Dealing with Bleeding Associated with Surgery
With any procedure we perform, there are common complications, including pain, swelling, bruising, infection and bleeding. Among these, bleeding is almost always a concern patients will express at their initial consultation.
The amount of bleeding associated with any procedure performed is dependent on many variables, including age, past medical history, medications and extent of surgery. A patient who has one tooth removed in their lower jaw is certainly less likely to experience bleeding issues than a patient who had their remaining seven lower teeth extracted with four dental implants placed at the same time.
Fortunately, most patients come through their oral surgeries with few, if any complications from a bleeding standpoint. The best way to limit those complications is through prevention.
Compiling a good medical history and finding out what is going on with the patient before ever touching them surgically is the best way to treat bleeding. For example, atrial fibrillation is a common abnormal heart rhythm that puts patients at increased risk for stroke and may require the use of blood thinners. Congenital conditions like hemophilia predispose certain patients to bleeding if they are wounded.
Thoroughly understanding a patient’s history allow us to take appropriate measures, such as:
- Altering their Coumadin therapy before their scheduled oral surgery so they don’t bleed afterwards.
- Stopping their Eliquis, Pradaxa or Xarelto for a couple days before and after their scheduled oral surgery so they don’t bleed.
- Using procoagulants like Gelfoam in the extraction sites of patients who are on Plavix and Aspirin so they will clot and not have excess bleeding.
- Arranging for patients who have congenital bleeding disorders to receive blood products or other therapies in anticipation of their oral surgery.
If patients at risk for bleeding issues are identified ahead of time, adjustments and alterations can be made pre-operatively so they shouldn’t have to do anything more post-operatively than a regular oral surgery patient. Only the very rare patient would actually need to return to the office with a true bleeding issue.
So, how do we alleviate a patient’s concerns before they ever sit in the surgical chair? Communication with the patient and their referring dentist and medical doctor is essential for us to take the proper precautions so patients will not have to deal with bleeding problems afterwards.