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All Journal JITEKGI Jurnal Ilmiah dan Teknologi Kedokteran Gigi Indonesian Journal of Dentistry
Pipiet Okti Kusumastiwi
Universitas Muhammadiyah Yogyakarta
Dentistry Health Professions Medicine & Pharmacology Public Health

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Management of Tooth Extraction in Patients with Anticoagulant Therapy: Case Report Hasna Nabila Khairunisa; Pipiet Okti Kusumastiwi
Indonesian Journal of Dentistry Vol 6, No 1 (2026): February 2026
Publisher : Faculty of Dentistry Universitas Muhammadiyah Semarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26714/ijd.v6i1.17688

Abstract

Introduction: Consumption of anticoagulant drugs such as warfarin is the main therapy in patients with heart valve disease. Prophylactic antibiotics are recommended for patients with heart disease prior to tooth extraction.Objective: To describe the comprehensive dental management of a patient with a history of heart disease and chronic anticoagulant therapy undergoing multiple tooth extractions.Case: A 67-year-old female patient came to UMY Dental Hospital complaining of discomfort when chewing food because of remaining roots in several of her upper right posterior teeth. This started with a tooth that had cavities and was not treated, causing the crown of the tooth to break little by little on its own. The tooth had hurt about 2 months prior, and she had taken painkillers (Paracetamol). Currently, there are no complaints of pain or other accompanying symptoms. The patient has a history of heart disease since childhood and is currently taking anticoagulant medication (Notisil®). Objective examination showed root residue in teeth 15 and 16, percussion (-), palpation (-), and bitetest (-).Outcome: The patient was given prophylactic antibiotics 60 minutes before tooth extraction and discontinued warfarin 5 days prior to the tooth extraction (as advised by a cardiologist). The extraction was performed smoothly and without complications. The open socket was packed with Spongostan® and sutured using a figure-of-eight technique. On the 14th day post-extraction, the wounds were nearly fully covered, indicating that healing was predominantly in the proliferative phase.Conclusion: Tooth extraction in patients undergoing anticoagulant therapy requires a multidisciplinary approach, involving both the management of anticoagulant medication and clinical strategies such as the administration of prophylactic antibiotics and the application of hemostatic agents like Spongostan® following the extraction.
Extraction of Mandibular Second Molar In A Former Drug Users, Alcohol Consumers, and Active Smokers Pipiet Okti Kusumastiwi; Syifa’ Ardlina
Jurnal Ilmiah dan Teknologi Kedokteran Gigi (JITEKGI) Vol 21, No 2 (2025): November 2025
Publisher : Fakultas Kedokteran Gigi Universitas Prof. Dr. Moestopo (Beragama)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32509/jitekgi.v21i2.6011

Abstract

Background: Extraction of Mandibular Second Molar Extraction in Former Drug Users, Alcohol Consumers, and Active Smoker has a high risk of complications. Case report and case treatment: A 34-year-old male presented with a non-restorable carious lesion on the lower right second molar (tooth 47) and requested extraction. The patient reported poor oral hygiene, active smoking, alcohol consumption, and a prior history of chlorpromazine abuse. The extraction was performed under Inferior Alveolar Nerve Block (IANB) using Lidocaine. Anesthesia lasted approximately one hour, after which pain resumed. Post-extraction healing was monitored over two months, during which the socket of tooth 47 showed delayed epithelial closure. Discussions: Alpha-adrenergic receptor blockade from chlorpromazine, hepatic cytochrome P450 enzyme alterations due to alcohol, systemic acidosis, and post-operative smoking are known to influence the efficacy of local anesthesia and impair healing. Nicotine-induced vasoconstriction and xerostomia further disrupt tissue regeneration. Despite the absence of acute complications, socket healing remained incomplete at 8 weeks post-extraction. Conclusion: This case emphasizes the importance of evaluating systemic and behavioral risk factors before extraction.
Co-Authors Hasna Nabila Khairunisa Syifa’ Ardlina