Dentistry And Blood Thinners = Dangerous Mix?
Blood thinners are prescription medications taken by many dental patients. Blood thinners are used in medicine to prevent potentially fatal blood clots. Blood clots can lead to stroke, heart attack, deep vein thrombosis (DVT), or pulmonary embolism (PE). These blood thinners prevent clotting they cause a possible danger to dental procedures that may cause bleeding. The lifesaving benefits of these drugs very often outweigh the potential dangers they can have for you.
How Does Blood Clotting Work In The Body?
There are two main processes by which the body forms a blood clot normally. The first process involves platelets (small blood cells) which goto the site of a wound and clump together to form a plug which slows the flow of blood through the vessel and forms a covering to begin the healing process. The next phase of the process is called coagulation when proteins in the blood bind with each other to fill in the gaps between the platelets, stabilize the clot formation, and make it more solid until bleeding stops.
Medicines Used As Blood Thinners
There are 2 types of blood thinners. They are as follows:
-Antiplatelet – These blood thinners include aspirin, Ticlid (ticlopidine), and Plavix (clopidogrel). These medicines target the initial phase of the clot process by preventing platelets from binding to the blood vessel walls or to one another. Aspirin is a good example of how these medicines act on the body. The mechanism by which Aspirin achieves this is by creating permanent changes in the platelets which last throughout the lifetime of the platelet (approximately 7-10 days). This can only be reversed once the body produces new platelets that have not yet been exposed to Aspirin.
-Anticoagulant – These blood thinners include Coumadin (warfarin). Coumadin works by inhibiting the second phase of blood clotting by blocking production or the function of proteins that stabilize the clot (also called anticoagulation). For Coumadin, it generally takes several days after the beginning the medication for it to reach its full anticoagulation effect, and then again several days after the medication is stopped for the anticoagulation effect to cease. Many foods and other medications can affect coumadin by either increasing or decreasing its effectiveness. Your physician will need to frequently monitor to check your level of anticoagulation activity. Newer anticoagulants have come to market and these include Pradaxa (dabigatran), Xarelto (rivaroxaban) and Eliquis (apixaban). These medications have an advantage over coumadin in that they do not need as long a time as coumadin to reach their full anticoagulation effect, and also to stop that effect when discontinued. The downside is their anticoagulation activity cannot be monitored as easily as it is for coumadin. Another medication, Lovenox (enoxaparin), is used in prevention of pulmonary embolism (PE) and Deep vein Thrombosis (DVT). These blood thinners are given through self-injection.
Dentist Preparations For Blood Thinners
Generally, bleeding from dental procedures is fairly easy to control and bring to a stop, even in patients who are taking these blood thinner type medications. It is important to note that both the effect of these medicines on blood clotting and the potential for bleeding from dental procedures can vary quite a bit from individual to individual. So each patient must be considered individually based on their clotting factor and the dental procedure being performed. A consultation with the patient and their physician can lead to a change in dose prior to dental procedure or even stopping the medication altogether to complete the dental work.
It is very important for those on blood thinner medications to communicate with your dentist regarding medical history. Your dentist will ask you to provide a complete medical history including:
-All medical conditions (including heart disease, irregular heartbeat, stroke, liver disease, kidney disease, and/or history of blood clots)
-All medications currently being taken. Not just blood thinners but all medications. This is important because they could interact with what your dentist is using as well.
-Treating physician information
-Reason for taking blood thinners
-Anticipated time that you will be on blood thinners
-The results of your monitoring of the effects of these agents (blood test results)
-Any issues that have arisen with your blood thinners.
Your dentist may ask to run some tests prior to your dental treatment and call your physician before attempting to do the dental procedure(s). Your dentist may ask to do the dental procedure in one of 3 ways:
-Continue taking blood thinners as normal with no changes.
-Alter the dose or type of blood thinners for a short period of time
-Stop the blood thinners prior to the dental procedure.
Precautions may also be taken by your dentist before, during and after the dental procedure to reduce the chances of significant oral bleeding. It is important to not that you should never discontinue or change your blood thinners or dose without the advice of your physician and dentist. It is also important to be aware that over the counter medications such as Motrin, Advil and Aleve, can also increase the anti platelet effects. Additionally “non-traditional” medications can interfere with, or increase the effects of your anticoagulant medications.
Dental Procedures With Bleeding Risks
The following procedures are the ones most linked to increased bleeding.
-Professional teeth cleaning (also referred to as dental prophylaxis)
-Scaling and root planning (also referred to as a deep teeth cleaning)
–Dental implant placement
Blood Thinners Conclusion
Being on blood thinners comes with many benefits but also some risks. We can minimize these risks at least on the dental side by communicating properly to have your dental procedures completed safely and successfully. Remember, to maintain a regular dental hygiene and dental examination schedule for a healthy smile.