controlling its bleeding more manageable.

  2) Additional post-extraction measures are typically implemented (such as the use of clotting aids What are these? ) that can help to ensure that the patient’s postoperative bleeding is more readily controlled.

• It’s customary that your dentist will consult with your physician when formulating the plan that’s used for your treatment.

▲ Section references – Koerner

Unilaterally deciding to avoid anticoagulants before your tooth extraction could be dangerous.

It’s important for a patient to understand that blood-thinning agents (anticoagulants, platelet inhibitors, etc…) are characteristically given as continuous therapy. With the effect they provide an important factor in preventing serious health consequences from occurring.

It’s never appropriate for a patient to cease the use of these medications without first consulting with a qualified medical professional.

Important but unrealized side effects of medications and dietary supplements.

The drugs mentioned above are characteristically taken for their blood-thinning effect. And it would be rare that a person taking one of them wasn’t at least minimally aware of this fact and had an understanding that this information would be of importance to their dentist before pulling any of their teeth.

Less well-known but important side effects.

In comparison, the next several groups of medications, supplements, vitamins, and herbal compounds we discuss are likely taken for different therapeutic reasons. Their inhibitory effect on the blood clotting process is generally considered a side effect and therefore an important factor that the person taking the agent may not be aware of.

Your dentist’s concern isn’t just about excessive blood loss during or following your procedure. Your body’s ability to form a blood clot in your tooth’s socket plays an important role in the post-extraction healing process Here’s how. If an adequate one doesn’t form, complications will occur.

2) NSAID pain relievers / anti-inflammatories. –

Risk: Produces an inhibitory effect on blood clotting.

i) Examples of over-the-counter (OTC) NSAID products include: aspirin (including baby aspirin), ibuprofen (Advil, Motrin), naproxen (Aleve).

These may be medications you can avoid before having your tooth extraction.

• People frequently take OTC NSAIDs (aspirin, ibuprofen, naproxen, etc…) on a self-prescribed, transient basis as a means of controlling minor discomfort (headache, tooth pain) or for their anti-inflammatory effect (minor joint pain, muscle soreness).

  If so, optionally ceasing their use for some days before your surgery can remove them as a concern with your extraction procedure.

  (Your dentist will need to specify the required time period because its duration varies with different drugs and the dentist’s opinion. Examples: Aspirin cessation as many as 10 days. Ibuprofen cessation as few as 2 to 3 days.)

• It’s also important to state that there are multiple factors that a dentist will consider when determining what level of bleeding risk (large or small) is associated with the patient’s use of OTC NSAID compounds, both transient and therapeutic regimens.

  A simple phone call to your dentist’s office in advance of your extraction appointment can clarify what action if any you should take.

ii) Examples of prescription NSAID drugs include: diclofenac (Zorvolex), indomethacin (Indocin)

These may be medications you can avoid before having your tooth extraction.

• In cases where you take a prescription NSAID on a self-regulated, transient basis, optionally ceasing its use for some days before your surgery can remove its use as a concern with your extraction procedure.

  (Your dentist will need to provide you with specific instructions because the duration varies with different drugs as well as the dentist’s opinion. Examples: Diclofenac cessation as few as 2 to 3 days.)

• It’s also important to state that there are multiple factors that a dentist will consider when determining what level of bleeding risk (large or small) is associated with the patient’s use of prescription NSAID compounds, both transient and therapeutic regimens.

  A simple phone call to your dentist’s office in advance of your extraction appointment can clarify what action if any you should take.

▲ Section references – Koerner

3) Nutritional and herbal supplements.

Risk: Produces an inhibitory effect on blood clotting.

Examples of nutritional, vitamin, and dietary supplements of concern include – garlic, ginseng, ginkgo biloba, feverfew, chamomile, fish oil, vitamin E.

These may be supplements you can avoid before having your tooth extraction.

• Ideally, a recommendation about the process of ceasing the use of nutritional or herbal supplements would come from the medical professional who made the original recommendation for their use. Unfortunately, the unregulated, self-prescribed nature of many people’s usage makes this type of authority unavailable.

  A phone call to your dentist’s office in advance of your extraction appointment may clarify what action if any you should take.

▲ Section references – Koerner

4) Antibiotics.

Risk: May produce an inhibitory effect on blood clotting.

Vitamin K is a compound that plays an important role in the blood clotting process. A person’s level of vitamin K may be reduced due to the effect of broad-spectrum antibiotics on intestinal bacteria. The potential for this effect is most associated with (NMTT side chain) cephalosporin antibiotics and/or prolonged antibiotic use.

▲ Section references – Nakano

Unilaterally deciding to stop the use of these medications before a tooth extraction could be dangerous.

No patient should decide to discontinue the use of an antibiotic on their own. Instead, their dentist and physician must determine how their need for an extraction is best managed in light of their antibiotic therapy history.

5) Chemotherapy drugs.

Risk: Produces an inhibitory effect on blood clotting.

▲ Section references – Koerner

Unilaterally deciding to stop the use of these medications before a tooth extraction could be dangerous.

No patient should decide to discontinue the use of chemotherapy agents on their own. Instead, their dentist and physician must determine how their need for an extraction is best managed in light of their therapy history.

6) Corticosteroids.

Patients who take corticosteroids may be at risk for acute adrenal insufficiency when experiencing stress (like that created when having a tooth pulled).

At a minimum, the patient’s case should be managed so the level of stress and anxiety they experience is kept to a minimum.

After consultation with the patient’s medical doctor, it may be decided that steroid supplementation prior to the patient’s procedure is indicated so their body can adequately respond to the stress associated with their procedure. (Hydrocortisone/Solu-Cortef is frequently the supplement that’s given.) With especially difficult or extended surgeries, administration of an additional quantity of supplementary steroids may be needed some hours following the procedure.

▲ Section references – Hupp, Fragiskos

Unilaterally deciding to stop the use of these drugs before a tooth extraction could be dangerous.

No patient should decide to discontinue the use of corticosteroids on their own. Instead, their dentist and physician must determine how their need for an extraction is best managed in light of their therapy history.

An infected tooth slated for extraction.

7) Immunosuppressive drugs.

▲ Section references – Hupp

Unilaterally deciding to stop the use of these medications before a tooth extraction could be dangerous.

No patient should decide to discontinue the use of immunosuppressive drugs on their own. Instead, their dentist and physician must determine how their need for an extraction is best managed in light of their therapy history.

Postoperative x-ray of an extraction site.

The area of bone that needs to fill in during the healing process is obvious.

8) Bisphosphonate medications (antiresorptive drugs).

▲ Section references – Sambrook

Unilaterally deciding to stop the use of these medications before a tooth extraction is ill-advised.

No patient should decide to discontinue the use of bisphosphonate agents on their own. Instead, their dentist and physician must determine how their need for an extraction is best managed in light of their therapy history.

9) Drug interactions.

One or more of the medications, herbal compounds, or dietary supplements that you take may interact with some of the drugs your dentist frequently uses to perform tooth extractions. The interaction may amplify or reduce the effect of either the dentist-administered or patient’s medication, with potentially very significant consequences. Drug toxicity is possible.

The interaction may occur with compounds used prior to, during, or following a person’s extraction procedure. The effects encountered can include:

• Drug interactions that inhibit blood clotting.
• Interactions that result in oversedation of the patient or respiratory depression.
• Interactivity that causes changes in blood pressure levels or cardiac function.
• Interactions that result in drug toxicity.
• A loss of antibacterial effect of antibiotics.

Your defense is presenting a complete meds list.

It would be impossible to formulate a list of all of the different compounds that have the potential to cause some type of interaction with the drugs your dentist normally uses when performing extractions.

However, all that’s needed to keep you safe is your providing your dentist with a complete meds list (including all of the medications, dietary supplements, vitamins, and herbal compounds that you take, both prescription and OTC).

▲ Section references – Patton