Crowned tooth with old silver points extraction

[rabbit55]

I have a very old, maybe 50 years ago, crowned tooth with 2 silver points (tooth 4, premolar upper right). There has been a slow growing spot on the x ray and now the dentist said it's an abscess although no pain but it has to come out. It is attached to tooth 3 with a crown that covers both. I understand that they have to cut it away from tooth 3 but once it's cut and they start the extraction, is it harder because it's crowned and will it be hard for them to remove the silver points? I am going to someone that's very well know where I live but petrified. I am not getting sedation, just local anesthesia and afraid of the pain even so. Do they usually give an injection in the palate as well as the outer gum? Are my chances of getting dry socket higher because of the removal of the silver points?

 

[Gordon]

It's a bit tricker because of the double crown, the crown material is quite hard and takes a while to cut through, while obviously being careful not to damage the tooth that's going to remain.

Having silver points in the canals makes no difference to the extraction. It needs a drop or 2 of local in the palate but it shouldn't be worse than a tiny bit of discomfort, more pressure than anything else if the dentist knows what they're doing.
No difference in post op healing/risk of dry socket due to the silver points.

 

[rabbit55]

@Gordon Thank you so much for replying. I will ask my dentist this but from your experience..I am on an anticoagulant because I have a few cardiac stents. I have to stop Brilinta 5 days before the extraction. I am wondering when to resume it because I want o of course not get dry socket so want the clot to form and if I take the Brilinta too soon, since it's an anti-clotting...I can possibly halt the clot from forming. If you can tell me what you would advise your patients, I'd appreciate it. I won't take this as advice as my cardiologist said I have to ask the dentist but it makes sense to me to not resume it so fast.

 

[Gordon]

Bear in mind that I practiced in the UK and under our guidelines, I"m afraid my advice would be not to stop it at all.
Much rather deal with a bleeding socket than a clot someplace critical.

 

[rabbit55]

Thanks Gordon. Yes, there is that risk but the protocol here for any surgery is to stop 5 days before. The concern here is not just a bleeding socket but the inability to form the clot at all. If it keeps bleeding, how can a clot form? I am going to do what they say but just wondering how the clot can form. Those of us on anti-coagulents have a hard time when we cut ourselves anywhere and have to go to urgent care to get a surgi-glue to stop the bleeding.

 

[Gordon]

It just doesn't seem to be an issue, assuming your INR is not something ridiculous then the clot forms perfectly well, if somebody had a very high INR then I might pop in some fibrin foam and a suture or two but that's rarely necessary.

 

[rabbit55]

Thanks again...I have been reading and it seems that the ADA agrees with you regarding the cardiac risk. I will talk to my doctor about not discontinuing the drug or modifying how long, dose. I am afraid of my heart getting a clot now after everything I've read. They did the INR and it was perfect.

 

[Gordon]

Ideally you'd want an INR done the same day as the extraction, if possible. It tends to vary a bit from day to day.