Children with prosthetic cardiac valves and other invasive mechanical devices that direct blood flow require anticoagulant medication for prevention of thrombosis. Dental surgery for these children has historically consisted of decreasing and/or discontinuing the oral anticoagulant and instituting heparin therapy prior to the planned dental procedure, which can result in thromboembolism and increased morbidity and mortality. This case report demonstrates that oral anticoagulation need not be decreased or discontinued prior to extraction of multiple carious primary teeth in a child at risk for thromboembolism.