No matter what your clinical position is on the dental team, one of the most difficult challenges to overcome while providing patient care is using instrumentation around heavily bleeding gingival tissue. Whether you’re a dentist-assistant duo performing delicate work such as the cementation of permanent crowns or a hygienist completing meticulous periodontal therapy, bleeding gums can pose a major threat to the quality of care we provide to patients. Here are some tips to try to achieve hemostasis.
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Wet gauze
A traditional approach to managing bleeding tissues is to saturate cotton gauze with water and apply prolonged pressure to the affected area. The pressure assists in reducing blood flow, which allows clotting to occur. Making sure the gauze is wet will prevent the cotton from drawing large amounts of blood from the tissues and will be easier to remove without disrupting tissue recovery. Wet gauze is a popular postoperative step after tooth extractions, as well as localized treatment areas where bleeding is heavy.
Commercial hemostatic products
There are several products you can apply at the source of gingival bleeding to quickly gain control of the working area. These products have active ingredients such as gelatin, collagen, cellulose, thrombin, or epsilon-aminocaproic acid that can either be placed over the affected area temporarily or absorbed by the tissues to assist in hemostasis.1 Deciding on the most appropriate product will depend on the type of procedure being performed, the amount of bleeding present, the patient’s unique health history, and the level of postoperative care warranted for the individual. Dental professionals are encouraged to discuss specific products and their applications with the manufacturers.
Laser cauterization
Tissue management is just one of the many innovative uses of laser technology in dentistry. Within a matter of seconds, heavy bleeding can be easily stopped without the use of chemicals or packaged products. When used according to the manufacturer’s instructions, the gentle heat from the laser tip seals the open tissue and allows the affected area to begin to recover. A growing number of clinicians are adopting this technique for quick relief that lasts long after the patient’s appointment.
Systemic health review
There are times when heavy bleeding may be expected during a procedure, such as oral surgery. Other times, however, tissues can exhibit heavy bleeding with very little stimulation. When oral hygiene instruction and periodontal treatment don’t seem to yield much improvement with gingival bleeding, it’s important to investigate the issue further.
Thoroughly reviewing the patient’s health history to identify medications that have anticoagulative effects is crucial in preparing the patient for upcoming treatment. When you see Coumadin, aspirin, Plavix, Eliquis, or Pradaxa on the patient’s medication list, collaborating with the patient’s physician for future visits is wise.2 Likewise, if heavy bleeding persists when blood-thinning medications are not being taken, a physician referral to investigate underlying systemic causes is in the patient’s best interest. In some cases, undiagnosed vascular disorders, immune ailments, or platelet dysfunction can be the cause.
Procedural gingival bleeding is an unpleasant experience for both the patient and the clinical team. But remember that options are available to effectively manage this issue so quality care can be provided. These solutions are case-specific; we must consider the individual’s needs, health history, and desired clinical outcomes. In situations where bleeding is a continual concern for the patient, we need to recognize when it’s time to lift our gaze from the oral cavity, acknowledge the whole person we’re caring for, and refer accordingly.
Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.
References
- Klieb H, Gilbert M. How to manage spontaneous gingival hemorrhage. J Can Dent Assoc. 2014;80:e54.
- Froum S, Jacob GA. Bleeding post tooth extraction: techniques to establish hemostasis. Perio-Implant Advisory. 2015. Updated December 2, 2021. https://www.perioimplantadvisory.com/clinical-tips/article/16411502/establishing-hemostasis-postextraction
