Dental treatment in patients with heart disease and use of warfarin.

Abstract

Dental treatment in people with cardiac disorders such as pre-infarction or valve surgeries, who use anticoagulants such as warfarin and have poor oral hygiene should be planned from the beginning between the dentist, specialists and even doctors (cardiologists, hematologists, surgeons, etc.). Substituting warfarin for low molecular weight heparin (LMWH) as bridging therapy in the case of multiple extractions is the best alternative to avoid complications of heavy bleeding and/or thromboembolism. In this case the best choice was the use of Enoxaparin. The use of antibiotics also contributes to the success of the treatment, avoiding infections after the surgical procedure and even more so if the patient has pre-existing conditions. Precaution with appropriate therapeutic protocols the integrity of the patient before, during and after performing multiple extractions; thus avoiding abundant bleeding, possible postoperative infection and/or systemic decompensation. A 67-year-old male patient with 2 pre-infarctions and heart valve surgery with poor oral hygiene requires: prophylaxis, removal of dental calculus and multiple extractions to subsequently execute total upper acrylic dental prostheses and lower cobalt chrome prostheses to improve aesthetics and chewing function. Two weeks after the multiple extractions, the prosthetic area is in excellent condition and dental prostheses with excellent adaptability, stability, functionality and good aesthetics could be made. Applying bridging therapy with enoxaparin was the best alternative to avoid profuse bleeding and/or formation of thromboembolism that could lead to systemic complications for the patient.