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Haemostasis part 1: the management of post-extraction haemorrhage

From Volume 41, Issue 4, May 2014 | Pages 290-296

Authors

Neal J McCormick

BDS(Lpool), MFDS RCPS(Glasg)

General Professional Trainee (GPT), Health Education North East

Articles by Neal J McCormick

Undrell J Moore

BDS, PhD, FDS RCS(Eng)

Senior Lecturer in Oral Surgery, Newcastle Dental Hospital, Richardson Road, Newcastle Upon Tyne, NE2 4AZ, UK

Articles by Undrell J Moore

John G Meechan

BDS, PhD, FDS RCS(Eng), FDS RCS(Ed), FDS RCPS

Senior Lecturer, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle uponTyne, NE2 4BW, UK

Articles by John G Meechan

Abstract

The management of bleeding complications following a dental extraction is an essential skill for the dental practitioner. Extractions are often carried out on patients with complex medical histories and a long list of medications. This paper aims to help the clinician manage post-extraction haemorrhage. A review of the management of patients on anti-thrombotic medications will be covered in a subsequent paper.

Clinical Relevance: This article reviews the management of haemorrhage following tooth extraction; from the risk assessment of any underlying medical conditions and medications, to the clinical techniques used to control bleeding following an extraction.

Article

Haemostasis at the site of a dental extraction is considered to be a prerequisite before the patient leaves the clinic. Failure of haemostasis could occur in any patient; however, a number of different medical conditions and medications may interfere with this process.

The most recent Adult Dental Survey (2009) has shown a growing number of our patients are remaining dentate.1 People are living longer as a result of increasing health awareness and the success of medical treatments. The concept of ‘polypharmacy’ management requires dental clinicians to have an increased knowledge of the drugs that may affect dental treatment and their potential for drug interactions. Some drug therapies can increase the potential for bleeding post-operatively.

Risk assessment prior to embarking on a tooth extraction can allow the operator to foresee complications such as a haemorrhage. This involves careful planning and a thorough analysis of the medical history.2Table 1 shows the haemorrhage risk factors surrounding a dental extraction.

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