Bleeding Risk in dental patients Preconference ISDH workshop-2018

Patient history 56 year old male Medical history-once off incident of a DVT lower limb-12 months previous Married with 3 adult children- his daughter died of PE at 22 years old Query family genetic clotting condition Meds: NOAC-Dabigatran 20mg daily, Losec Allergies :Penecillin Dental History partially dentate, poor OH ,periodontal disease Dental anxiety fuelled by general anxiety particularly since his daughter’s death

Patient history Dental Attendance- only if in pain. Presenting complaint- mobile(mobility 2) UL5 pain ,discomfort, anchor for existing partial acrylic denture Patient concerns- has a wedding soon of his daughter best friend and so he wants the pain/discomfort gone Is not in a good place in relation to having any longterm treatment planning in relation to his periodontal disease

Patient concerns- has a wedding soon of his daughter best friend and so he wants the pain/discomfort gone Dental/general anxiety- fear of pain during extraction especially the needle -fear of bleeding that will not stop - fear of a DVT and death if he stops or alters regime of the Oral anticoagulants -fear of having to attend the hospital as opposed to his familiar surrounds of the dental clinic- doesn’t like hospitals since his daughter died -fear of cost of treatment- he doesn’t have a medical card

Brainstorm How best to approach this case? What risk assessment do we carry out? Where does this patient fit in the ICF structure? How do we manage the patient’s concerns? What other information do we need? Where do we look for advice? How do we rationalise our treatment planning approach to the patient?, to the medical consultant?, to ourselves? What are the cost implications of treatment options and is this relevant? What systems do we have in place in our own service should we choose to extract the tooth in primary care?