Visits that rarely need any change

These involve little or no bleeding. You take your medication as usual. If your gums bleed a bit more during a cleaning, Frank expects that and works around it.

• Cleanings and exams
• Fillings, onlays and crowns
• Invisalign, whitening and night guards
• X-rays and scans

Visits that get planned

Extractions, deep cleanings, gum grafts and implant surgery all involve some bleeding. For these I want to know which medication you take, the dose, and why you are on it. For most patients on aspirin or a single newer anticoagulant, we proceed without stopping it and manage bleeding locally. For warfarin, a recent INR helps. For combinations of medications, I talk to your physician first.

If a physician does recommend a brief pause, that instruction comes from them, in writing, with timing. It never comes from me alone.

How I control bleeding

With these, almost every extraction on a blood thinner stops bleeding in the office before you leave.

• Firm pressure with gauze for longer than usual
• Local measures: dissolvable packing in the socket, sutures, and a clotting gel when needed
• Scheduling surgery early in the day and early in the week so you can reach us if something oozes
• Clear written aftercare, including what is normal and what is not

What to tell us or bring

Call us before a planned extraction or gum procedure if you are unsure. It is much easier to plan a week ahead than in the chair.

• The name and dose of every blood thinner, including daily aspirin
• Why you take it, and which physician manages it
• Any recent INR result if you are on warfarin
• Any history of bleeding problems or a recent stent or valve procedure