Come visit us at

Come visit us at

Thursday, January 31, 2013

Dr. why do I have to fill out all of these Questions?

Many times a new patient will come to the office and start filling out our medical questionnaire and half way through get angry and flustered.  They then come to the front desk and ask:  What do all these questions have to do with my teeth?

Well that is really a great question and the answer goes something like this.

Most people will never have a problem in the dental office but we in the dental office have to be prepared in case of emergency and we have to make sure that we don't do anything that will cause a medical emergency in the dental office.  This starts with a thorough medical history of our patients.  We want to know that our patients are not allergic to any antibiotic that we may need to give them, we want to know that they have not had a bad reaction to the local anaethetic that we need to put the tooth to sleep.  We need to know that our patients are not allergic to our gloves etc.  We want to know if our patients are taking any medications for an underlying condition as our anaethetics could react adversely with those medications or a medication that we may prescribe could act adversely with a medication that they are taking.  We want to know if they have an underlying condition so that we can determine if they are suitable for treatment in a dental office or may require referral for treatment in a hospital setting.  We would want to know regarding underlying conditions so that in case of emergency we are better suited to help them.  The different possibilities are endless but knowing as much as possible about our patients medical history will help us avoid any unfortold medical emergencies and if they arise will help us better deal with them.  In our office we take blood pressure readings for all new patients and at recall appointments for our existing patients.  15% of the population walks around with undiagnosed hypertension and we have literally come across a number of those patients.  Incidentally we have had patients whose family phycicians have told them that their dentist saved their life.  We also take blood glucose for our diabetic patients to see how controlled their diabetes is.  The examples and their importance are endless.  I hope you got the picture!

What do all these questions have to do with your teeth?  They have so much to do with your teeth and your overall well being!  Thit is a great question, thank you for asking so we could have the opportunity to explain this to you!

All the best
Dr. Ron Barzilay

having fun doing dentistry in Hamilton Ontario

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Wednesday, January 9, 2013

It's ok to pull that tooth Doc, I already stopped my Blood thinners!

Doc, it is OK to pull that tooth, I have already stopped my blood thinners!


Alot of patients coming into the office, are on blood thinners and have a lot of questions.  Some patients come into the office and are on blood thinners and already have the answers.

Most people who are taking blood thinners are taking them to prevent blood clots in their blood vessels that could end up moving and blocking major vessels or structures.  The ensuing loss of oxygen to the blocked structures could have major consequences for the patient, including death.

This is a concern in dentistry since almost every procedure we do may cause bleeding.  From fillings, to cleanings, to extractions, to periodontal surgery, to root canals and so on.  In dealing with the thousands of patients that we have here in our office we must always be careful with those patients who have bleeding tendencies. 

Bleeding tendencies can be subidivided into those patients who have natural bleeding disorders and those patients whose bleeding is caused by medication that they are taking to "thin" the blood.  In this blog I am talking about those patients taking blood thinners as those are the majority we see.
 Many patients are taking Warfarin type medications and many are taking Aspirin.  Those patients taking Warfarin medications can have a largely increased clotting time.  Those patients on Warfarin have a test done called INR (international normalized ratio).  This INR is a target goal for coagulation depending on the underlying condition so that a patients' dosage is adjusted to the target goal.  In most situations a dentist can still work without having the patient stop his medication.  This will depend on the patient specific factors such as the INR, patients overall health, expected bleeding and the length of the procedure.
Many patients are on low dose Aspirin.  This usually does not represent a problem and most dental procedures can go ahead without any change.
Patients on Heparin are usually in a hospital setting so that is really not an issue but today there is is LMWHs (low molecular weight heparin) which allows the use of Heparin type medication outside the hospital setting and this may require stopping a patients medication.

After all this, the question really is what should you the patient be doing?  The answer is very simple.  Speak to your dentist, he will have the answers and if he doesn't he will be in touch with your physicians to dicuss the proper treatment for your specific situation.  In most cases you will not have to ask your dentist as your dentist will be discussing it with you.  In consultation with your physician he will tell you wether you need to stop medication or continue.  Most important never do anything on your own. Stopping your medication even for a short time on your own may have a very negative affect.  No matter what you read on the internet or heard on Oprah.  Speak to your dentist, because every situation is different and there are no cookie cutter solutions.

All the best

Dr. Ron Barzilay

enjoying dentistry in Hamilton, Ontario Canada