BASED on when it occurs, haemorrhage (bleeding) can be classified as primary, intermediate, or secondary. Primary haemorrhage occurs during the time of surgery and is attributable to cutting the blood vessels. Under normal conditions, applying pressure, along with retraction and contraction of blood vessels, is sufficient to arrest bleeding. Frequently, when infiltration anaesthesia is used, the vasoconstrictor (blood-vessel-contracting) agent also helps promote the arrest of bleeding. Many factors, both extrinsic and intrinsic, can promote coagulation.
There can be no doubt that haemorrhage is frequently associated with the profession of dentistry. Also, no one can deny that bleeding after an extraction is a perennial worry for many patients. No other profession has been so involved in this process, except when medicine was preoccupied with using “leeches to bloodlet” as a form of treatment.
Intermediate haemorrhage refers to bleeding which occurs within 24 hours of surgery (extraction). This likelihood depends on many factors, e.g., removal of pressure, dissipation of vasoconstrictors, and relaxation of blood vessels.
Secondary haemorrhage occurs 24 hours after surgery and is frequently attributable to many factors, e.g. intrinsic trauma (loose bone chips), infection, chronic alcoholism, smoking, etc.
For discussion, the post-extraction wound consists of two tissue types: hard and soft. The hard tissue component, bone, makes up most of the wound, whereas the soft tissue makes up the smallest part. Haemorrhage can occur from either component.
Bleeding from bone can be difficult to control because, unlike a soft tissue wound, the walls cannot collapse and provide the relaxation needed to promote vessel retraction and contraction. The most common cause of haemorrhage is infection, periodontal (gum) or periapical (root tip). When infection is present, it often causes inflammatory proliferation (granular tissue) and inflammatory hyperaemia (increased blood flow). Therefore, the number of blood vessels increases, along with hyperaemia. The treatment for haemorrhage can be arbitrarily grouped as follows: prevention, pressure, cold, haemostatic agents, and vasoconstriction (local anaesthetic).
Methods to minimise, if not prevent, haemorrhage should be restored. Atraumatic surgery, removing chronic bleeding granulation tissue, removing fractured bone splinters, and excising old necrotic clots (if that is the cause) are measures well worth taking. Preventive therapy is undoubtedly one of the most important forms of therapy available to control haemorrhage.
Applying direct pressure to the wound is the most effective way to stop bleeding. Compressing the wound margins to relieve tension allows the vessels to retract and contract. The patient should bite on cotton or gauze for an hour to help collapse blood vessels and encourage clotting. Suturing, filling the wound with gauze soaked in benzoin, applying ice packs, and injecting local anaesthetic around the site are all ways to arrest bleeding. Premarin and vitamin K administered systemically can also be used.
