In my dental clinic, I faced an emergency situation with a patient who had a severe tooth infection requiring surgical extraction. After the procedure, the patient experienced prolonged bleeding five hours post-extraction. Here's how I managed this challenging scenario:
Initial Assessment and Procedure:
Patient Presentation: The patient came in with an infected tooth, causing significant pain and swelling.
Anaesthetic Challenges: Due to the infection, achieving effective anesthesia was difficult. The acidic environment around the infected area reduced the efficacy of the anesthetic.
Surgical Extraction: I adapted my approach to manage the infection and ineffective anesthesia. This involved using a different anesthetic technique, such as a nerve block, periodontal ligament block and adjusting the anesthetic dosage.
Managing Prolonged Bleeding:
Immediate Response: Upon noticing the prolonged bleeding, I acted quickly to assess the situation. I first ensured the patient was calm and comfortable, as stress can exacerbate bleeding.
Local Hemostatic Measures: I applied direct pressure to the extraction site using a sterile gauze. When this standard approach was insufficient, I considered other local hemostatic measures such as applying a hemostatic agent and placing sutures to control the bleeding.
Medical History Review: I reviewed the patient's medical history for any conditions or medications that might contribute to prolonged bleeding, such as blood thinners or a history of clotting disorders.
Postoperative Instructions: I provided the patient with detailed postoperative care instructions, emphasizing the importance of minimizing physical activity and avoiding hot foods or drinks, which can promote bleeding.
Follow-Up and Care:
Monitoring: My team and me closely monitored the patient in my clinic until the bleeding was under control. I reassured the patient.
All things done... some patients may not appreciate that sometimes the presence of infection will not make the typical onset of Anaesthesia as predictable as one expects. Even waiting a long period of time before the extraction may still elicit pain. Bleeding is the next unwanted but certainly expected outcome in the presence of infection.
The tooth was removed :) with swift dexterity and the extraction socket compressed with a pressure pack. The bleeding stopped within half an hour and antibiotics were commenced to treat the infection.
Remember to always come in early so that the dental surgeon will be able to predictably deliver Anaesthesia that you will be grateful for.