Blood Thinners and Dental Care
Dental patients often take “blood thinner” medications to prevent the formation of blood clots, which can lead to serious conditions like stroke, heart attack, deep vein thrombosis (DVT), or pulmonary embolism (PE). However, these medications affect the body’s clotting mechanism, posing concerns for dentists during procedures that may cause bleeding.
Clot Formation Process
Understanding how blood clots form is essential. The process involves two main phases. Initially, platelets, small blood cells, clump together at the site of injury, forming a plug that slows down blood flow and creates a matrix. The next phase, called coagulation, occurs when proteins in the blood interact to stabilize the clot, fill in gaps between platelets, and make it more solid until bleeding stops.
Antiplatelet Medications
Some medications like aspirin, Ticlid (ticlopidine), and Plavix (clopidogrel) work on the first step of clot formation. They stop platelets from sticking together and to the walls of blood vessels. Aspirin, for example, makes lasting changes in platelets that can only be undone when the body makes new platelets that haven’t been affected by the medication.
Anticoagulant Medications
Anticoagulant medications, such as Coumadin (warfarin), hinder the second phase of clotting by inhibiting the production or function of proteins that stabilize the clot. It takes several days for warfarin to reach its full anticoagulation effect after starting the medication, and it continues to exert its effect for several days after discontinuation. Monitoring the activity of warfarin is necessary due to the influence of various foods and medications. Newer anticoagulants like Pradaxa (dabigatran), Xarelto (rivaroxaban), and Eliquis (apixaban) reach full anticoagulation effect more quickly than warfarin and can be stopped more easily. Lovenox (enoxaparin) is a self-injected medication used for preventing PE and DVT.
Dental Procedures Associated with Bleeding
Some dental procedures can cause bleeding. These include teeth cleaning, deep teeth cleaning, gum surgery, tooth removal, dental implants, and biopsies.
Preparations for Dental Procedures
Dentists can usually control and stop bleeding during dental procedures, even if patients are taking blood thinners. However, the medications affect clotting differently for each person, so dentists need to consider the risk of bleeding from the procedure compared to the risk of harmful blood clots before deciding whether to change the medication or stop it.
Preparing for Dental Procedures
Your dentist will ask for a comprehensive medical history, including information about any medical conditions you have (e.g., heart disease, irregular heartbeat, stroke, liver disease, kidney disease, history of blood clots), current medications, the name of your physician, the purpose of your antiplatelet and/or anticoagulation therapy medications, the anticipated duration of medication use, blood test results, and any problems you’ve experienced with your medications. Before proceeding with the dental procedure, your dentist may perform tests and consult with your physician.
The dental procedure can be done in three ways:
- continuing the medications as usual,
- changing the dosage or type of medications, or
- stopping the medication temporarily.
Precautions may be taken before, during, and after the procedure to minimize the risk of significant oral bleeding. It is important not to discontinue or alter medications without the guidance of your physician and dentist.
Questions and Answers About Blood Thinner Medications
Q: Do I need to check my clotting times before a dental appointment?
A: Depending on the medication and the dental procedure, your dentist or physician may order specific blood tests shortly before the dental procedure to assess the medication’s impact on your clotting ability.
Q: Why shouldn’t I stop my blood thinners before dental care just to be safe?
A: Studies have shown that discontinuing these medications can be very dangerous, and serious bleeding from dental procedures is uncommon, even while taking these medications. Dentists can effectively control bleeding through various methods, such as pressure, stitches, medications, and socket packing. Stopping these important medications is rarely necessary, except for high-risk patients. The decision to discontinue or change medication is made through consultation between your dentist and physician, who will determine the appropriate timing and duration of medication discontinuation and resumption.
Q: How can I minimize bleeding after a dental procedure?
A: Most invasive dental procedures result in bleeding that can be controlled with simple measures. Applying firm pressure on the bleeding sites with moist gauze or tea bags for 30 minutes is often sufficient to stop the bleeding. Patients should avoid spitting, rinsing, using a straw, drinking hot beverages, and smoking for at least 24 hours. It is also advisable to avoid eating hard or sharp foods for the first two to three days. Your dentist may prescribe medications to minimize bleeding, so make sure to follow their instructions.
Q: When should I seek help for oral bleeding, and who should I contact?
A: If you have concerns about bleeding after a dental surgery, feel free to contact your dentist. If you have followed all the recommended local precautions and experience continuous bleeding for several hours or the formation of a large blood clot (known as a “liver clot”), you should seek help. Your dentist should provide you with contact information for after-hours emergencies, such as an office or cell phone number or an on-call pager. If that’s not available, visit your local emergency room.
Q: What other precautions should I take if I am on blood thinners?
A: Inform your prescribing doctor about any new medication, both prescription and over-the-counter, while taking blood thinners. Your pharmacy will also check for potential drug interactions. If you have any doubts, consult your physician or dentist to ensure there are no conflicts. Keep in mind that over-the-counter medications like Motrin, Advil, and Aleve can increase the antiplatelet effects of blood thinners. “Herbal” or “non-traditional” medications can also interfere with or enhance the effects of anticoagulant medications.
Conclusion
Managing dental care for patients taking blood thinners requires careful consideration of the risks and benefits. Dentists assess the individual’s medical history, consult with physicians, and employ appropriate precautions during and after dental procedures to minimize the risk of significant oral bleeding. It is crucial to follow medical advice and not alter medications without professional guidance.
