Teeth Patient Case Study

Inderbir Singh

My Patient is a 42-year old African-American female, stated that “my teeth and gum hurts”   Her last dental appointment was to remove the third molar and panoramic radiograph was taken at that time. She never got her teeth cleaned. The extraoral examination was done everything was within normal limits. Patient brushes once daily with a hard manual toothbrush and fluoride toothpaste. The patient never flosses. She drinks(alcohol) occasionally and never smoked.

The patient stated that she take warfarin calmodulin and ibuprofen(sometimes as a painkiller).

Ibuprofen: is Nonsteroidal anti-inflammatory drug works by preventing the formation of prostaglandin by inhibiting the cyclooxygenase enzymes COX1 and COX2

 Warfarin: Coumadin basically is warfarin and patient take it for atrial fibrillation came from thromboembolism warfarin is anticoagulant take about four hours for the drug to reach the peak concentration even though it has nearly 100 percent oral bioavailability. Due to the half-life of 36–42 hours it takes about 4 days or even more to achieve steady-state concentrations of any given warfarin dose. The chief pharmacodynamic effect of warfarin is caused by its inhibition of factor II.  

 Warfarin clinical outcomes can also be influenced by the interaction with diet, in particular vegetables containing vitamin K, such as spinach and kale, and avocado.The effect of warfarin can be reversed with the administration (pharmacologically or nutritionally) of vitamin K1, as a matter of fact, this phenomenon is also termed as called phytonadione, Since my patient also taking ibuprofen which has antiplatelet effects and a tendency to cause gastrointestinal ulceration, conventional, it can increase the bleeding risk of warfarin without altering INR. According to research done by the various group the interactions of herbal medicines with warfarin has also been reported. As stated by a patient he drinks alcohol occasionally, and it may decrease the serum concentration of vitamin K antagonist, more specifically this effect has been describing in heavy alcoholic patient though. 

To successfully manage this patient, before any dental treatment, it is very important to get patient recent INR result from their primary doctor and ensure that patient is in reasonable limit which is between 2 to 3. A Recent review has argued that inappropriate adjustment in the warfarin therapy create greater risk for the hemorrhage during the dental procedure, and hence research does not support that change in the therapy but still, the primary physician must be contacted. 

References:

Advil (ibuprofen) [prescribing information]. Madison, NJ: Pfizer Inc.; January 2017.

Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319.[PubMed 11487763]

Alade SL, Brown RE, Paquet A Jr. Polysorbate 80 and E-Ferol toxicity. Pediatrics. 1986;77(4):593-597.[PubMed 3960626]

Aranda JV, Varvarigou A, Beharry K, et al. Pharmacokinetics and protein binding of intravenous ibuprofen in the premature newborn infant. Acta Paediatr. 1997;86(3):289-293.[PubMed 9099319]

American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Perioperative Management of Antithrombotic Therapy. CHEST. 2008;133:299–339S.