Dental treatment with diabetes, heart conditions or blood thinners

Diabetes

• Gum disease and diabetes affect each other: poorly controlled diabetes worsens gum disease, and treating gum disease can help blood sugar control.
• Healing after extractions and surgery is slower, and infection and dry socket are more likely when blood sugar is high.
• Eat and take your diabetes medicines as usual on the day unless told otherwise, and bring your recent readings or HbA1c result.
• Book morning appointments if you are prone to low blood sugar, and tell the dentist if you feel unwell during treatment.

Blood thinners

Warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel, ticagrelor and aspirin all increase bleeding. Do not stop them yourself; stopping can cause a stroke or heart attack. Most extractions can be done while you continue your medicine, using local measures to control bleeding. Your dentist may ask for a recent INR result if you take warfarin, or liaise with your doctor about timing.

Heart conditions

• Take your usual medicines on the day, including blood pressure tablets, and tell the dentist if your blood pressure has been high.
• A small number of heart conditions, such as an artificial heart valve or a previous heart valve infection, may need antibiotics before certain dental procedures. Your cardiologist and dentist will advise.
• If you have had a recent heart attack or stroke, non-urgent treatment may be delayed for a period; tell your dentist the date.

Bone medicines and radiotherapy

Bisphosphonates (for example alendronate or zoledronic acid) and denosumab, used for osteoporosis and some cancers, and previous radiotherapy to the head and neck, can affect how the jawbone heals after an extraction. Keeping teeth healthy matters more in these situations, and saving a tooth with root canal treatment may be preferred over removal. Tell your dentist before any extraction or implant surgery. Ideally, have a dental check before starting these treatments.

Other things to mention

• Pregnancy. See dental care in pregnancy
• Allergies, including to antibiotics, latex or local anaesthetic
• Kidney or liver disease, which can affect which painkillers and antibiotics are suitable
• Epilepsy, asthma, or a weakened immune system

What to bring

A current list of your medicines (a photo of the boxes or your pharmacy label is fine), recent test results if relevant, and your doctor’s or specialist’s contact details. See also wisdom tooth removal: medical conditions that need planning.

Frequently asked questions