Author: Adam R. Pershing, DMD

Blood thinners are a type of medicine that prevents your blood from clotting inside a blood vessel, which can lead to a heart attack or stroke. They can also keep blood clots from forming or getting larger. They are typically used to treat certain types of heart disease, heart defects, or other medical conditions that could increase your risk of developing blood clots.

A side effect to taking blood thinners is the difficulty to stop bleeding. This needs to be considered before any dental procedures take place. Always inform your dentist if you are taking a blood thinner medication, especially if you’ve just started one. It will be noted in your chart, and your cardiologist or other specialist will be consulted if you require a dental procedure with the potential for increased bleeding.

Precautions

Most general dental procedures, including teeth cleanings, fillings, and crowns, will not be affected if you are taking blood thinners. The only time an issue could arise is during an invasive surgery that has the potential to cause bleeding, such as a tooth extraction or gum surgery. Because the blood thinners don’t allow the blood to clot normally, stopping the bleeding during either of these procedures may be difficult.

After you’ve informed your dentist about which type of blood thinner you’re taking and the exact dose, and after consulting with a specialist, your dentist may suggest temporarily stopping or reducing your medication as a precaution. Other precautions may be taken, such as using hemostatic agents during your procedure to encourage blood clotting at the operation site, or being careful to suture the site to avoid hitting smaller blood vessels that can easily bleed.

Returning to Normal

If your medication was temporarily stopped or the dosage reduced for a dental procedure, you will be able to resume your blood thinners soon after the procedure is complete. It’s important to keep an open line of communication with your dentist, surgeon, and doctor. By all of you working together, your health will be at a much lower risk and your dental procedure will take place without complication.

When accidents happen, our oral and maxillofacial surgeons are here to help. Facial trauma refers to any unexpected force to the face that results in any injury to the teeth, bones, or soft-tissue of the face.

These injuries can affect vital functions, like breathing through the nose or blinking, and are associated with mishaps like car accidents and sports injuries, and typically demand emergency care.

Facial trauma can look like:

• Chipped, Loosened or knocked out teeth

If treated immediately, a loosened or knocked out tooth can successfully be re-implanted into the jaw. When that isn’t possible, a dental implant is a great option to replace a missing tooth.

• Broken jaw, eye socket, or other facial bones

The treatment of broken facial bones is unique, and requires special techniques to stabilize the bones so facial appearance, structure, and function can be restored. Sometimes, this involves wiring the upper and lower jaws together so that bones heal in alignment with each other. In other cases, plates and screws are used to secure bones in position. In all cases, function and aesthetics are priority.

• Injury to the soft tissue and skin of the face, including salivary glands or facial nerves

There are many small soft tissues in the face, some of them include salivary glands that help us digest food to facial nerves that help us smile. These procedures vary, but typically involve closing wounds with stitches or sutures, and applying medication to prevent infection.

Prevention is the best treatment for facial trauma. Wearing seatbelts and using protective gear like helmets and mouthguards can greatly reduce your risk of facial trauma.

If you ever find yourself in emergency care for facial trauma, make sure to ask for a consultation with an oral and maxillofacial surgeon so you receive the best possible outcome.

Dentists prefer to preserve your natural teeth as much as possible, but sometimes that just isn’t an option. There are two ways a tooth can be removed, depending on how severe the damage is to the tooth:

• Simple extraction: Local anesthesia is used, which is a numbing agent either applied or injected into the extraction site. Simple extractions are performed on teeth that are visible to the naked eye. An elevator and forceps will only be needed to remove the tooth.
• Surgical extraction: Under general anesthesia, where you are completely unconscious during the procedure, surgical extractions are performed when the tooth cannot be easily accessed. Either the tooth has not fully erupted or it has broken under the gum line. A small incision in your gum will need to be made in order for the surgeon to gain access to the tooth. Gum tissue will be pushed back and bone surrounding the problem tooth will be removed, or part of the tooth itself will be cut. This process makes it easier for your surgeon to remove your tooth with an elevator and forceps.

Tooth extractions are most commonly discussed in reference to removing wisdom teeth. However, a tooth extraction can be required for a number of other reasons, such as tooth decay, gum disease, overcrowded teeth, impacted teeth, broken teeth, and baby teeth that have not fallen out naturally.

Why You Might Need a Tooth Extraction

• Tooth decay – this is the most common reason for removing a tooth. Patients who have avoided visiting their dentist for years may face this reality. Without the bi-yearly checkups and professional cleanings, your dentist will never be able to diagnose early onset tooth decay before it’s too late. As time goes on, your tooth will experience these stages:

1. Tooth decay affects tooth enamel.
2. Once worn through tooth enamel, the inner part of the tooth begins to deteriorate.
3. As the decay eats a hole through the center of the tooth, the tooth suffers even more damage.
4. When bacteria reach the center of the tooth, the ending result is a root canal infection.

The longer you go without treatment, the more severe the infection and damage will be. If your dentist has come to a point where your tooth cannot be saved, an extraction, followed by a bridge or implant, will be strongly recommended. Cavities detected early can be resolved with a simple filling.

• Gum disease: Just as destructive as tooth decay in its advanced stages, gum disease attacks the gum tissue, ligaments, and bone that support the teeth. As these structures deteriorate, the teeth become looser until finally they fall out on their own or require an extraction, followed by gum disease and tooth replacement treatment.
• Overcrowded teeth: As part of a patient’s orthodontic treatment plan, a tooth extraction may be necessary if there is overcrowding in the mouth. The extraction creates more space for the remaining teeth to be pulled and shifted into proper alignment.
• Impacted teeth: Impaction occurs when a tooth has not fully erupted beyond the gum line, or only partially erupts. Overcrowding, a tooth that is twisted or tilted at abnormal angles, or a tooth that comes in displaced, are all reasons why a tooth may become impacted. Wisdom teeth are often impacted because the jaw is not large enough to accommodate these teeth.
• Broken teeth: A tooth may need to be extracted when a tooth breaks at or near the gum line, making it nearly impossible to perform a tooth restoration.
• Baby teeth: Sometimes, baby teeth can come in at an abnormal position, causing the permanent tooth underneath it to not erupt normally. Removing this baby tooth will allow the permanent tooth to erupt without issue.

Oral cancer may not be as well known as other forms of cancer, but that doesn’t make it any less dangerous. Oral cancer screenings are vital to detect any precancerous or cancerous conditions in the mouth before they progress to an advanced stage of the disease. An oral cancer screening is a quick procedure that involves visual and touch examinations to assess the inside of your mouth. Some dentists use additional tests, such as dye or ultraviolet light. If your dentist discovers any abnormal lesions, a small tissue sample can be collected and sent to the lab for more thorough testing.

Risks and Signs of Oral Cancer

Some people have a higher risk of developing oral cancer, sometimes at no fault of their own. Causes of oral cancer include:

• Tobacco use of any kind, such as cigarettes, cigars, pipes, chewing tobacco, snuff, dip and vaping
• Heavy alcohol consumption
• Family history of cancer
• Human papillomavirus (HPV)
• Significant sun exposure
• Poor diet

There are certain symptoms and signs of oral cancer to look for. Some of these include:

• Red or white spots or sores anywhere in the oral cavity
• A sore that bleeds easily or does not heal
• A lump, thickening, or rough spot
• Pain, tenderness, or numbness anywhere in the mouth or on the lips
• Difficulty chewing, swallowing, speaking, or moving the jaw or tongue

Surgical Treatment of Oral Cancer

If you’ve recently been diagnosed with oral cancer, there are several treatment options available to you. These include:

• Glossectomy: The removal of partial or larger portions of the tongue
• Mandibulectomy: The partial removal of the jawbone when a tumor is too close or attached to the bone
• Maxillectomy: The removal of the bones that make up the hard palate or nasal sinuses
• Reconstructive surgery: The transplantation of tissue from one area in your body, such as your forearm, thigh, or abdomen, to the affected area of your mouth
• Dental implants: An additional procedure that can be done during certain mouth surgeries, so that a separate surgery is not required
• Lymph node removal: Oral cancers often spread to the lymph nodes in the neck and can be removed during oral surgery. The purpose of this removal is to reduce the chance of the cancer returning in the future. Lymph node removal is commonly recommended for cancers that infect the tongue, floor of the mouth, or lower gums.

Talk to your dentist today about scheduling routine oral cancer screenings. You will have the best chance for a full recovery if oral cancer is detected early.