Dental Management of Anticoagulant

Question 1

Dental procedures unlikely to cause bleed?

Answer 1

LA - infiltration, intra-ligamental, mental, blocks
BPE
Supra-gingival scale
Simple restorative tx
Impression
Ortho fitting/ adjusting

Question 2

Dental procedures likely to cause bleed - low risk

Answer 2

Simple XLA (1-3 teeth)
Incision and drainage swelling
6 point chart
RSD
Restoration sub-gingival margin

Question 3

Procedures cause bleed -high risk

Answer 3

Comp XLA +3 teeth, adjacent teeth
Flap raising
Biopsy
Gingival recontouring

Question 4

What systemic/ medical diseases should you be aware of?

Answer 4

Renal failure - associated platelet dysfunction
Liver disease -reduction coag factors - reduced platelet no and function
Haematological malignancy
Chemotherapy - reduced platelet
Inherited bleeding disorder

Question 5

What signs would indicate poss bleeding disorder?

Answer 5

Brusing, purpura, petichae, bleeding gums - unrelated poor OH, epistaxis, hx peri-op bleeding, fatigue

Question 6

What tests to do see if bleeding likely?

Answer 6

FBC, clotting screen

Question 7

5 drugs thats increase bleeding?

Answer 7

1. Anti-platelet
2. Cytoxotoxic drug - bone marrow suppression
3. NSAID - impair platelet function
4. SSRI anti-depressant - citalopram
5. Immunosupressants

Question 8

What is tranexamic acid?

Answer 8

Anti-fibrinolytic agent - inhibit breakdown fibrin clots - block binding plasminogen and plasmin to fibrin
Use: 4x day start 10 min post XLA, rinse hold 2 min spit, use 5 days, avoid drink 1 hour post

Question 9

Why isn’t tranexamic used primary setting?

Answer 9

Expensive and diff obtain and no more benefit that local haemostatic measure
(only beneficial when used alone)

Question 10

Types of inherited bleeding disorders?

Answer 10

Haemophilia
von Willebrand
Autosomal recessvie

Question 11

What is vWd?

Answer 11

Inherited bleeding disorder - clotting factor and platelet abnormality

Question 12

What is desmopressin - DDAVP?

Answer 12

Synthetic replacement vasopressin - stimulate release FVIII and VWF

Question 13

How long can expect bleeding w/ DAPD?

Answer 13

Clopidogrel + aspirin = 45-60mins

Question 14

Can check bleeding with antiplatlets?

Answer 14

No - be aware that will be increased bleeding

Question 15

Problem with warfarin?

Answer 15

Multiple drug and dietary interactions - variation in pt response to drug
INR >1 is increased bleeding