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Just Dental Truths!
Just Dental Truths!, Dentist
Category: Dental
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Experience:  29 year clinical Practioner
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1. 40 year old male. 2. Using warfarin years due to blood

Customer Question

Hello sir,
1. 40 year old male.
2. Using warfarin for 10 years due to blood clotting disorder.
3. Using antidepressants citaloparm.
4. When waking up in the morning little blood evident in saliva. When suck hard on back side of the mouth and teeth, have decent amount of blood coming out.
5. Went to a dentist, which explained that I have periodontal disease in the upper back part of the mouth on both sides which is medium is severity and less so on the lower back jaw.
Question: does the usage of warfarin increase the likelihood of such bleeding because of the dental condition? Does the combination of antidepressants plus warfarin has such effect?
Why do the gums tend to bleed in the morning and night rather then in the day?
How long will such condition continue?
Submitted: 1 year ago.
Category: Dental
Expert:  Just Dental Truths! replied 1 year ago.

Medium or Moderate Periodontitis is much better than Severe Periodontitis, but yes Moderate Perio., can cause some red saliva due to generally small amounts of blood. The use of Warfarin (a blood thinner) would tend to exacerbate the blood in the saliva situation - very possibly - yes. Citalopram also may lead to possible increased bleeding. I would consult your Physician regarding this problem, in conjunction with you Dentist or Periodontitis. My Father was having some medical troubles, and both of these medications were employed, so I'm fairly familiar with them. I'm not so certain that you actually are bleeding more at night (although you may be). But, it likely may well be that saliva flow during sleep, is somewhat subdued, and thus, it likely may appear that your saliva has a higher concentration of blood/red color on your pillow in the morning, etc. I hope that makes sense Sir.

Dr. Rampton

*PS: I'm assuming you had teeth cleaned recently, likely with the Periodontist office? If you've not had them cleaned yet, I would suggest you do, and therafter have them cleaned as deemed prudent by your Dentist/Periodontist, as keeping them very clean will keep the blood to a lower level!

Customer: replied 1 year ago.
Dear dr,I did start a procedure to clean up the teeth as a procedure to begin an ongoing treatment of the period disease. I was advised to keep coming for deep cleaning every 3 months and if this doesn't help, an operation to open the gums and clean properly will be conducted.I also guessed that the grinding of teeth at night plus some sucking of gums while sleeping could be causing the extra bleeding at night?Does serious treatment of the dental disease stop the bleeding over the medium to long term? Or the drinking of warfarin plus antidepressants will make it an ongoing issue?
Customer: replied 1 year ago.
I would also like to add, that actual brushing doesn't cause severe bleeding. And in the morning once I rinse the mouth once or twice even before the brushing the bleeding stops. Any idea why?
Expert:  Just Dental Truths! replied 1 year ago.

With warfarin in particular, you'll always need to be precautious as it is a medication which promote thin blood and thus more bleeding into your gums and other tissues potentially. Serious treatment stop bleeding over the medium to long term? A very good question. Truth be told, I'd ask the Periodontist that question. Why? If the amount of needed cleaning/debris and tartar in need of debriding is significant, then yes, over the medium to long term bleeding should decrease. But, I can't see "the amount of needed cleaning/debris", and your Periodontist could BEST answer that question. It is a good question however! With regard to at night grinding and sucking of the gums at night - yes it could indeed be a possible contributor as well Sir!

So; summarizing, perhaps asking your Periodontist about the amount of debris/cleaning, and will it decrease the bleeding. Warfarin will "yes" always be a at least a minor contributor to potential bleeding, but not significant bleeding necessarily. And, sucking the gums and grinding "may" also be a minor contributor. The bot***** *****ne to me is if your Periodontist would suggest performing the surgery on you, if his Father had the exact same situation. Would he perform it on his Father??? I'd ask him that, really... I hope this helps you Sir!

Perhaps when you rinse in the morning, you may inadvertently be swishing away the saliva?

Expert:  Just Dental Truths! replied 1 year ago.

I "DO" indeed hope the above made sense Sir!

Expert:  Just Dental Truths! replied 1 year ago.

If you have any additional concerns/questions, please do not hesitate to ask.

Also, please do rate my answer, if you would please.

Thank you. Dr. Rampton

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