Dental care procedures, such as teeth cleanings, inserting acrown, or performing a root canal, can occasionally result in bleeding of the gums. While bleeding is always minimized, some bleeding is unavoidable in dental procedures. There are typically no long-term effects nor high risks associated with slight gum bleeding.
However, in general, a person can bleed more while taking blood-thinning medications. Therefore, patients who are on blood thinners should inform our dental team prior to undergoing any dental care.
What Are Blood Thinners? Anticoagulants and Antiplatelets Explained.
Antiplatelet and anticoagulant medications, colloquially referred to as blood thinners, are important medications that can help reduce the chance of blood clots in a high-risk patient. Anticoagulant medications act upon blood cells by slowing down or preventing the process of blood cells forming clots, known as coagulation. This “thins” out the blood, making it flow more easily through the veins, and subsequently, making it flow more quickly and easily out of an open wound.
These blood thinners can often be prescribed to someone who has coronary artery disease (CAD), a congenital heart defect (CHD), a history of clots, a history of deep vein thrombosis (DVT), a history of pulmonary embolism (PE), or a history of cerebrovascular accident (CVA), also known as stroke.
Occasionally, blood thinners are prescribed after surgery to prevent post-surgical clots. Blood thinners are typically halted or discontinued prior to surgery to prevent bleeds during surgery.
Because these are serious medical conditions, most patients who are prescribed blood thinners are aware of the reason for their medications. Some patients who deal with polypharmacy are not aware of every medication function, and therefore, should get a list of current medications from their healthcare provider before seeking dental care.
Antiplatelet medications work specifically to stop platelet blood cells, which do most of the binding together in coagulation, from clumping together.
Anticoagulants:
Warfarin (Coumadin)
Heparin (Hep-Lock)
Enoxaparin (Lovenox)
Dabigatran (Pradaxa)
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Edoxaban (Savaysa)
Antiplatelets:
Aspirin
Clopidogrel (Plavix)
Ticlopidine (Ticlid)
Prasugrel (Effient)
Ticagrelor (Brilinta)
Dipyridamole (Persantine)
Non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil or ibuprofen can also cause blood thinning, although not always. Furthermore, NSAIDs are typically not taken on a daily basis, like anticoagulants and antiplatelets.
What to Know About Dental Care on Blood Thinners
If you are only taking blood thinners (anticoagulants, antiplatelets, NSAIDs) for a temporary condition or finite amount of time, such as use for one week after surgery, then the smartest decision usually is to postpone dental care if possible until after the cessation of using blood thinners.
However, dental care can be done safely when on blood thinners. If you are taking blood thinners daily or indefinitely, stopping the use of blood thinners is generally not feasible. In fact, there can be more risk in stopping the use of blood thinners for patients who need them (which can lead to the aforementioned medical conditions, like clots, stroke, or heart attacks in at-risk patients) than with dental care with blood thinners.
Dental prophylaxis, or teeth cleaning, is a common dental procedure that dentists can most likely provide while a patient is on blood thinners. While bleeding can occur, there are many techniques in dental care to staunch or slow bleeding. One example is the use of gauze to staunch bleeds. Furthermore, the practice of minimally invasive dental techniques, suctioning and hemostatic devices, and even simply biting down during certain parts of a procedure, can reduce bleeding.
As long as our dental team is fully informed about your medication use, they can come up with a safe dental care plan that specifically caters to your use of blood thinners.
A thorough examination of medical history should include any current medications, medication or food allergies, medical conditions, genetic conditions, surgical history, major cardiac event history, dental history, dental surgery history, pregnancy status, alcohol or smoking or drug use, level of hydration, and labs such as clotting factor presence and Internalized Normal Ratio (INR) or Partial Thromboplastin Time (PTT).
By assessing these factors, you can be most prepared and knowledgeable about your own health. If you do not know this medical history information, you can contact any prior physician’s office or your primary care physician to obtain a medical record. Labs can be obtained at standard lab testing facilities or at an urgent care, emergency room, or physician’s office, depending on the situation.
Other dental procedures can often incorporate more bleeding than simple dental prophylaxis.
Some examples of these dental procedures are:
Root canals
Scaling and deep teeth cleaning
Dental crown placement
Tooth extraction or removal
Gum surgery
Biopsies of teeth or gum tissue
Wisdom teeth removal
If you’re taking blood thinners on a long-term basis, then you should inform our dental team, physician, and any specialists to identify the best course of action for upcoming dental procedures. This will be a unique decision from patient to patient.
Sometimes, the best way to protect oneself is through thorough communication and support from professionals. That is why it is important to consult with our dental team and your prescribing physicians about blood thinners prior to dental care.
Moving Forward: Care for Oral Bleeding
So what if you are on blood thinners and have oral bleeding after dental care?
Oral bleeding after dental care may occur after a procedure, but it is usually well-controlled and short-lived. Some simple bleeding might last for around 30 minutes after surgery, but it can be controlled through the use of gauze. Drinking cold or room-temperature fluids from a cup is recommended.
Some behaviors to avoid limiting oral bleeding after dental care:
Excessive spitting or rinsing out the mouth
Smoking
Drinking hot beverages
Eating sharp foods like chips, popcorn, or nuts
Using a straw, which might irritate or poke gums (unless a straw is needed to prevent choking)
If you have bleeding from your gums or mouth for several hours in a row, and it is constant and non-staunchable with gauze, you should call your doctor. Alternatively, if you feel worried about the amount of blood loss you’ve experienced, you can go to an emergency care facility. Although this is highly unlikely in a patient who is on blood thinners, if you are experiencing large blood clots coming from the mouth, you should seek emergency care as well.
Most people can obtain safe, healthy, and beneficial dental care while on blood thinners. Dental health is connected to heart health and happiness, so it’s important not to neglect dental care because of mild worry. This information is intended to help educate, empower, and inform all patients on blood thinners.
For further questions about blood thinners and dental care, contact our dental team here at Lifetime Dental Health.
