Anticoagulation Service For Health Professionals

Dental

Patients on oral anticoagulant therapy routinely undergo dental procedures. For many of these procedures alteration of anticoagulation is not necessary since the associated bleeding is trivial or can be readily controlled by local measures. Interruption or modification of warfarin therapy is not indicated for patients undergoing the following dental procedures.

1. Fillings
2. Crowns
3. Bridges
4. Root Canal (endodontics)
5. Routine cleaning
6. Deep cleaning*
7. Single or double tooth extraction
8. Scaling and polishing
*May require multiple (i.e. staged) procedures in order to decrease bleeding.

All patients undergoing elective dental procedures should have an INR performed within 24 hours before the procedure (preferably on the same day). If the INR is > 3.5, consideration should be made to delaying the procedure in consultation with the managing dentist.

Bleeding risk of anesthetic injections:

Dental procedures that in themselves do not increase the risk of significant bleeding can require anesthetic injections that can cause bleeding. If the planned procedure requires a posterior-superior alveolar block, then anticoagulant therapy must be interrupted since this anesthetic procedure can be complicated by bleeding that cannot be controlled adequately by local measures.

References:

1. Wahl MJ: Dental surgery in anticoagulated patients. Arch Intern Med; 1998; 158:1610-1616.

2. Blinder D, Manor Y, Martinowitz U et al: Dental extractions in patients maintained on continued oral anticoagulant: Comparison of local hemostatic modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod; 1999; 88:137-140.