Bleeding After Dental Surgery

4.15 Bleeding After Dental Surgery

Presentation
The patient had an extraction or other dental surgery performed earlier in the day, now has excessive bleeding at the site, and cannot reach his dentist.
What to do:



Ask what procedure was done. Inquire about antiplatlet drugs like aspirin, underlying coagulopathies and previous experience with unusual bleeding.



Using suction and saline irrigation, clear any packing and clot from the bleeding site.



Roll a 2" x 2" gauze pad, insert it over the bleeding site, and have the patient apply constant pressure upon it (biting down usually suffices) for 20 minutes.



If the site is still bleeding after 20 minutes of gauze pressure, infiltrate the extraction area and inject into the socket with a local anesthetic and vasoconstrictor such as 2% lidocaine with 1:100,000 or 1:50,000 epinephrine, until the tissue blanches. Again, have the patient bite on a gauze pad for 20 minutes. The anesthetic allows the patient to bite down harder and the epinephrine helps restrict the bleeding.



If this does not stop the bleeding, pack the bleeding site with Gelfoam, with gauze soaked in topical thrombin, or with bone wax (if the site is a bony socket), place the gauze pad on top, and apply pressure again.



An arterial bleeder resistant to all the above may require ligation with a figure eight stitch.



Assess any possible large blood loss with orthostatic vital signs.



When the bleeding stops, remove the overlying gauze, have the patient leave the site alone for a day, and see his dentist in followup.
What not to do:



Do not routinely obtain laboratory clotting studies or hematocrits, unless there is a suspicion that they should be abnormal.
Discussion
Occasionally, this problem can be handled over the telephone. Some say a tea bag works even better than a gauze pad