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Medically Compromised Patients Oral Surgery Restorative Dentistry

Are local anesthetics still controversial for patients taking oral anticoagulants?

This summary is based on the article published in the British Journal of Oral and Maxillofacial Surgery: Safety of local anaesthesia in dental patients taking oral anticoagulants: is it still controversial? (January 2012)

Purpose of the Study

To investigate the safety of local infiltration techniques and the inferior alveolar nerve block (IANB) in dental patients taking oral anticoagulants.

Main Findings

  • Bleeding as a result of the use of local anaesthesia in patients with therapeutic INR is unlikely, provided that the IANB is done correctly.
  • IANB in patients with INR within therapeutic range is safe. Haemorrhagic complications after local anaesthesia, including the IANB (possibly even other nerve blocks), are not likely, and if they do happen they resolve uneventfully.
  • It is advisable to use intraligamentary or intraseptal techniques of local anaesthesia in these patients, as they are safer in that they are less likely to provoke haemorrhagic complications.
  • To lessen the possibility of them happening with IANB, needles with smaller diameter should be used, and the needle should be advanced slowly as the anaesthetic solution is injected.
  • The anaesthetic with vasoconstrictor should be used, together with the IANB technique with which the dentist is familiar.


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1 Comment

  1. JCDA Oasis December 3, 2013

    On Behalf of Dr. David Rose

    The advice to use smaller diameter needles for IANB in anti-coagulated patients is contrary to the recommended recent trend to use larger diameter needles (eg 25G) to ensure adequate aspiration as well as to prevent needle deflection.


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