SAMMC Departments: Coumadin and Dental Care

Patient Information

Coumadin

Special Considerations for Coumadin® and Dental Care

There are many unique aspects to dental care that could, in some patients, affect the heart. One of these is anticoagulation. Patients with cardiac disease should advise their dentists of their heart condition. Treating heart patients with dental problems must be done carefully.

The first task is obtaining an accurate and comprehensive medical history from the patient. Most dentists will use a checklist which the patient is asked to complete prior to any dental care. For patients with heart murmurs or replacement heart valves, antibiotics will be needed before, during and shortly after conventional dental treatments. These treatments include even routine cleanings, although standard dental x-rays alone do not require antibiotic coverage. In addition, valve replacement patients are often receiving Coumadin® as well. Your dentist surely needs to know that Coumadin® is being taken prior to the onset of any dental care. If you have just started taking Coumadin® , then please update your dentists records so that he/she will have this fact in your dental office files.

Bleeding from the gums after brushing or flossing is not uncommon in any adult. Most often, this is a sign of chronic inflammation in the gums at the margin with the tooth. This condition is called gingivitis. Minor bleeding is not worrisome. However, Coumadin® patients will occasionally experience more significant bleeding from the gums. Usually this is a sign that the Pro-Time is elevated. Excessive bleeding after brushing or flossing should prompt a patient to recheck the Pro-Time right away. If the Pro-Time and INR are in the ranges for which your doctor recommends, then it is possible that your dental and gum condition needs attention soon. If the Pro-Time and/or INR are elevated, the bleeding probably will resolve with a reduced dose of Coumadin®

If properly administered, Coumadin® does not cause serious bleeding during cleaning or drilling on teeth. However, a root canal procedure or an extraction of a tooth involves deeper tissues supplied by blood vessels. For root canal or extractions, bleeding complications can occur even with standard doses of Coumadin® . Your dentist and cardiologist (or surgeon) should evaluate whether it is advisable to temporarily stop Coumadin® around the time of your dental procedures. Some patients can safely stop Coumadin® for short periods of time. For instance, patients taking chronic Coumadin® for prevention of venous thrombosis or stroke probably have little risk in stopping for a few days. Most heart valve patients can stop for a few days, under close supervision of their treating cardiologist or surgeon. However, for some patients, an alternative anticoagulant regimen is recommended during the time where Coumadin® is withheld. Most often, it is simple and safe to just stop Coumadin® for a few days before certain dental procedures.

After completion of the procedure, Coumadin® is usually started again at the same dosage as taken before the procedure. A Pro-Time should be checked in 2 or 3 days to confirm that restarting Coumadin® has taken effect. If not, a temporary dosage increase may be needed. Another common practice in these situations is to administer heparin after stopping Coumadin®. After withholding the drug, heparin is begun, either as a shot under the skin (subcutaneously) or by continuous intravenous infusion (usually in a hospitalized setting). It takes approximately 3 days for Coumadin® to wear off after stopping treatment. However, heparin is a short acting drug which will continue to prevent clotting and yet can be reversed quickly if needed.

If you are facing dental procedures in the near future, make sure your dentist knows you are taking Coumadin®. Your dentist can advise you whether you are at risk for bleeding if Coumadin® is still in effect at the time of your dental procedure. If so, consult your surgeon, cardiologist, or treating physician about temporary stoppage of Coumadin® for your dental procedures and inform the Coumadin Clinic of any changes.

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