Effect of periodontal treatment on oral anticoagulation in patients with heart disease.
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.


OBJECTIVE
To assess the influence of PD on oral anticoagulation in patients with heart disease.


METHODS
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.


RESULTS
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).


CONCLUSIONS
This study showed that dental treatment in patients with any type of PD significantly increases INR.
Moreira
Paula
P
Universidade Federal Fluminense-Rio de Janeiro, RJ, Brasil. pfincl@yahoo.com.br
Filho
Paulo Moreira S
PM
Silva
Edimilson A
EA
Weksler
Clara
C
Drable
Sandra Gama
SG
Tura
Bernardo R
BR
Fonseca
Maria da Graça
Mda G
Cunha
Ademir B
AB
Fischer
Ricardo G
RG
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006331:Heart Diseases / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010510:Periodontal Diseases / Q000150:complications / Q000628:therapy*; D011446:Prospective Studies; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin