Tooth Extractions in Thyroid Disorders

Procedural Bleeding Considerations

• Simple dental extractions are classified as low bleeding risk procedures with a 2-day risk of major bleeding of 0-2% in patients with thyroid disorders, and can proceed with continued anticoagulation plus local hemostatic measures for patients on anticoagulation 1
• Multiple tooth extractions are classified as high bleeding risk procedures with a 2-day risk of major bleeding of 2-4% in patients with thyroid disorders, and require more careful hemostatic planning, with consideration of oral tranexamic acid mouthwash for local hemostasis if bleeding risk is elevated 1

Preoperative Assessment

• The American Thyroid Association recommends verifying current thyroid function status, medication compliance, and signs of uncontrolled disease before any dental extraction in patients with thyroid disorders, although the specific guideline is not provided here, a similar recommendation can be found 2

Special Populations

• The National Comprehensive Cancer Network recommends screening patients with MEN 2 syndromes for pheochromocytoma before any surgical procedure, including dental extractions, and removing pheochromocytomas with α-adrenergic blockade before any other surgery to avoid hypertensive crisis 3, 4

Infection Control

• The Centers for Disease Control and Prevention recommends standard universal precautions for all dental extractions regardless of thyroid status, and handling extracted teeth as clinical specimens with appropriate infection control measures 5, 6, 7