Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease

Lockhart, P.B., Gibson, J., Pond, S.H. and Leitch, J. (2003) Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease. British Dental Journal, 195(8), pp. 439-445. (doi: 10.1038/sj.bdj.4810593)

Abstract

Current teaching suggests that many patients are at risk for prolonged bleeding during and following invasive dental procedures, due to an acquired coagulopathy from systemic disease and/or from medications. However, treatment standards for these patients often are the result of long-standing dogma with little or no scientific basis. The medical history is critical for the identification of patients potentially at risk for prolonged bleeding from dental treatment. Some time-honoured laboratory tests have little or no use in community dental practice. Loss of functioning hepatic, renal, or bone marrow tissue predisposes to acquired coagulopathies through different mechanisms, but the relationship to oral haemostasis is poorly understood. Given the lack of established, science-based standards, proper dental management requires an understanding of certain principles of pathophysiology for these medical conditions and a few standard laboratory tests. Making changes in anticoagulant drug regimens are often unwarranted and/or expensive, and can put patients at far greater risk for morbidity and mortality than the unlikely outcome of postoperative bleeding. It should be recognised that prolonged bleeding is a rare event following invasive dental procedures, and therefore the vast majority of patients with suspected acquired coagulopathies are best managed in the community practice setting.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Gibson, Professor John
• Authors: Lockhart, P.B., Gibson, J., Pond, S.H., and Leitch, J.
• Subjects: R Medicine > RK Dentistry; R Medicine > RC Internal medicine
• College/School: College of Medical Veterinary and Life Sciences
• Journal Name: British Dental Journal
• Publisher: Nature Publishing Group for the British Dental Association
• ISSN: 0007-0610
• Copyright Holders: © Copyright British Dental Journal
• First Published: First published in the British Dental Journal 195 (8):439 - 445
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher