Suturing Bleeding Socket

Question 1

Pt rings complaining of bleeding socket post -XLA. What information give over the phone?

Answer 1

Reassure blood likely exaggerated as mixed w/ saliva
Advised pt to wet gauze provided and place over socket and bite for 20-30 mins, is no opposing teeth apply finger pressure over gauze
Bleeding continue after 30 mins come to practice

Question 2

What hx to take for bleeding socket?

Answer 2

Compliance - followed post-op instructions
MH - undiagnosed clotting disorder?
MH - medications failed to disclose

Question 3

What is apixaban?

Answer 3

DOAC
Often preserved prevention DVT/ AF/ PE

Question 4

How to manage pt on warfarin prior to XLA?

Answer 4

Check IRN - needs to be under 4 and taken in last 72 hours (excluding weekend - alcohol can affect)

Question 5

Should pt stop warfarin prior to XLA?

Answer 5

If IRN between 2 and 4 do not stop = risks of bleeding is less than risk of thrombosis

Question 6

How to manage bleeding socket in practice?

Answer 6

Pressure - gauze soaked in cold water for 20-30 mins
Gauze socked in tranexamic acid
Infiltration LA w/ adrenaline
Bipolar diathermy
Radiograph - no retained tissue

Question 7

What is surgical management of bleeding socket?

Answer 7

LA
Irrigate socket w/ saline
Homeostatic agent placed in socket - surgical
Suture w/ absorbable material
Reinforce post-op instruction

Question 8

What are the post-op instructions?

Answer 8

Avoid hot food and drink as can stimulate bleeding
Avoid alcohol 24 hours
No mouth rinsing 24 hours to prevent dislodging clot
Bleeding beings - apply pressure