Frequency of Gingival Bleeding in Patients Undergoing Antiplatelet Therapy

Muhammad Jamil; Hussam Muhammad Ashfaq

doi:10.65293/jbkcd.v1i02.14

Authors

Muhammad Jamil Department of Periodontology & Implantology, Khyber College of Dentistry, Peshawar, Khyber Pakhtunkhwa, Pakistan.
Hussam Muhammad Ashfaq Associate Professor, Department of Periodontology & Implantology, Khyber College of Dentistry, Peshawar, Khyber Pakhtunkhwa, Pakistan.

DOI:

https://doi.org/10.65293/jbkcd.v1i02.14

Keywords:

Gum Bleeding, Antiplatelet Therapy, Aspirin, Clopidogrel, Dual Therapy, Smoking, Platelet Count, INR

Abstract

Objective: This study aims to ascertain the occurrence of gingival hemorrhage in patients undergoing antiplatelet therapy and evaluate the related risk factors.

Study Design: A cross-sectional study

Place and Duration of Study: Department of Periodontology & Implantology, Khyber College of Dentistry, Peshawar, Pakistan; from January 2023 to June 2023.

Materials and Methods: A total of 150 individuals are receiving antiplatelet treatment. Demographic information, medical history, tobacco use, and prescription specifics were documented. The occurrence and intensity of gum bleeding were evaluated utilizing a standardized bleeding index. Statistical analyses, including chi-square tests and logistic regression, were conducted to determine the relationships between gum bleeding and various covariates.

Results: The incidence of gum bleeding among patients was 42%. Smoking status (p = 0.001), male gender (p = 0.042), dual antiplatelet therapy (p = 0.048), and therapy duration beyond 3 years (p = 0.020) were strongly correlated with heightened gum bleeding. A logistic regression study revealed that smoking (OR = 2.80, 95% CI: 1.50–5.20, p = 0.001) and dual therapy (OR = 1.75, 95% CI: 1.01–3.10, p = 0.048) are independent predictors of gum bleeding. Patients with gum bleeding exhibited a significantly reduced platelet count (p = 0.035), whereas INR levels demonstrated a moderate positive link with the degree of bleeding (r = 0.45, p = 0.002).

Conclusion: Gum hemorrhage is a prevalent phenomenon in individuals undergoing antiplatelet therapy, with tobacco use and dual therapy exacerbating the risk. Routine oral health evaluations and preventive measures should be implemented for patients at high risk of developing oral health issues. Further study is needed to investigate targeted therapies aimed at reducing bleeding issues in this demographic.

Author Biography

Hussam Muhammad Ashfaq, Associate Professor, Department of Periodontology & Implantology, Khyber College of Dentistry, Peshawar, Khyber Pakhtunkhwa, Pakistan.

Corresponding Author: hussam@kcd.edu.pk

References

1. Sandhu P, Mayor S, Sproat C, Kwok J, Beneng K, Patel V. The continuation of oral anticoagulation and antiplatelet therapy for dento-alveolar surgery: a service evaluation. Br Dent J [Internet]. 2023;235(5):313–8. Available from: http://dx.doi.org/10.1038/s41415-023-6227-5

2. Woolcombe SA, Ball RE, Patel JP. Managing direct oral anticoagulants in accordance with the Scottish Dental Clinical Effectiveness Programme guidance for patients undergoing dentoalveolar surgery. Br Dent J [Internet]. 2022;232(8):547–54. Available from: http://dx.doi.org/10.1038/s41415-022-3999-y

3. Lupi SM, Rodriguez Y Baena A. Patients taking direct oral anticoagulants (DOAC) undergoing oral surgery: A review of the literature and a proposal of a Peri-operative management protocol. Healthcare (Basel) [Internet]. 2020;8(3):281. Available from: http://dx.doi.org/10.3390/healthcare8030281

4. Lababidi E, Breik O, Savage J, Engelbrecht H, Kumar R, Crossley CW. Assessing an oral surgery-specific protocol for patients on direct oral anticoagulants: A retrospective controlled cohort study. Int J Oral Maxillofac Surg. 2018;47(7):940–6.

5. Bajkin BV, Wahl MJ, Miller CS. Dental implant surgery and risk of bleeding in patients on antithrombotic medications: A review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020;130:522–32.

6. Barootchi S, Tavelli L, Majzoub J, Stefanini M, Wang H-L, Avila-Ortiz G. Alveolar ridge preservation: Complications and cost-effectiveness. Periodontol 2000 [Internet]. 2023;92(1):235–62. Available from: http://dx.doi.org/10.1111/prd.12469

7. Hasegawa T, Yanamoto S, Tachibana A, Kojima Y, Koyama Y, Maeda M, et al. The risk factors associated with postoperative hemorrhage after tooth extraction: a multi-center retrospective study of patients receiving oral antithrombotic therapy. Oral Maxillofac Surg [Internet]. 2017;21(4):397–404. Available from: http://dx.doi.org/10.1007/s10006-017-0645-y

8. Iwata E, Tachibana A, Kusumoto J, Hasegawa T, Kadoya R, Enomoto Y, et al. Risk factors associated with post-extraction bleeding in patients on warfarin or direct-acting oral anticoagulants: a retrospective cohort study. Oral Maxillofac Surg [Internet]. 2022;26(4):641–8. Available from: http://dx.doi.org/10.1007/s10006-022-01039-0

9. Huang J, Liu J, Shi H, Wu J, Liu J, Pan J. Risk factors for bleeding after dental extractions in patients receiving antithrombotic drugs-A case control study. J Dent Sci. 2022;17(2):780–6.

10. Sanz M, Marco Del Castillo A, Jepsen S, Gonzalez-Juanatey JR, D’Aiuto F, Bouchard P, et al. Periodontitis and cardiovascular diseases: Consensus report. J Clin Periodontol [Internet]. 2020;47(3):268–88. Available from: http://dx.doi.org/10.1111/jcpe.13189

11. Chahine J, Khoudary MN, Nasr S. Anticoagulation use before common dental procedures: A systematic review. Cardiol Res Pract. 2019;

12. Schmitt CM, Rusche B, Clemm R, Neukam FW, Buchbender M. Management of anticoagulated patients in dentoalveolar surgery: a clinical comparative study. Clin Oral Investig [Internet]. 2020;24(8):2653–62. Available from: http://dx.doi.org/10.1007/s00784-019-03124-3

13. Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary. Europace [Internet]. 2018;20(8):1231–42. Available from: http://dx.doi.org/10.1093/europace/euy054

14. Manfredini M, Poli PP, Creminelli L, Porro A, Maiorana C, Beretta M. Comparative risk of bleeding of anticoagulant therapy with vitamin K antagonists (VKAs) and with non-vitamin K antagonists in patients undergoing dental surgery. J Clin Med [Internet]. 2021;10(23):5526. Available from: http://dx.doi.org/10.3390/jcm10235526

15. Shi Q, Xu J, Zhang T, Zhang B, Liu H. Post-operative bleeding risk in dental surgery for patients on oral anticoagulant therapy: A meta-analysis of observational studies. Front Pharmacol [Internet]. 2017;8:58. Available from: http://dx.doi.org/10.3389/fphar.2017.00058

16. Elani HW, Starr JR, Silva D, Gallucci JD. Trends in dental implant use in the US, 1999-2016, and projections to 2026. J Dent Res. 2018;97(13):1424–30.

17. Hugo FN, Hilgert JB, Bozzetti MC, Bandeira DR, Gonçalves TR, Pawlowski J, et al. Chronic stress, depression, and cortisol levels as risk indicators of elevated plaque and gingivitis levels in individuals aged 50 years and older. J Periodontol [Internet]. 2006;77(6):1008–14. Available from: http://dx.doi.org/10.1902/jop.2006.050037

18. Dietrich T, Ower P, Tank M, West NX, Walter C, Needleman I, et al. Periodontal diagnosis in the context of the 2017 classification system of periodontal diseases and conditions - implementation in clinical practice. Br Dent J [Internet]. 2019;226(1):16–22. Available from: http://dx.doi.org/10.1038/sj.bdj.2019.3

19. Ueno M, Shimazu T, Sawada N, Tsugane S, Kawaguchi Y. Validity of self-reported periodontitis in Japanese adults: The japan public health center-based prospective study for the next-generation oral health study. Asia Pac J Public Health [Internet]. 2020;32(6–7):346–53. Available from: http://dx.doi.org/10.1177/1010539520944721

20. Bascones-Martínez A, Muñoz-Corcuera M, Bascones-Ilundain C. Side effects of drugs on the oral cavity. Med Clin (Barc) [Internet]. 2015;144(3):126–31. Available from: http://dx.doi.org/10.1016/j.medcli.2014.01.025

21. Romano F, Perotto S, Bianco L, Parducci F, Mariani GM, Aimetti M. Self-perception of periodontal health and associated factors: A cross-sectional population-based study. Int J Environ Res Public Health [Internet]. 2020;17(8):2758. Available from: http://dx.doi.org/10.3390/ijerph17082758

22. Kim H-N, Jang Y-E, Kim C-B, Kim N-H. Socioeconomic status and self-reported periodontal symptoms in community-dwelling individuals: data from the Korea Community Health Surveys of 2011 and 2013. Int Dent J [Internet]. 2018;68(6):411–9. Available from: http://dx.doi.org/10.1111/idj.12407

23. Nadanovsky P, Dos Santos APP, Bloch KV. Prevalence of self-reported gingival bleeding in a representative sample of the Brazilian adolescent population. J Clin Periodontol [Internet]. 2018;45(8):952–8. Available from: http://dx.doi.org/10.1111/jcpe.12959

24. Vered Y, Sgan-Cohen HD. Self-perceived and clinically diagnosed dental and periodontal health status among young adults and their implications for epidemiological surveys. BMC Oral Health. 2003;13(1).

25. Saka-Herrán C, Jané-Salas E, González-Navarro B, Estrugo-Devesa A, López-López J. Validity of a self-reported questionnaire for periodontitis in a Spanish population. J Periodontol [Internet]. 2020;91(8):1027–38. Available from: http://dx.doi.org/10.1002/JPER.19-0604

26. Ramos RQ, Bastos JL, Peres MA. Validade diagnóstica de agravos bucais autorreferidos em inquéritos populacionais: Revisão da literatura. Revista Brasileira de Epidemiologia. 2013;16(3):716–28.

27. Bondon-Guitton E, Mourgues T, Rousseau V, Cousty S, Cottin J, Drablier G, et al. Gingival bleeding, a possible “serious” adverse drug reaction: An observational study in the French PharmacoVigilance Database. J Clin Periodontol [Internet]. 2017;44(9):898–904. Available from: http://dx.doi.org/10.1111/jcpe.12770

28. Kitagawa M, Kurahashi T, Matsukubo T. Relationship between general health, lifestyle, oral health, and periodontal disease in adults: A large cross-sectional study in japan. Bull Tokyo Dent Coll [Internet]. 2017;58(1):1–8. Available from: http://dx.doi.org/10.2209/tdcpublication.2016-2100

29. Patel N, Patel V, Sarkar D, Nokes T, Blacklock P. Dual anti-platelet therapy and dento-alveolar surgery. How do we manage patients on anti-platelet medication? Br Dent J [Internet]. 2014;217(11):E24. Available from: http://dx.doi.org/10.1038/sj.bdj.2014.1055

30. Bajkin BV, Urosevic IM, Stankov KM, Petrovic BB, Bajkin IA. Dental extractions and risk of bleeding in patients taking single and dual antiplatelet treatment. Br J Oral Maxillofac Surg [Internet]. 2015;53(1):39–43. Available from: http://dx.doi.org/10.1016/j.bjoms.2014.09.009