A wise man once said that if we prepare for an emergency, it ceases to exist. In everyday practice marked by the reality of uncertainty, a dental practitioner must be well-versed in recognizing the onset of a dental emergency. He or she must be astute in tackling the situation as soon as possible to alleviate the symptoms of his or her patient and get back to the dental procedure on the same day. If the symptoms persist, then reschedule the appointment to a time and date deemed suitable by the dentist and the patient.
As they say, “Prevention is better than cure”. The best way to avoid an emergency is to take a detailed medical history in a language that the patient understands. At the end of the history, take a written consent from the patient which says that he has understood all the facts regarding his or her case.
The dentist must ask leading questions about any past illnesses, prescribed medications, as well as the name and address of the treating physician. You mustn’t hesitate about ordering tests for determining the patients’ blood sugar, blood pressure, etc. to find out if they have any illnesses that they may be unaware of. For example, many diabetics don’t know their present sugar levels due to infrequent tests.
You can avoid a medical emergency if you are aware of the patient’s history and can take the necessary precautions.
Exodontia is a very relevant branch of dentistry practiced all over the country. Uncontrolled bleeding is one of the complications that can happen when a dentist gives local anesthesia and proceeds to extract a tooth. If the bleeding doesn’t stop following the extraction, despite placing the pressure pack, this may cause a dentist to panic.
What Causes Uncontrolled Bleeding During Dental Procedures?
Uncontrolled bleeding may be caused due to systemic reasons. For e.g., the patient may be a hypertensive but hasn’t taken his or her medication for some time or on the day of the extraction. There are patients who aren’t hypertensive but are scared of dental treatment. These patients suffer from what is called, ‘white coat hypertension’. In such cases, the anxiety causes an episode of transient hypertension which may be responsible for the bleeding.
There are many patients who are on blood thinners like ecosprin, clopidogrel et al, to avoid formation of a blood clot in vessels in case of stroke, myocardial infarction deep vein thrombosis, cholesterol patients et al. Whilst operating on such patients, even the simplest dental procedure involving oozing of blood can cause a panic.
What Can You do About It
Despite having a detailed medical history, if uncontrolled bleeding occurs, stop the procedure, apply pressure, and reassure the patient that the situation will soon be in control. To stop the bleeding, you can:
Curette the Socket
There is a lot of granulation tissue in the socket, post extraction especially in teeth having periodontal disease, chronic periapical disease, or a combination of both. Thus, curetting the socket would play a vital role in success here. Once the infected tissue comes out, the bleeding will slowly cease. Continue irrigating the socket with anti-septic solutions like Hexidine to provide adequate debridement and place a new pressure pack.
If this still doesn’t work, then drugs like coagulants must be used. Conventionally an ampule of ethamsylate must be crushed and the solution must be expressed onto a sterile cotton pack and promptly placed in the mouth with the patient closing his or her teeth in whatever maximum intercuspation as possible. If the bleeding still doesn’t stop, then intra-muscular injection of the same drug can be given to the patient.
Use Hemostatic Agents
Some other local hemostatic agents which act as mechanical barriers include bone wax (sterile mixture of bees wax, paraffin, isopropyl palmitate), which acts as a mechanical barrier. Manufactured by ETHICON and absorb-able gelatin sponge or Abgel. Surgicel is oxidized regenerated cellulose acting as a mechanical barrier.
In the sequel to this article we will continue our discussion on uncontrolled bleeding and ways to manage the same.
- Textbook of Oral and Maxillofacial Surgery by Neelima Anil Malik 3rd Edition
- Textbook of Medical Physiology by Guyton And Hall Latest Edition
- Textbook of Oral and Maxillofacial Surgery by Vinod Kapoor 2nd Edition
Dr. Shawn D'souza
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