Table 3.165.
Key considerations for dental management in patients on warfarin (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 2 | Bleeding tendency |
| Appropriate dental care | 2/4 | Type of procedure; INR guideline; underlying disease |
| Pain and anxiety control | ||
| – Local anaesthesia | 1 | Avoid nerve block |
| – Conscious sedation | 1 | Haematoma |
| – General anaesthesia | 3/4 | Warfarin reduction or heparin |
| Patient access and positioning | ||
| – Access to dental office | 0 | |
| – Timing of treatment | 1 | Morning; early in the week |
| – Patient positioning | 0 | |
| Treatment modification | ||
| – Oral surgery | 3 | INR guideline; bleeding control protocol |
| – Implantology | 3 | See oral surgery |
| – Conservative/Endodontics | 1 | |
| – Fixed prosthetics | 1 | |
| – Removable prosthetics | 0 | |
| – Non-surgical periodontology | 3 | See oral surgery |
| – Surgical periodontology | 3 | See oral surgery |
| Hazardous and contraindicated drugs | 2 | Avoid some NSAIDs, metronidazole and others |
*
0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.