Clinical practice advice

Assessing Bleeding Risk

Refer to Section 3 of the full guidance.

The following best practice advice is based on clinical experience and expert opinion.

• Assess whether the required dental treatment is likely to cause bleeding and, if so, whether it has a low or higher risk of bleeding complications (see Bleeding risks for dental procedures).

• Ask the patient about their current or planned use of anticoagulants or antiplatelet drugs and other prescribed and non-prescribed medications, when taking or confirming their medical history.

• • The patient should have been advised by their prescriber/dispenser about their anticoagulant or antiplatelet drug(s) and the need to inform their dentist. However, some patients may not know that their medication is an anticoagulant or antiplatelet drug. For a list of anticoagulants and antiplatelet drugs which may be encountered with outpatients in the UK see Anticoagulants and antiplatelet drugs
  • Other medications that can also affect a patient’s bleeding risk are listed in Patient bleeding risk factors - Other medication
  • Be aware that many patients take non-prescribed medications such as aspirin, or other NSAIDs. Patients taking these may have a higher bleeding risk
  • Confirming the details of the patient’s medical history in advance (e.g. by phone or other remote methods) to check for any changes that could impact treatment and require postponement, could reduce wasted appointments and travel

• Ask the patient whether their anticoagulant or antiplatelet treatment is lifelong or for a limited time (see Indications for anticoagulant or antiplatelet therapy).

• • If the patient is on time-limited medication, it may be possible to delay dental treatment until they have stopped taking the drug(s)

• Ask the patient about any medical conditions that they have.

• • The medical conditions for which anticoagulants and antiplatelet drugs are commonly prescribed in the UK are listed in Indications for anticoagulant or antiplatelet therapy. If a patient has one or more of these conditions, they may be taking an anticoagulant or antiplatelet drug
  • Some patients may have other medical conditions such as kidney or liver disease or bone marrow disorders that can affect their coagulation and platelet function (see Patient bleeding risk factors - Other medical conditions)

• Ask about the patient’s bleeding history (e.g. incidences of bleeding requiring retreatment or a hospital visit, prolonged bleeding from other wounds, spontaneous bleeding, easy bruising etc).

• • A patient’s previous experience of bleeding in response to invasive dental or surgical procedures or to trauma may be a useful indicator of the likelihood of bleeding complications from the current dental treatment