Bleeding may occur following a number of dental procedures. These include injections, biopsy, surgery involving bone or soft tissue, or simply the removal of a deciduous tooth. Predicting bleeding following these procedures usually depends on taking a history, including a family history, noting bleeding episodes after dental treatment and whether anticoagulant drugs are being taken.

Patients taking warfarin, e.g. those with certain prosthetic heart valves, and needing dental surgery may present some problems. There is the issue of postoperative bleeding and the possibility of a change in prothrombin times with some antibiotics. It is prudent to seek the assistance of the physician managing the coagulation therapy.

Generally, it is reasonable practice, having checked the preoperative tests of prothrombin times (INR), to proceed with the surgery leaving the patient's warfarin therapy unchanged. Most postoperative bleeding can be prevented by the use of firm sutures when closing the wound. Postoperative tests of the prothrombin time (INR) should be arranged with the patient's physician 48 hours after surgery. Any adjustment of the warfarin therapy can be made following these tests. When postoperative bleeding occurs, primary management is reinforcement of sutures, when indicated, and pressure. If these measures fail, the patient's physician should be consulted.

Patients who have taken aspirin or a nonsteroidal anti inflammatory drug may experience bleeding following some dental procedures. Once again, primary postoperative bleeding is anticipated by firm sutures and pressure.

When there is a family history of an inherited bleeding disorder, the advice of the physician managing the patient's condition should be sought.

R.G. Woods

Australian Dental Association