4.15 Bleeding After Dental Surgery

Presentation

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.

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