Steele J, O'Sullivan I.: The NHS Information Centre for Health and Social Care; 2011
Henderson SJ. Risk management in clinical practice Part 11 – Oral surgery. Br Dent J. 2011; 210:17-23
Meechan JG, Greenwood M. General medicine and surgery for dental practitioners Part 9: Haematology and patients with bleeding problems. Br Dent J. 2003; 195:305-310
Robinson PD.Oxford: Elsevier; 2000
Carrotte PV, Waterhouse PJ. A clinical guide to endodontics – update Part 2. Br Dent J. 2009; 206:133-139
Wassell RW, Barker D, Walls AWG. Crowns and other extra-coronal restorations: impression materials and technique. Br Dent J. 2002; 192:679-690
Blinder D, Manor Y, Martinowitz U, Taicher S, Hashomer T. Dental extractions in patients maintained on continued oral anticoagulant: comparison of local haemostatic modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88:(2)137-140
Blinder D, Manor Y, Martinowitz U, Taicher S. Dental extractions in patients maintained on oral anticoagulant therapy: comparison of INR value with occurrence of postoperative bleeding. Int J Oral Maxillofac Surg. 2001; 30:(6)518-521
Carter G, Goss A. Tranexamic acid mouthwash – a prospective randomized study of a 2-day regimen vs 5-day regimen to prevent postoperative bleeding in anticoagulated patients requiring dental extractions. Int J Oral Maxillofac Surg. 2003; 32:(5)504-507
Thomson PJ, Greenwood M, Meechan JG. General medicine and surgery for dental practitioners. Part 6 Cancer, radiotherapy and chemotherapy. Br Dent J. 2010; 209:65-68
Perry DJ, Noakes TJC, Heliwell PS. Guidelines for the management of patients on oral anticoagulants requiring dental surgery. Br Dent J. 2007; 20:389-393
Scully C, Wolff A. Oral surgery in patients on anticoagulant therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 94:57-64
Birkhahn R Shock index in diagnosing early acute hypovolemia. Am J Emerg Med. 23:(3)323-326
Ballinger A, Patchett S. Pocket Essentials of Clinical Medicine, 4th edn. Oxford: Elsevier Saunders; 2008
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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