Elderly patient with recent stroke for dental clearance.

76-year-old man for upper dental clearance


  • Significant tooth decay and gum disease
  • Affecting ability to eat and impacting on QoL
  • AF – on Apixaban
  • IHD
  • OSA – CPAP
  • Mycotic AAA – EVAR 2019. On lifelong clopidogrel
  • NIDDM – HbA1c – 6.6%
  • CKD


  • Recent CVA – Feb 2021. Lacunar infarct of internal capsule and Thalamus.
  • 3 previous CVA’s
  • Dysphagia due to previous CVA.
  • Dentition worsening oral intake and exacerbating symptoms
  • Patient very keen for procedure to be done as soon as possible


Ongoing ischaemic events on anticoagulation and anti-platelet therapy

  • Will the risks be significantly reduced in this patient after 9  months?
  • Other options – outpatient dental procedures are done on anticoagulant therapy, can he have some of his teeth out in the community while awaiting full dental clearance?
  • Should Neurologist/Haematologist advice should be sought regarding the cause of the CVA’s and management of anticoagulation


  • Discussion with surgical team:                
    • Further review with regards to symptomatic management options.
    • Happy to extract teeth with uninterrupted clopidogrel therapy
  • Liaise with neurologist and haematologist