Bleeding dental socket: Difference between revisions
No edit summary |
|||
| (14 intermediate revisions by 5 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | |||
[[File:Enamel.png|thumb|Diagram of the tooth displaying the enamel, dentin, and pulp]] | |||
{{Dental numbers}} | |||
==Clinical Features== | |||
*Bleeding from dental socket | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Template:Dental Problems DDX}} | {{Template:Dental Problems DDX}} | ||
==Evaluation== | |||
*Clinical diagnosis | |||
*Slight oozing normal for up to 24 hours post-extraction <ref> Hupp J, Tucker MR, Ellis E. Contemporary oral and maxillofacial surgery.6th ed. Mosby, 2013. </ref> | |||
*Evaluate for bleeding disorder if bleeding not controlled with simple pressure (post-extraction bleeding often initial manifestation of coagulopathy) <ref> Tintinalli, Emergency Medicine, 4th edition, pg. 1109 </ref> | |||
**CBC | |||
**PT/INR | |||
==Management== | ==Management== | ||
*Direct pressure on site of bleeding (can have patient bite on gauze or tea bag) | |||
**Pressure should be applied for 20 minutes | |||
**Smaller gauze with focal pressure better than larger gauze that covers adjacent teeth occlusal surface | |||
**Large clots should be wiped away prior to applying gauze | |||
*If direct pressure unsuccessful: | |||
**Lidocaine with epinephrine injection; reapply gauze | |||
**Apply small piece of absorbable gelatin sponge (e.g. - Surgicel) | |||
**Consider [[Tranexamic acid]] (TXA): soak gauze in solution and apply to socket, with pressure | |||
**Flaps may be sutured closed | |||
==Disposition== | |||
*Discharge | |||
==See Also== | ==See Also== | ||
*[[Dental | *[[Dental problems]] | ||
== | ==References== | ||
<references/> | |||
[[Category:ENT]] | [[Category:ENT]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category:Symptoms]] | |||
Latest revision as of 20:56, 2 December 2021
Background
Dental Numbering
- Adult (permanent) teeth identified by numbers
- From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
- Children (non-permanent) teeth identified by letters
- Common landmarks:
- 1: Right upper wisdom
- 8 & 9: Upper incisors
- 16: Left upper wisdom
- 17: Left lower wisdom
- 24 & 25: Lower incisors
- 32: Right lower wisdom
Clinical Features
- Bleeding from dental socket
Differential Diagnosis
Dentoalveolar Injuries
Odontogenic Infections
- Acute alveolar osteitis (dry socket)
- Acute necrotizing ulcerative gingivitis (trench mouth)
- Dental abscess
- Periapical abscess
- Periodontal abscess
- Ludwig's angina
- Pulpitis (dental caries)
- Pericoronitis
- Peritonsillar abscess (PTA)
- Retropharyngeal abscess
- Vincent's angina - tonsillitis and pharyngitis
Other
Evaluation
- Clinical diagnosis
- Slight oozing normal for up to 24 hours post-extraction [1]
- Evaluate for bleeding disorder if bleeding not controlled with simple pressure (post-extraction bleeding often initial manifestation of coagulopathy) [2]
- CBC
- PT/INR
Management
- Direct pressure on site of bleeding (can have patient bite on gauze or tea bag)
- Pressure should be applied for 20 minutes
- Smaller gauze with focal pressure better than larger gauze that covers adjacent teeth occlusal surface
- Large clots should be wiped away prior to applying gauze
- If direct pressure unsuccessful:
- Lidocaine with epinephrine injection; reapply gauze
- Apply small piece of absorbable gelatin sponge (e.g. - Surgicel)
- Consider Tranexamic acid (TXA): soak gauze in solution and apply to socket, with pressure
- Flaps may be sutured closed
Disposition
- Discharge