Case Study
This morning Dr Muzzafar Zaman carried out direct observation of one of his associates treating his patients and we discussed his care of one of his patient’s today. The patient’s personal details and medical history were checked. This patient had no limbs so came in a wheelchair and his medical history revealed him to be on Clopidogrel,(brand name Plavix), an antiplatelet. A dental history was taken which revealed that the patient had been experiencing pain from a broken UL6. An extraoral examination, soft tissue check, charting, occlusal examination, periodontal assessment including BPE scores, and oral hygiene assessment were recorded. It was noted from the examination that there was a grossly carious UL6. A radiograph was required to confirm the diagnosis. The radiograph was justified, graded and reported on. The diagnosis was recorded and a discussion with the patient followed to agree on a treatment plan for an unrestorable tooth. Options included leave or extract but in addition, it also considered a third option which could have been to extirpate and seal in view of the patient’s medical problems. I was pleased to observe that the patient’s wishes were respected and taken into account. The patient consented for the extraction and we discussed any implications as the patient was taking Plavix. I also advised the associate to read The Scottish Clinical Dental Effectiveness programme on the management of patients on anticoagulants.
The guidance highlights the main type of anticoagulant drugs that a dentist will encounter. The dentist also needs to clarify if the procedure poses a risk of bleeding. In this case, an extraction definitely poses a risk of bleeding and therefore precautionary measures are required. The precautionary measures are those such as trying to minimise trauma and use sutures and packing. The main types of drugs which are highlighted in the above guidelines include vitamin K antagonists such as Warfarin. It also includes aspirin and other antiplatelet drugs such as this patient was taking. In addition, it mentions the novel anticoagulant drugs such as Apixaban. The guidance also states that there is no risk of excessive bleeding by carrying out an injection such as an ID block or an infiltration.