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Update on Medically Compromised Patients for Oral Surgery: The Bleeders and the Non-healers Sarah Woolcombe Talli Taylor Tara Renton Dental Update 2024 49:3, 707-709.
Professor of Oral Surgery, King's College London; Honorary Consultant in Oral Surgery, King's College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, London
Coagulation and wound healing following oral surgery procedures involve a number of intricate steps. The disturbance of normal physiological processes can be influenced by local and systemic factors that affect post-operative bleeding and healing of the surgical site. This article provides an update on medical conditions and medications, to aid identification of susceptible individuals, and describes the appropriate management of patients presenting with post-operative bleeding or a non-healing socket.
CPD/Clinical Relevance: An understanding of post-operative bleeding and non-healing helps to prevent their occurrence and assists with optimal management when they do present.
Article
Post-operative bleeding is a recognized complication following minor oral surgery with an incidence of up to 26% following dental extraction.1 Clinically significant post-operative bleeding may be defined as that which:2
Most minor episodes of bleeding cause concern or inconvenience to the patient, and severe incidents can result in significant morbidity and mortality. Post-operative bleeding can be categorized according to its timing relative to the surgical procedure (Table 1).
Post-operative bleeding has been attributed to various factors that can be broadly classified as local or systemic.1 Systemic factors that increase the risk of bleeding include platelet disorders, clotting factor deficiencies, vascular disorders and fibrinolytic defects (Table 2).4 Disorders of haemostasis can also be classified according to the causative, underlying systemic disease (Table 3).
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