Hemorrhage

Hemorrhage in a dental context refers to bleeding that is heavier or more prolonged than expected during or after a procedure. While some bleeding is normal with extractions, surgeries, and even deep cleanings, hemorrhage implies a level of bleeding that requires intervention to control.

Several factors increase the risk of dental hemorrhage. Patients taking anticoagulant medications like warfarin, aspirin, or newer blood thinners such as apixaban and rivarelbán are at higher risk. Liver disease, blood clotting disorders, and certain herbal supplements can also impair the body's ability to form clots. This is why a thorough medical history review before any surgical procedure is absolutely essential. Intraoperative hemorrhage is managed with direct pressure, hemostatic agents like gelatin sponges or oxidized cellulose, sutures, and sometimes electrocautery. Post-operative hemorrhage, which occurs after the patient leaves the office, is more concerning because the patient must recognize the problem and respond appropriately. Clear, written post-op instructions are vital. Patients should know to bite firmly on gauze, avoid spitting or using straws, refrain from vigorous rinsing, and contact the office immediately if bleeding soaks through gauze within an hour.

For practice management, having a hemorrhage protocol in place is not optional. Every team member should know where emergency supplies are located and what steps to follow. Documentation should include the patient's medication list, any modifications made in consultation with their physician, the hemostatic measures used during the procedure, and the post-op instructions given. This documentation protects both the patient and the practice.