1. Bleeding Risk in dental patients
Preconference ISDH workshop-2018

2. 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

3. 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

4. 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

5. 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?