Dental Treatment for Patients on Blood Thinner

Blood thinners do not affect most dental procedures.  However, blood thinners can have an effect on blood clotting during dental surgery.  Depending on the medication, the dosage and the extent of dental surgery, bleeding can be a concern.  The low level of aspirin use for blood thinning is rarely a concern.  However, stopping aspirin use the day before dental surgery is usually recommended. 

Warfarin use presents the most common potential bleeding problems that dentists encounter.  Stopping coumarin medication prior to dental treatment is controversial.  Since it takes 48 to 72 hours for warfarin to be effective, it must be stopped 2-3 days before treatment, which puts the patient at risk for serious blood clotting complications.   So the risk-benefit has to be determined, that is, uncontrolled bleeding verses blood clot formation in the vessels.

Warfarin should not be stopped for most dental procedures including most extractions and implant placements.  But with any dental surgery, a consultation with the patient’s physician and a recent INR blood test should be reviewed.  Usually an INR up to 2.5 is acceptable and safe for dental surgery, thus coumarin does not need to be stopped or lowered.  With a common sense approach, I ask my patients if they clot, that is, the bleeding stops, in a reasonable amount of time with direct pressure on a skin cut.  During dental surgery, treatment can be done to enhance clotting, such as, the use of clotting agents, stitches, bone grafts and membranes.  Bone grafts and membranes preserve bone in an extraction site as well as reduce bleeding.

Last year I saw a dental phobic 57-year–old patient Todd, who was taking warfarin for deep venous thrombosis from poor circulation in his lower legs and thighs.  He was in severe pain from a split lower left molar and needed an extraction.  After consulting with his physician and determining his INR was 2.2, Todd continued his normal warfarin regime.  With conscious sedation, his tooth was removed and a bone graft and membrane were placed with no bleeding complications.  He was comfortable throughout the procedure with no memory of the event.  Eight weeks later, a root replacement titanium implant was placed under conscious sedation with him continuing his warfarin use.  Just as during his first treatment, Todd had no bleeding problems and happily had no memory of the implant procedure.   4 months later, an implant crown was fabricated and placed with the same great results.

While a risk-benefit assessment, bleeding verses clotting, must be made for each patient, dentist can perform most dental treatments safely for patients taking warfarin without the need for stopping warfarin therapy.     

Enjoy Life and Keep Smiling!

George Malkemus has had a Family and Cosmetic Dental Practice in Rohnert Park for over 27 years at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com.  Visit Dr. Malkemus’ Web site at http://www.malkemusdds.com