Any surgical procedure is invasive by its very nature, whether minimally (e.g. via injections or tiny incisions), via keyhole surgery, or through large incisions. This includes dental surgery and other procedures involving the oral cavity – from fillings to root canal therapy (endodontics), dental extractions, and major oral surgery.
As well as considerations of infection control in surgery, minimizing blood loss is also imperative. This is medically referred to as haemostasis.
What is Haemostasis?
Haemostasis is the body’s natural response to an injury. It stops bleeding, conserves blood, helps prevent infection, and enables the body to repair the damage. It is a complex process that strives to keep blood within the blood vessels.
If the wall of a blood vessel is damaged (punctured, cut, bruised, or otherwise compromised) the lining of the vessel works in tandem with platelets in the blood to create a clot and prevent blood loss.
- The wall of the blood vessel constricts.
- Platelets in the blood rush to the area and adhere to it adjacent to the injury.
- The platelets secrete substances to create an insoluble clot or plug (scab) that seals the injury to prevent more bleeding; it also minimizes the risk of infection by keeping bacteria and other germs out of the body.
- The clot or plug is stabilized into a more solid form. The blood clot is remodelled into a fibrin clot, and this eventually replaces the same kind of tissue that was present before the injury occurred.
Sometimes the process of haemostasis can malfunction, or the injury to the blood vessel is too severe for the body to handle. Haemorrhage occurs when bleeding is uncontrolled.
Haemostasis in Oral and Dental Surgery
The mouth is highly vascular, and any dental procedure can cause bleeding. Even something as benign as brushing and flossing can, especially in the presence of any level of gum disease, result in a surprising amount of bleeding for such a minor cause.
Many of the tiny blood vessels in the mouth are very close to the surface, and between these and the deeper vasculature, some procedures can cause bleeding that can be difficult to control. Dentists need to be prepared for and mitigate this as much as possible. This requires the use of appropriate techniques, dental equipment, and suitable haemostatic agents to prevent and control bleeding as soon as it occurs.
From the outset, using the right technique and dental instruments is essential – such as the appropriate dental needles for the specific procedure and access point. A needle used to inject anaesthesia for extractions may differ from one used for an endodontic procedure, and the area of the mouth and type of injection required will dictate which needle is used. This is just an example of how equipment selection can minimize the likelihood of bleeding.
Bleeding within the mouth in dentistry is very common, and it is usually mild and short-lived. It can, however, quickly become severe or even progress to haemorrhage if not controlled properly. This is a medical emergency.
Before any procedure that could potentially cause bleeding, such as an extraction, dentists or oral surgeons (and any surgeon for that matter) must assess the patient’s medical history to ascertain whether they have any issue that may increase their bleeding risk. This includes everything from chronic liver disease to the use of blood thinners, aspirin, Fish Oil, and alcohol.
How is Bleeding Controlled?
Bleeding in the dental setting may be controlled in several ways – from ice application to intense and prolonged compression with a dressing, use of collagen sponges, clinical topical products, or laser or electrocautery to stop the bleeding.
Dentists are experts in preventing and handling blood loss during procedures. The onus, however, is also on patients to provide a complete, honest medical history including family history and lifestyle habits. This enables the dentist to understand risks and take steps to mitigate them from the outset.
