Excessive bleeding following minor trauma. Case report Renato Simionato, BDSc
(Received for publication April 1991. Revised August 1991. Accepted August 1991.)
A 28 year old male presented requesting a routine check-up. His past medical and dental history revealed only an excessive bleeding episode some ten years earlier following the extraction of two adjacent molar teeth. After further questioning it seemed that the procedure had been quite traumatic and lengthy. He had returned to the dentist some hours later when sutures were placed to control the bleeding. No further treatment was required. The excessive bleeding was attributed to the procedure rather than an underlying coagulopathy as there was no familial history of a bleeding disturbance and, apart from the episode ten years earlier, he had not noticed any other bleeding tendency. A routine examination was carried out followed by removal of minor but generalized supragingival calculus and plaque deposits with an ultrasonic scaler and hand instruments. Oral hygiene instruction followed after which the patient was dismissed. No evidence of excessive bleeding was evident. He presented the following day with bloodstained lips and blood oozing from the interdental gingivae between the lower left second incisor, canine and first premolar (Fig. 1). The area was irrigated, silk sutures placed and pressure applied. As an underlying bleeding disturbance was suspected, the patient was sent for a full blood examination and bleeding profile. On review the following day no further bleeding was evident (Fig. 2). The tests revealed only a mildly prolonged activated partial thromboplastin time (36.0: range 24-35). On repeat testing it was 39.0. The patient was referred to a haematologist who after testing noted only a mild reduction in factor VIII. In fact, the reduction was much less than that seen even in the mildest forms of haemophilia. All that was suggested was that he avoid aspirin in any form, and that he be made aware of the increased risk of bleeding after surgical procedures. The degree of bleeding following quite benign 252
Fig. 1. -Appearance on day following oral hygiene procedures showing haemorrhage from interdental papillae between 32, 33 and 34.
Fig. 2.-Appearance next day. Note control of bleeding by placement of sutures and application of pressure.
trauma is unusual. As the severity of the bleeding tendency relates in general to the plasma concentration of factor VIII, it was interesting to find that the patient had only a very mild reduction of factor VIII. The case also shows the value of local measures, irrigation, sutures and pressure, in resolving an increased tendency to bleed. Address for correspondenceheprints: 2 Royston Street, Viewbank, Victoria, 3084. Australian Dental Journal 1992;37(4):252.
(Received for publication April 1991. Revised August 1991. Accepted August 1991.)
A 28 year old male presented requesting a routine check-up. His past medical and dental history revealed only an excessive bleeding episode some ten years earlier following the extraction of two adjacent molar teeth. After further questioning it seemed that the procedure had been quite traumatic and lengthy. He had returned to the dentist some hours later when sutures were placed to control the bleeding. No further treatment was required. The excessive bleeding was attributed to the procedure rather than an underlying coagulopathy as there was no familial history of a bleeding disturbance and, apart from the episode ten years earlier, he had not noticed any other bleeding tendency. A routine examination was carried out followed by removal of minor but generalized supragingival calculus and plaque deposits with an ultrasonic scaler and hand instruments. Oral hygiene instruction followed after which the patient was dismissed. No evidence of excessive bleeding was evident. He presented the following day with bloodstained lips and blood oozing from the interdental gingivae between the lower left second incisor, canine and first premolar (Fig. 1). The area was irrigated, silk sutures placed and pressure applied. As an underlying bleeding disturbance was suspected, the patient was sent for a full blood examination and bleeding profile. On review the following day no further bleeding was evident (Fig. 2). The tests revealed only a mildly prolonged activated partial thromboplastin time (36.0: range 24-35). On repeat testing it was 39.0. The patient was referred to a haematologist who after testing noted only a mild reduction in factor VIII. In fact, the reduction was much less than that seen even in the mildest forms of haemophilia. All that was suggested was that he avoid aspirin in any form, and that he be made aware of the increased risk of bleeding after surgical procedures. The degree of bleeding following quite benign 252
Fig. 1. -Appearance on day following oral hygiene procedures showing haemorrhage from interdental papillae between 32, 33 and 34.
Fig. 2.-Appearance next day. Note control of bleeding by placement of sutures and application of pressure.
trauma is unusual. As the severity of the bleeding tendency relates in general to the plasma concentration of factor VIII, it was interesting to find that the patient had only a very mild reduction of factor VIII. The case also shows the value of local measures, irrigation, sutures and pressure, in resolving an increased tendency to bleed. Address for correspondenceheprints: 2 Royston Street, Viewbank, Victoria, 3084. Australian Dental Journal 1992;37(4):252.
