Practice abstract
British Dental Journal 195, 405 - 501 (2003)
Published online: 8 November 2003 | doi:10.1038/sj.bdj.4810660
Dental management considerations for the patient with an acquired coagulopathy. Part 2: Coagulopathies from drugs
P B Lockhart1,5, J Gibson2, S H Pond3 & J Leitch4
- Patients with potential for bleeding are common in dental practice.
- Management of patients with acquired bleeding disorders begins with a careful medical and drug history.
- Significant postoperative bleeding due to medications is rare in dentistry.
- Altering a patient's anticoagulant medication often puts them at increased risk of morbidity and mortality.
- Almost all patients taking anticoagulants can receive dental care in the community setting.
Abstract
Dental patients often give a medical history that suggests the possibility of a coagulopathy from drugs, with a corresponding risk for prolonged bleeding during and following an invasive procedure. Identification of patients who may be prone to oral bleeding requires specific medical history information and the proper use of laboratory tests. Some NSAIDs are reported to cause prolonged oral bleeding, but scientific evidence is lacking. Likewise, the risk of oral bleeding from anticoagulants such as warfarin is often over stated, and unnecessary adjustment of NSAID or warfarin dosage puts patients at risk for significant morbidity and mortality. Some commonly employed laboratory tests such as the prothrombin time provide helpful information when used in the appropriate setting, but others, such as the bleeding time test, provide little or no predictive value in the determination of patients at risk for oral bleeding. Dental management of patients with potential coagulopathies from medications requires an understanding of basic principles of coagulation. The vast majority of these patients can be managed in the community setting without risk and without alteration of anticoagulant drug regimes.
- Chairman, Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina, 28232 USA;
- Senior Lecturer and Honorary Consultant in Oral Medicine
- GDP, 510 Allen Street, Kelso, WA, USA
- Clinical Lecturer in Oral Surgery and Sedation, Glasgow Dental Hospital & School, 387 Sauchiehall Street, Glasgow G2 3JZ, Scotland;
- This work was initiated while Dr. Lockhart was a TC White Visiting Professor at the Royal College of Physicians and Surgeons, and at Glasgow Dental Hospital and School, University of Glasgow, UK.
Correspondence to: P B Lockhart1,5
Chairman, Department of Oral Medicine, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232-2861, USA
e-mail: Peter.Lockhart@carolinashealthcare.org