Management of Tooth Extraction in Patients with Anticoagulant Therapy: Case Report

Abstract

Introduction: Consumption of anticoagulant drugs such as warfarin is the main therapy in patients with heart valve disease. Prophylactic antibiotics are recommended for patients with heart disease prior to tooth extraction.

Objective: To describe the comprehensive dental management of a patient with a history of heart disease and chronic anticoagulant therapy undergoing multiple tooth extractions.

Case: A 67-year-old female patient came to UMY Dental Hospital complaining of discomfort when chewing food because of remaining roots in several of her upper right posterior teeth. This started with a tooth that had cavities and was not treated, causing the crown of the tooth to break little by little on its own. The tooth had hurt about 2 months prior, and she had taken painkillers (Paracetamol). Currently, there are no complaints of pain or other accompanying symptoms. The patient has a history of heart disease since childhood and is currently taking anticoagulant medication (Notisil®). Objective examination showed root residue in teeth 15 and 16, percussion (-), palpation (-), and bitetest (-).

Outcome: The patient was given prophylactic antibiotics 60 minutes before tooth extraction and discontinued warfarin 5 days prior to the tooth extraction (as advised by a cardiologist). The extraction was performed smoothly and without complications. The open socket was packed with Spongostan® and sutured using a figure-of-eight technique. On the 14th day post-extraction, the wounds were nearly fully covered, indicating that healing was predominantly in the proliferative phase.

Conclusion: Tooth extraction in patients undergoing anticoagulant therapy requires a multidisciplinary approach, involving both the management of anticoagulant medication and clinical strategies such as the administration of prophylactic antibiotics and the application of hemostatic agents like Spongostan® following the extraction.