Post extraction dental haemorrhage
Assessment
- History: History of extraction, previous extractions, personal or family history of blood dyscrasia
- General examination: Look for signs of shock and manage appropriately if present
- Specific examination of the mouth
Types of post extraction haemorrhage
- Immediate haemorrhage at the time of extraction
- Reactionary haemorrhage, usually two to three hours post extraction due to wearing off of the vasoconstrictor effect of the local anaesthetic
- Secondary haemorrhage may occur at any time within the first week and is always indicative of infection
All three types of post extraction haemorrhage are dealt with as outlined below. However, for secondary haemorrhage, as well as local measures, there is a need to place the patient on antibiotics.
Management
- Identify where the bleeding is coming from.
(Access to an area where the patient can be treated in a supine position with good light and central suction is essential.)- Which socket or sockets?
- From soft tissue: The bleeding stops following digital pressure using one finger on each side of the bleeding socket and biting on a rolled up gauze swab moistened with saline or water
- From the base of the socket, from bone: The bleeding continues following digital pressure and biting on a gauze swab.
- From a vessel: The bleeding is more profound from within the socket or from a nearby vessel
- Try local measures as described above to arrest haemorrhage, having identified the site.
- If local measures are unsuccessful call the Dental SHO
- Management options then include:
- Placement of local anaesthetic with a vasoconstrictor
- Bleeding from the soft tissues is usually arrested by placing a horizontal mattress suture across the socket
- Bleeding from the base of the socket, from bone, is usually arrested using a pack such as 'Surgicel' or in some instances soaking ribbon gauze in Whitehead's varnish and packing the socket full.
- Bleeding from a vessel. Within bone this may be arrested using packs as outlined above. However, if the vessel is within soft tissues there is a need to identify the vessel and either cauterise or ligate the vessel. This may in some instance necessitate a small flap procedure to identify the site of the vessel
