It's 10 p.m.; do you know where your patient's hemostasis is?

If you are a dentist who engages in surgical treatment, such as extractions and/or implant therapy, a dreaded phone call can be from your emergency service regarding a patient you treated earlier in the day who now has uncontrollable bleeding. This is of greater concern if the patient has a medical history that warrants anticoagulation medication and the physician did not let your patient go off medication prior to surgery. Are all anticoagulation medications equal in their ability to predispose your patient to bleeding? What is the difference between aspirin, Coumadin, Plavix, Pradaxa, Eliquis, and heparin? What is your patient being anticoagulated for, and at what therapeutic level should they be? When should you order an INR test versus a bleeding time?

These are just a few of the questions that you should be able to answer prior to engaging in surgical treatment. Of course, an open discussion with the patient’s physician is certainly warranted whenever you have questions about a patient’s medication and medical history. Dr. Gregg Jacob, attempts to answer many of these questions about hemostasis in this month’s feature article. He offers a decision matrix as to when patients should be given home-care instructions and when they should come back to the office for hemostatic measures.

MORE CLINICAL TIPS FROM DR. SCOTT FROUM . . .
'Help! My implant fell out!'
'How much do you charge for an implant? I just want to know the price!'
‘The implant you put in my mouth is now bleeding; what should I do?’
After a tooth extraction, are you guilty of chucking the tissue?