Q. What should I do if I start bleeding later at home after dental surgery?

Rarely is postoperative bleeding severe after dental surgery or extractions.  Mild bleeding usually results from either food or a toothbrush touching the wound margins.  Such bleeding is minor and very temporary.

More severe bleeding can occur, and in some cases, it may indicate there is an underlying clotting problem or a defect in the later stabilisation of the blood clot.  The formation of the initial clot takes place by the sticking together of Platelets (one of the types of Blood cells) forming a platelet plug.  A series of chemical reactions then take place resulting in the formation of a stable fibrin blood clot.  Some medications can interfere with this process and the most commonly used drug that does so is Aspirin.

If you have been taking Aspirin on a daily basis then all you will need to do is apply firm pressure to the wound or tooth socket using a bite pack for around 10 minutes.  It is not necessary for you to stop taking your daily Aspirin for most dental surgical procedures.  Normally clotting would only take 5 minutes but to allow the clot to form with fewer working Platelets, it is best to apply pressure for longer; around 10 minutes should be sufficient.

Pressure packs only work if pressure is applied constantly.  If you keep releasing the pressure to see if the bleeding has stopped, then the clotting time starts again when pressure is reapplied.  Leave the pressure pack in place with pressure applied continuously for the full time advised.

Q. If I take Warfarin, must I stop 5 days before surgery to prevent uncontrolled bleeding?

Firstly, Warfarin is used to prevent your blood from clotting spontaneously and causing a clot to form within your circulation.  It is, therefore important to take it to prevent a blood clot forming and then breaking up and blocking fine blood vessels in your brain leading to a stroke.  So never just stop Warfarin without first discussing it with either your GP or your cardiologist.

In some cases, the cardiologist may feel that your risk of suffering from a stroke is very low and may be happy to stop Warfarin for 5 days before dental surgery but in most cases, this is not necessary.  Always discuss this with your dentist and your GP if there is any doubt.

It is possible to check on the effectiveness of Warfarin therapy by performing a simple blood test called an INR (International Normalised Ratio).  This is a ratio of your ability to stop bleeding compared to an internationally accepted normal value.  Generally, if you have an INR below 2.0, then it is safe to have dental extractions and other dental surgical procedures.  If the INR is above 2.0, then your dentist or surgeon must determine the likelihood of significant bleeding.  It is possible to apply other procedures to assist in stopping bleeding, including the use of special haemostatic foams in dental extraction sockets that make the blood clot, and stitches can be used to help apply pressure to the wound and assist in bringing bleeding under control.

In more severe cases with a raised INR, and an extensive surgical procedure, a suspension of Tranexamic acid 5% can be applied to bite packs and pressure applied to stop bleeding.  This medication is only available on prescription by your surgeon who will advise you on the need for its use if it is required.

Q. I take anticoagulants that are not related to Warfarin.  Does an INR measure how effective these are too?

No!  An INR only measures the degree of anticoagulant effect in patients taking Warfarin.

Q. Is there any way to assess how much my clotting has been diminished by my alternative anticoagulant drugs?

No!  The treatment protocol must be discussed between your cardiologist and the surgeon.  Depending on which of the several anticoagulants you are taking, and the risk to which you might to exposed if you stop taking them, a decision will be made by your cardiologist on how best to control your blood clotting.

Alternative anticoagulants may include Clopidogrel, Lepirudin, Dabigatran, Rivaroxaban and Apixaban.  They do not all work in the same way and the period of time for which they must be stopped prior to surgery varies from 24 hours for some drugs up to 7 days for others.  You will also be advised when it is safe to resume your usual anticoagulant medication after your dental surgery.

Q. When taking medications like antibiotics or anti-inflammatory drugs, is it important to take my tablets on time every time?

When a drug is prescribed every 8 hours it is important to try to stick as closely as possible to every 8 hours to prevent the blood concentration of the drug from falling to an inadequate level.  If the concentration of the antibiotic does fall, then it will no longer be effective at killing bacteria.

Q. After dental surgery when do I have my stitches removed?

Nowadays, Dr. Priestland normally uses dissolving stitches.  They normally disappear at some time between 7 and 21 days after your dental surgery.  Very occasionally stitches fail to dissolve due to a deficiency of a particular salivary enzyme.  If they persist and annoy you, call the practice and we will remove them.

Sometimes Dr. Priestland may want some stitches to remain in place for a prolonged period.  If so he will use blue polypropylene (Proline) stitches.  They feel a bit like very fine fishing line!!  They must be removed.

In the final part of these FAQs,  we answer questions about oral hygiene and diet.

If you have any questions after reading through this article, contact the friendly team at NQ Surgical Dentistry today on (07) 4725 1656 or call in to see us at 183 Kings Rd, Pimlico QLD 4812