DENTAL SPEAK : Averting the risk of aspirin while extracting a tooth

Three months back the early morning phase saw the arrival of a 74-year-old priest who had three root pieces which had remained in his month for more than five years without any sign or symptom of inflammation or infection. Of late the right upper first molar which had been reduced to three root-ends had began to cause a lancinating type of pain that caused the patient a chronic headache. It all seemed simple and clear.

The gums around the roots were to be infiltrated with lignocaine, the local anesthetic and after four minutes or so the root foreceps would be used to remove the three roots. Lignocaine was injected into the mucosa.

The Dental Surgeon (DS) was in the process of extracting the roots when it dawned upon him that he had overlooked to ask the basic question: “Are your having any medication for any medical condition?”

The DS put the root forceps back into the instrument tray. He then posed the question to the priest. The DS was jolted out of his ‘self imposed languor’ when the priest replied, “I had stents placed in my heart. This was about eight years ago. Since then I have been instructed by my cardiologist to take 75 mg of aspirin orally a on a daily basis.”

The DS, left pondering for a while, confessed, “I am sorry that I did not, while I was conducting your clinical dental examination, make a preliminary enquiry about your medical history. It therefore behoves upon me to carry out your treatment with utmost care and caution. I will not carry out the extraction of the roots today. You will have to stop taking Ascard – 75 (acetylsalicylic acid, safety coated aspirin) for a continuous period of about six days after which only the roots will be removed. This is to ensure that the clotting mechanism comes into play, thereby there is no scope of excessive bleeding later.”

The patient said, “My cardiologist had conveyed to me then that aspirin lessens the danger of heart attacks and strokes by preventing formation of blood clots on the surface of ruptured atherosclerotic plaques,” The DS commended the scientific temper of the ‘padri’, “I am sure you must be aware of the pros and cons of aspirin therapy. However, while I erred into not querying about your medical history you should have taken the initiative of notifying me your usage of aspirin.”

The patient said, “I shall henceforth be careful. I shall reveal my side of the story whenever I undergo a medical or dental intervention by the medicos.”

Eventually all the remnants of the three teeth were ousted with an internal of one week each between the three extractions. Aspirin was stopped five to six days prior to commencement of the extraction and about three days after the extraction.

The DS thought this was a safe regimen to follow in order to bring about an effective healing process too. The patient returned to the dental clinic after six weeks to carry out crown and bridgework for the gaps that had resulted after removal of the roots. The bridgework was embarked upon again after a similar stoppage of aspirin by the patient.

According to Saint Bridget of Sweden (1303 – 1373) who was born as Birgitta Birgersdotter, and who was a mystic and founder of the Bridgettines nuns and monks: “ Let everyone who has the grace of intelligence fear that, because of it, he will be judged more heavily if he is negligence.

The DS self redeemed himself by confessing his near slip to the patient thereby keeping his conscience unbesmirched by negligence.

Dr K. S. Gupta is a dental surgeon with a private clinical dental practice