Controlling Hemorrhage in Exodontia and Oral Surgery

Abstract

Every patient should be evaluated preoperatively, in order to eliminate the possibility of an abnormal bleeding condition. Hemorrhagic disorders can be diagnosed by a thorough history supplemented with laboratory tests and a physical examination, when indicated. Surgery must be delayed until discrepancies in the coagulation mechanism or vascular defects have been corrected. Transfusions of fresh, whole blood may be needed; especially in cases of blood dyscrasias. This method of treatment will prevent serious complications. Surgical blood loss usually is underestimated in normal patients. Excessive primary bleeding can be prevented by employing sound surgical techniques. The majority of postoperative hemorrhages result from inadequate débridement of the wound, ineffective hemostasis, or failure on the part of the patient to follow postoperative instructions. The use of local hemostatic agents is helpful in arresting hemorrhage. Gelfoam and Topical Thrombin solution are recommended because of their effectiveness and their compatibility with normal healing. Systemic agents have limitations; however, if the proper agent is selected for a particular situation, it can be of value as an adjunct to other measures in establishing hemostasis.