Interruption of warfarin before dental surgery

Objective was to find out whether interruption of warfarin before undergoing dental surgery is necessary and to determine the effects of stopping pre-operative warfarin in Patients undergoing minor oral surgical procedures

After taking full medical history, clinical examination and an orthopantogram, randomization was then done by convenience sample technique. A preoperative International Normalized Ratio [INR] and coagulation screen were arranged, with Consent on the day of dental surgery. The group I continued taking warfarin as usual [anticoagulant group]. The group II stopped taking warfarin 2 days before their dental surgery procedure. If a patient's INR was >2, a further dose of warfarin was omitted. The dental surgery was performed under local anesthesia. Oral antibiotic prophylaxis was given for patients at risk of endocarditis in both groups

Two hundred and eighteen patients form the study group. 114 were to the anticoagulant group [Group I] and!04 to the warfarin withdrawn group [Group II]. There were no significant differences between the groups in the mean age, gender, number of teeth extracted. Mean INR for the group I was > 2.5 than the group II, at 1.6 [p=0.001]. The overall rate of bleeding complications in the group I was higher than in the group II [30% compared with 14%]

It is concluded that the minor oral surgical procedures can be done without discontinuing the warfarin

Lingual nerve damage during third molar surgery

The aim of this study was to investigate the relationship of lingual nerve damage to the experience of the operator and anesthetics modality during lower third molar surgery. A total of 300 patients had surgical removal of lower third molars. Surgeries were done under local and general anesthesia. The patients were asked about any numbness of tongue immediately after recovery or on the next morning in case of indoor patients. In the follow up appointments on first, 3rd and seventh day, they were asked again about any numbness of the tongue or any improvement noted. The frequency of 6% of altered lingual sensation was found in this study. The care was taken to include even trivial alterations in sensation of the lingual nerve occurring in the immediate post-operative period or even if there was quick recovery. The lingual nerve damage was recorded high [10%] with the most junior operator. No direct link of nerve damage was found with anesthesia but frequency of nerve damage was noted high during general anesthesia i.e., 7.14%. It was concluded that the frequency of nerve damage was more when the experience of the operator was less