Treatment in the dental practice of the patient receiving anticoagulation therapy

Background: The use of anticoagulants is ubiquitous in outpatient medical practice, with anticoagulants now among the most common classes of medications prescribed in the United States. Despite its safety, anticoagulation around minimally invasive dental procedures remains a source of discomfort for dental practitioners and a common reason for referral to specialist anticoagulation clinics. The introduction of new anticoagulant options, as well as the changing practice pattern in anticoagulant prescription, somewhat contributes to this situation. Reviewing the commonly used anticoagulants in outpatient medical practice, as well as their implications in dental practice, is integral to providing safe oral health care.

Conclusions: Direct oral anticoagulants are now the preferred agents for most patients receiving anticoagulation therapy. With patients receiving any type of therapeutic anticoagulation, clinicians usually can perform dental procedures such as restorations, limited dental extractions, endodontic procedures, soft-tissue biopsies, and scalings safely without anticoagulation therapy interruption. Although local hemostatic maneuvers are often sufficient during dental procedures, antifibrinolytic medications, as well as local sponges and glues, can be used to ensure adequate hemostasis. Different classes of anticoagulants interact with commonly prescribed medications in unique ways and may require differing management and monitoring.

Practical implications: Clinicians can perform most dental procedures safely despite patients' receiving therapeutic anticoagulation. Recognizing common classes of anticoagulants, incorporating strategies to minimize bleeding, and understanding how commonly prescribed medications in dentistry interact with anticoagulants are essential to practicing safe, comprehensive care.