Educational practices regarding anticoagulation and dental procedures in U.S. dental schools

Evidence suggests that stopping oral anticoagulation with warfarin is not necessary in patients requiring low-risk dental procedures and may actually increase thrombosis risk. However, widespread belief remains among dentists that stopping oral anticoagulation for dental procedures is necessary. The purpose of this study was to investigate the teaching practice of U.S. dental faculty responsible for providing education to dental students about anticoagulation. Surveys were mailed in 2003 and 2004 to fifty-five U.S. dental faculties to assess their teaching practice regarding anticoagulation and dental procedures. Twenty-eight (50.9 percent) of the schools returned surveys. Contrary to evidence indicating anticoagulation does not need to be altered, many dental faculty responded that they teach dental students to discuss with medical providers/patients about altering warfarin therapy for several routine procedures: 21.4 percent (cleaning), 14.3 percent (restorative treatment), 46.4 percent (single simple extraction), 64.3 percent (multiple simple extractions), and 17.9 percent (root canal). However, 67.9 percent stated an International Normalized Ratio (INR) of 2.0-3.0 would be acceptable prior to dental procedures. A discrepancy was also found between the number of faculty recommending altering warfarin in intermediate- to high-risk individuals compared to those recommending heparin bridging for the same patients. Overall, this study identified inconsistencies between teaching practices in U.S. dental schools and medical evidence. Dental faculty should consider comparing their teaching material with evidence regarding anticoagulation and dental procedures. Continuing education may be necessary for practicing dentists regarding this topic.