An antifibrinolytic mouthwash can be helpful for a variety of oral procedures where bleeding may be a concern. The antifibrinolytic drugs frequently used by dentists are aminocaproic acid (ACA) and tranexamic acid (TXA). In studies these drugs have been shown to significantly reduce bleeding when applied locally either as a preventative measure or a post-operative treatment.

Hematologic disorders that affect the fibrolytic system can result in bleeding complications during oral surgery. Certain blood-thinning drugs like NSAIDS can also be a concern. Conditions that may require the use of ACA or TXA for an oral procedure include hereditary blood-clotting diseases and other disease that affect blood clotting. Some conditions that may cause bleeding problems include:

• Hemophilia A
• Hemophilia B
• Von Willebrand’s disease
• Liver disease

History of TXA and ACA

Tranexamic acid and aminocaproic acid were first used to treat menstrual blood loss. This indication was first described in 1968 and in the following decade many other applications were introduced. The most important application that developed may have been for treating hyperfibrinolysis associated with cardiopulmonary bypass and liver transplantation. Now these drugs are commonly found in emergency departments to stop bleeding in trauma patients. Even though there is no FDA indication for use in dental surgery, TXA and ACA have long been used in the form of mouthwashes by dentists to control bleeding.

TXA and ACA for Dentistry

Tranexamic acid and aminocaproic acid can be used both as a preventative measure for patients with hematologic disorders and to control bleeding postoperatively. Studies have shown that when used in dental procedures, postoperative bleeding is significantly reduced with the use of TXA or ACA.  In the past, patients who were on anti-coagulants were sometimes told to discontinue use of their medication before dental extractions. Research has shown that this is not the best solution and can sometimes lead to further complications. Even though these complications may occur infrequently, when they do occur they can be severe. Patients can continue to take their anticoagulant medication when a hemostatic mouthwash is used to control bleeding.

The use of antifibrinolytics can allow many procedures to be done in a primary care office for patients with hematologic disorders or who are on anticoagulants.  These patients might otherwise need to have their oral procedure in a hospital. Procedures that may benefit from the use of TXA or ACA include:

• Tooth extractions
• Periodontal surgery
• Scaling and root planing
• Root canal treatment
• Minor oral surgery
• Local anesthesia administration

These mouthwashes may also be prescribed to be used after the procedure. An example prescription would be rinsing with a tranexamic acid mouthwash for 2 minutes four times a day for 7 days. This is commonly prescribed for patients on anticoagulants so they do not have to discontinue their medication. Using antifibrinolytic agents in the form of a mouthwash does not increase plasma levels significantly, which minimizes systemic effects.

TXA and ACA are available in tablets, syrups, and injections but the form that dentists most often use is a mouthwash. A tranexamic acid or aminocaproic acid mouthwash can be used prior to and after an oral procedure.  Some dentists choose to purchase these drugs in tablet form, crush the tablets, and mix them in a solution. This can add time to a procedure and dosages may be inconsistent. A TXA or ACA mouthwash can be made by a compounding pharmacy that is ready to be used when it is needed, with no crushing of tablets or mixing required.

Other Mouthwashes Used in Dental Procedures

Tranexamic acid and aminocaproic acid are only two types of mouthwashes that dentists use during oral procedures. Another popular mouthwash used by dentists is dyclonine topical anesthetic. This can be used to numb the entire mouth before an oral procedure. Dyclonine can be combined with chlorhexidine to both anesthetize and prevent infection. This mouthwash may be effective after a procedure to reduce pain and promote healing. There are many products available from our compounding pharmacy for helping dentists improve outcomes for their patients.