Key result
Nonsurgical periodontal therapy reduces periodontal inflamed surface area by ~43% during continuous DOAC use without bleeding.
Why the study?
Optimal management of periodontal treatment in patients receiving DOACs is poorly established, and bleeding concerns may cause clinicians to delay or limit treatment.
Does nonsurgical periodontal treatment improve periodontal inflamed surface area in patients receiving continuous DOAC therapy?
Cohort (n=67)
Single-blind
No
Does nonsurgical periodontal treatment improve periodontal inflamed surface area in patients receiving continuous DOAC therapy?
Standardized Mean Difference: 0.77
p-value: p=<0.05
Basic periodontal treatment can be safely and effectively performed without discontinuing DOACs, reducing local periodontal inflammation without increasing bleeding risk.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“I congratulate the authors on this interesting research which is clinically valuable. The Introduction is well written and organized. The key concepts are defined correctly and their association are explained.”
“How can patients receiving anticoagulants be meaningfully compared with patients not taking anticoagulants with respect to periodontal parameters? Following periodontal treatment, inflammatory parameters such as bleeding on probing (BOP) and probing depth (PD) are generally expected to improve in patients with periodontitis regardless of anticoagulant use. Please explain how the study design accounts for this.”
“However, I suggest to change “periodontal inflammatory parameters” to “periodontal clinical parameters”... Calling BOP and PISA "inflammatory parameters" is accurate and standard. But calling PPD and PESA "inflammatory parameters" is imprecise. They are periodontal clinical/anatomical parameters that contribute to inflammatory burden (PISA) or correlate with inflammation.”
May support nonsurgical periodontal treatment without DOAC interruption; leaves open confirmation of safety and efficacy in randomized trials.
Background/Objectives: The optimal management of periodontal treatment in patients receiving direct oral anticoagulants (DOACs) remains poorly established, and bleeding concerns may lead clinicians to delay or limit treatment. We evaluated the clinical efficacy and safety of nonsurgical periodontal treatment in patients receiving DOAC therapy. Methods: This retrospective study included 67 patients receiving continuous DOAC therapy (edoxaban, apixaban, dabigatran, or rivaroxaban) who underwent nonsurgical periodontal treatment without drug discontinuation. Pocket probing depth, bleeding on probing, the periodontal inflamed surface area (PISA), the periodontal epithelial surface area (PESA), and serum inflammatory cytokine levels were evaluated. A ligature-induced-periodontitis mouse model was also used to assess the effect of apixaban on alveolar bone loss. Results: Nonsurgical periodontal treatment significantly reduced the PISA (42.9%) and PESA (10.8%) in the overall DOAC cohort, with no postoperative bleeding complications. Significant reductions in periodontal parameters were seen in the edoxaban (PISA: 44.2%, PESA: 10.9% reduction), apixaban (PISA: 45.6%, PESA: 11.7% reduction), and dabigatran (PISA: 61.3%, PESA: 16.1% reduction) groups, with no significant changes in the rivaroxaban group. Baseline PISA was positively correlated with baseline serum levels of interleukin-4 (r = 0.33), interleukin-1 beta (r = 0.29), interleukin-6 (r = 0.25), and interleukin-10 (r = 0.30). In the mouse model, apixaban administration did not aggravate ligature-induced alveolar bone loss. Conclusions: Basic periodontal treatment appears to be safe and effective for patients prescribed DOACs and may reduce local periodontal inflammation, resulting in systemic inflammatory burden. These findings support proactive periodontal intervention in patients receiving DOAC therapy, regardless of the specific anticoagulant used.
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Fujimori et al. (2026) conducted a cohort in Periodontitis in patients receiving DOAC therapy (n=67). Nonsurgical periodontal treatment without DOAC discontinuation was evaluated on Periodontal inflamed surface area (PISA) reduction (Cohen's d 0.77, p=<0.05). Nonsurgical periodontal treatment significantly reduced the periodontal inflamed surface area by 42.9% (Cohen's d 0.77) in patients receiving continuous DOAC therapy, with no postoperative bleeding complications.
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