Gerald S. Fine, D.D.S.
Oral and Maxillofacial Surgery
This past week I was asked to see a patient who had deep scaling performed in a dental office and whose dentist was unable to stem the bleeding which followed the treatment. The patient had not been seen in a few years and his medical history was not current. Since the patient's last visit he had suffered a stroke and was now taking Coumadin. today, practicing dentists are seeing increasingly numbers of patients who are taking Coumadin or other anticoagulent or antiplatelet medications. these drugs may lead to an increased risk of excessive bleeding after invasive dental treatments. An understanding of the indications for use as well as the diferences between an antithrombic medication and an antiplatelet medication may help avoid patient issues.
Current antithrombic drugs may be classified as anticoagulants, including heparin, low molecular-weight (L.M.W.) heparing and warfarin (Coumadin). The common indication for usuage is for theprevention of deep vein thrombosis. Stndard heparin is usually given in the hospital; the exception to this is the patient receiving hemodialysis. Because of the short half-life of heparin, invasive procedures can be carried out the day after dialysis. For patients taking Coumadin, the risk of bleeding complications appear to be relatively low. A wide range of drugs commonly used in dentristry may potentiate the action of Coumadine including accetaminophen (Tylenol) metronidazole (Flagyl) and broad-spectrum antibiotics. For patients taking low molecular weight heparin, no change in treatment is ncessary. For most patients taking local measures will suffice to manage postopeative bleeding.
The antiplatelet medications are much more frequently seen in our dental practices and are commonly taken by our patients. The antiplatelet medications are much more frequently seen in our dental practices and are commonly taken by our patients. The antiplatelet medications are commonly indicated for the prevention of stroke, recurrent MI (myocardial infarct) and coronary thrombosis. these medications include aspirin, nonsteroidal inti-inflammatory medications (Advil, Motrin, etc) and such drugs as Plavix, Ticlid, and Aggrastat.
To reduce the risk of excessive bleeding, thepatient taking NSAIDS (Advil, Motrin, etc) should consider stopping the medications 24-48 hours priior to any invasive procedure. for patients taking aspirin, the risk of bleeding is not high unless the bleeding time exceeds 20 minutes.
Patients taking a wide range of antithrombic and antiplatelet drugs are commonly encountered in all of our practices on a daily basis. With appropriate prcautions the dentist can safely provide necessary care to these patients.
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery