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Bleeding Complications in Dental Treatment – Guidelines

Bleeding complications during dental treatment can occur in patients with coagulation disorders or anticoagulants. The article summarizes medications, diseases, and clinical guidelines to prevent and manage complications in general and specialist dentistry.

Author: Emma Ekenstråle • Specialist i orofacial medicin • Dental Specialist • Department of Orofacial Medicine • Mälarsjukhuset Eskilstuna
Reviewed by: Vegard Garsjö • Dental Specialist • Specialist clinic of Orofacial Medicine • Gothenburg
8 min read
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    This article is based on an original article in Swedish, which can be found here

    The recomendations in this article are based on Swedish recommendations and guidelines

    BACKGROUND

    An increasing number of patients are treated with anticoagulant medication or other drugs with impact on blood coagulation. In addition, there are also the patients with coagulation disorders . It is therefore of utmost importance that we, when practising dentistry, are aware of how best to manage these patients during surgical procedures.

    It is also important that doctors are aware of the specific guidelines that apply to dental surgical procedures on this group of patients. Guidelines for surgical procedures in the oral cavity slightly differ from general recommendations.

    Previously, anticoagulant medication was discontinued prior to dental surgery. This procedure increased the patient's risk of developing a thromboembolic complication. As a result, Swedish dental guidelines now recommend that the patient continues to take their anticoagulant medication during the dental surgical procedure. This is based on the belief in the low risk of serious bleeding during dental procedures and the easy access and good visibility into the oral cavity.

    Studies regarding dental treatment and NOAK are limited. They have been in use since around 2010, thus providing several years of experience and expertise.

    The recommendations below are based on articles, clinical experience, reported side effects and guidelines.

    BLEEDING COMPLICATIONS CAUSED BY MEDICATION/DISEASES/DISORDERS

    MEDICATION; effecting primary hemostasis:

    • Platelet aggregation inhibitors
    • Heparin (can affect both primary and secondary)

    MEDICATION; effecting secondary hemostasis:

    • Heparin
    • Warfarin
    • NOAK

    DISEASES, effecting primary hemostasis:

    • Thrombocytopenia
    • Von Willebrand's disease
    • Inherited platelet disorders

    DISEASES, effecting secondary hemostasis:

    • Hemophilia: Von Willebrand's disease, Hemophilia
    • Liver disease
    • Some severe medical conditions such as leukemia and treatment with chemotherapy and monoclonal antibodies can affect both coagulation and blood count
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