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by Jeffrey Gross, DDS, FAGD of The Healthy Smile
That is a great question and one that we deal with regularly. Many patients take some medication to thin their blood. A more fundamental question is whether or not a blood thinner should be stopped at all. I want to talk about this today. Of course, the subject is well beyond the space that we have, and I know that I am not a primary care doctor or cardiologist. All that being said, I need a working knowledge of these drugs to render the best care available for my patients. I will summarize the medicines that are used for blood thinning and see their impact on your dental care.
There are three general categories of drugs that thin the blood. There are anti-coagulants, anti-platelet, and direct-acting anti-coagulants taken by mouth. The word coagulate means to slow down bleeding by the blood slowly turning from a liquid to solid. This slowing down is why we don’t bleed forever when we get a cut. The body has a process to slow down the bleeding naturally. This process is called coagulation. An anti-coagulant is something that interferes with this process and lets the blood stay in liquid form and not turn into a solid.
Patients who have had specific procedures, cardiac issues, or are prone to forming clots, which can block blood flow to the brain or heart are on some blood-thinning therapy. Having a clot form in a blood vessel which would prevent blood from reaching the brain could result in a stroke. If it blocks blood flow to the heart muscle, it could cause a heart attack. Sometimes this concern is temporary. In other cases, the decision to take a blood thinner is one that lasts a lifetime.
For the longest time, the drug Coumadin was used by everyone who was at risk for forming clots. Coumadin is in our category of anti-coagulant. Other medicines have the same effect, but they work through a different mechanism by inhibiting other cells involved with clotting called platelets. Common examples of these drugs are Plavix, Ticlid, Effient®), Brilinta, and aspirin. Patients who have experienced a DVT (deep vein thrombosis) or PE (pulmonary embolism), or who have had a heart attack or had a stent placed in their heart take these drugs.
There are some newer drugs on the market whose advertising flood the airwaves and internet. Examples of these include Pradaxa, Xarelto, and Eliquis. These drugs act differently than Coumadin. The doses do not need constant monitoring and are in the system for a shorter period.
Now that we have basic knowledge let’s try to answer our question. Should we stop and how long before our procedure? We will deal with the first part this week. If the treatment does not get near the gums, then bleeding is not even an issue. Therefore, there is no need to stop the blood thinner for a filling, bonding, veneer, crown, or bridge procedures to mention a few. The ability to not interrupt taking these drugs applies to all classes and types of blood thinners. Ask your dentist if the gums will be affected or not.
Next week, I will finish this topic as we discuss those procedures where bleeding can be an issue. In the meantime, if you have any questions about any dental topic, please call Joyce at 440-892-1810 and ask to speak to me. I will do my best to help you.
Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.
The Healthy Smile • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 • www.jeffreygrossdds.com
