She Was 78, on a Blood Thinner, and Needed a Tooth Out

Quick answer: For a routine dental extraction, blood-thinning medication is usually continued, not stopped. Bleeding from a socket can be controlled locally; a clot travelling to the brain or heart because medication was stopped cannot. The risk of stopping is generally greater than the risk of bleeding.

The call

Miriam, 78, from Sheinfeld, with an upper premolar that had fractured and become infected. She had atrial fibrillation and had been taking an anticoagulant for six years, and she arrived assuming she would be told to stop it for a week beforehand — because that is what she had been told twenty years ago for a different procedure.

Guidance has changed considerably, and for good reason.

What we found

Upper right first premolar, fractured below the gum, non-restorable, with a chronic infection at the root tip. A straightforward extraction in anatomical terms.

The medical picture was what needed managing. Atrial fibrillation, anticoagulated, well controlled, with a blood pressure of 148/86 that day, mild kidney impairment, and a long medication list she had brought with her in a plastic wallet — which is exactly what we ask for.

The current approach in dentistry is settled. For routine extractions of one to three teeth, anticoagulation is continued. The reasoning is a straightforward comparison of harms: post-extraction bleeding is inconvenient and almost always controllable with local measures in the chair, whereas interrupting anticoagulation carries a small but real risk of stroke or a clot, which is not recoverable.

For patients on warfarin, an INR checked within 24 to 72 hours and within the therapeutic range means treatment proceeds. For the newer direct oral anticoagulants, no routine blood test exists, and the usual approach is to treat in the morning, sometimes with a timing adjustment around the dose, in discussion with the prescriber. That discussion is not optional, and we had it.

What we did

Beforehand: phoned her cardiologist, confirmed her medication should continue, and scheduled the appointment for the morning, early in the week, so that any problem would arise while we were open.

The extraction: as atraumatic as possible. Local anaesthetic with adrenaline, which also helps constrict small vessels. Minimal trauma to the gum, the tooth eased out rather than levered aggressively.

Local haemostasis — the part that does the work: an absorbable gelatin sponge placed into the socket, sutures across the socket to hold the gum closed and the sponge in place, and firm pressure with damp gauze for twenty minutes. Then we kept her in the waiting room for a further half hour and checked again before she left.

Aftercare: written instructions, gauze to take home, no rinsing for 24 hours, no hot drinks that day, and a phone number for the evening.

The outcome

Minor oozing for a few hours, which is expected and not the same thing as bleeding. It settled overnight. Healed normally over the following three weeks.

Her medication was never interrupted.

What to do if this happens to you

1. Bring your full medication list, including anything from a hospital or a specialist.
2. Do not stop a blood thinner on your own initiative, and be cautious if a clinician suggests it without contacting your prescriber.
3. Ask for a morning appointment early in the week.
4. Expect oozing for several hours. Pink saliva is normal; a steady flow of red blood is not.
5. Bite firmly on damp gauze for twenty minutes without checking every two minutes. Repeated checking is the commonest reason bleeding continues.
6. Call if bleeding is heavy after an hour of proper pressure, or if you feel faint.

On blood thinners and need dental treatment? Ramat Beit Shemesh Urgent Dental Care liaises with your doctor before treating. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.