warfarin and Periodontal-Diseases

We retrospectively investigated hemostatic management for periodontal treatments in patients on oral antithrombotic therapy.. A total of 155 periodontal treatment procedures were performed in 139 patients who continued taking conventional antithrombotic drugs. Insertion of oxidized cellulose, compression, and suturing were used as local hemostatic measures. When hemostasis was difficult, hemorrhage was stopped using electrocautery and/or splint.. For the warfarin patients, 49 scaling procedures were performed in patients with INR of 4.82 or less, and 52 periodontal surgeries were performed in patients with INR of 2.97 or less. As for periodontal surgeries, electrocautery and splint were used in 30% and 70% of cases, respectively. In the entire patient population, posttreatment hemorrhage was seen in 2 (1.3%) of the 155 periodontal treatment procedures.. Scaling can be safely performed in patients on warfarin (INR <4.0) and/or antiplatelet therapy. Periodontal surgery can be performed in patients with INR less than 3.0 with proper local hemostatic procedures.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Dental Prophylaxis; Drug Therapy, Combination; Female; Fibrinolytic Agents; Gingiva; Gingival Hemorrhage; Hemostasis, Surgical; Humans; Male; Middle Aged; Periodontal Diseases; Platelet Aggregation Inhibitors; Retrospective Studies; Warfarin; Young Adult

In recent decades, there have been several studies on the correlation between periodontal disease (PD) and cardiovascular disease, but the influence of PD on the effect of oral anticoagulant drugs has not been reported.. To assess the influence of PD on oral anticoagulation in patients with heart disease.. Dental treatment for patients of the Anticoagulation Clinic of the Instituto Nacional de Cardiologia Laranjeiras (INCL), receiving warfarin as a prophylactic treatment for thromboembolic events, was performed without suspending the drug and according to the INCL's "Protocol of dental treatment for patients with acquired coagulopathy". A therapeutic anticoagulation level was maintained and was assessed using the international normalized ratio (INR) on the of the patient's visit. The patient was thus protected against thromboembolic events and could undergo dental treatment, even oral surgery. Our study comprised 40 patients who underwent prospective oral assessment and were divided into two groups: Group I--20 patients with PD; and Group II--20 patients without PD. Dental treatment was performed in the two groups as follows: PD control in Group I and treatment of dental caries in Group II. The INR of the patients was assessed before each dental consultation, to guarantee hemostasis during the procedures and to monitor the anticoagulation level obtained. INR prior to the dental intervention was then compared with that after the intervention in both groups. An INR increase of > or =50% was considered significant.. In Group I, all patients showed an increase in INR after the dental treatment, which was significant in 15 (75%). In Group II, only 8 patients had increased INR, which was significant in 5 (25%) (p = 0.002). Considering the oral health of the two groups,. the extent of tissue injury in the oral cavity was not significant compared to the INR increase; however, comparison between the two groups showed significant INR increase mainly in patients with PD (p = 0.002).. This study showed that dental treatment in patients with any type of PD significantly increases INR.

Topics: Adult; Anticoagulants; Female; Fibrinolytic Agents; Heart Diseases; Humans; International Normalized Ratio; Male; Middle Aged; Periodontal Diseases; Prospective Studies; Warfarin

In this study, patients with heart diseases were classified into 2 groups: Warfarin user and Warfarin non-user, and six salivary components were determined to assess intraoral pathologic conditions. Groups of healthy subjects and patients with periodontal disease without receiving any medication were set as control groups, and they were compared with those of the 2 groups with heart diseases. In patients with heart diseases in both the groups, albumin (ALB) level was found to be significantly higher compared to that in the control groups, and it was significantly higher in the patient group receiving Warfarin user and Warfarin non-user compared to that in the patient group with periodontal disease. C-reactive protein (CRP) levels were found to be higher in both the groups with heart diseases than those in the healthy group. Correlations between various salivary components and the clinical parameters were examined, showing significant correlations between ALB and gingival index (GI) and clinical attachment level (CAL), and between alanine aminotransferase (ALT) and GI, probing depth (PlI), bleeding on probing (BOP) and CAL. Significant correlations were also found between creatine kinase (CK) and PlI, GI and BOP. Thus, it was suggested that ALB and CRP might serve as the markers of intraoral pathologic conditions, and CK and ALT might serve as those alternative to GI.

Topics: Adult; Aged; Alanine Transaminase; Albumins; Anticoagulants; Aspartate Aminotransferases; Biomarkers; C-Reactive Protein; Cardiovascular Agents; Creatine Kinase; Dental Plaque Index; Gingival Hemorrhage; Heart Diseases; Humans; Middle Aged; Periodontal Attachment Loss; Periodontal Diseases; Periodontal Index; Periodontal Pocket; Saliva; Salivary Proteins and Peptides; Warfarin

Anticoagulation therapy is used to treat patients with a variety of hemostatic disorders in an attempt to prevent thrombus formation. A thorough understanding of the patient's medical history is essential before dental treatment that may require alteration of this anticoagulation therapy. Alteration of anticoagulation therapy should be undertaken only after consultation with the patient's physician because some patients are at greater risk than others for thrombus formation or hemorrhage. This case of a 29-year-old man with plasminogen activator deficiency illustrates how consultation can result in a coordinated treatment plan for medical and dental management formulated to help ensure safe surgical treatment for these medically compromised patients.

Topics: Adult; Blood Transfusion; Dental Care for Disabled; Dental Restoration, Permanent; Heparin; Humans; Male; Periodontal Diseases; Plasminogen Activators; Thrombosis; Tooth Extraction; Warfarin

Topics: Atrial Fibrillation; Carotid Artery Thrombosis; Humans; Male; Mandible; Medical History Taking; Middle Aged; Molar; Patient Care Planning; Periodontal Diseases; Preanesthetic Medication; Prothrombin Time; Tooth Extraction; Warfarin