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Pre-Operative Management

Patients taking low-dose Aspirin (75mg – 300mg daily), Clopidogrel (Plavix), Dipyridamole (Persantin, Persantin Retard, Asasantin Retard) or are taking Warfarin are at greater risk of bleeding after teeth have been removed or after a biopsy has been performed.

Patients taking low-dose Aspirin, Clopidogrel, Dipyridamole or are taking Warfarin should not have their medications stopped or altered prior to dental surgical procedures unless advised otherwise.

If the patient is on Warfarin, the INR is checked on the day of extraction or biopsy. If the INR is below 3.5 – 4.0, then the tooth extraction / biopsy can be done.

Peri-Operative Management

To minimise bleeding after the tooth extraction / biopsy:

  • the socket can be stuffed with various materials that assist clotting
  • the socket is stitched up tightly &
  • a mouth rinse containing Tranexamic Acid or Aminocaproic Acid (this prevents the breakdown of blood clots) can be prescribed.

Post-Operative Management

Patients should:

  • look after the initial clot at the operation site by resting while the local anæsthetic wears off & the clot fully forms (2 – 3 hours)
  • avoid rinsing the mouth for 24 hours
  • not to suck hard or disturb the operation site with the tongue or any foreign object
  • avoid hot liquids and hard foods for the rest of the day
  • Avoid chewing on the affected side until it is clear that a stable clot has formed. Care should then be taken to avoid dislodging the clot
  • bleeding continue or restarts, to apply pressure over the socket using a folded clean handkerchief or gauze pad. Place the pad over the socket and bite down firmly for 15 – 20 minutes. If bleeding does not stop, the Oral Surgeon should be contacted; repacking and re-stitching of the socket may be required

How Should Post-Operative Pain Be Managed?

Patients should follow the advice of their Anticoagulant Clinic with regard to the choice of painkillers for short-term mild to moderate pain.

Generally, Paracetamol is considered the safest simple painkiller for patients taking Warfarin and it may be taken in normal doses if pain control is needed and no contra-indication exists.

Patients should not to take Aspirin, Aspirin-containing compound preparations or Non-Steroidal Anti-Inflammatory Drugs e.g. Ibuprofen, which are considered less safe than Paracetamol in patients taking Warfarin.

Patients requiring a course of antibiotics post-operatively should be vigilant for any signs of increased bleeding.