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Minor Oral Surgery > Haemostasis > Flashcards

Haemostasis Flashcards

1
Q

What would a risk assessment prior to a tooth extraction involve?

A
  • careful planning
  • thorough analysis of medical history
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2
Q

What does the process of haemostasis involve?

A
  • vasoconstriction
  • platelet plug formation
  • coagualation cascade/network
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3
Q

Clot formation is a dynamic process. It involves a balance between what systems?

A

haemostatic and fibrinolytic systems

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4
Q

When does fibrinolysis occur?

A

When the plasminogen precursor is activated and becomes plasmin

Plasmin is then able to digest the fibrin threads in the clot

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5
Q

The majority of clotting factors are produced in the …

A

liver

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6
Q

Platelets are produced in the …

A

red bone marrow

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7
Q

Problems relating to clotting factors and platelets are either ________ or ________

A

acquired or congenital

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8
Q

Give an example of a congenital clotting factor deficiency

A

Haemophilia A (factor VIII deficiency)

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9
Q

State the 3 types of post extraction haemorrhages

A
  • primary haemorrhage
  • reactionary haemorrhage
  • secondary haemorrhage
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10
Q

What is a primary haemorrhage?

A

this is bleeding that occurs at the time of surgery

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11
Q

What is reactionary haemorrhage?

A

this is bleeding that occurs 2-3 hours after the procedure as a result of cessation of vasoconstriction

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12
Q

What is a secondary haemorrhage?

A

this is bleeding that occurs up to 14 days after the surgery.

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13
Q

What is the most likely cause of a secondary haemorrhage?

A

infection

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14
Q

Haemorrhages can also be classified according to the site affected. Give examples of such sites

A
  • soft tissue
  • bone
  • vascular
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15
Q

The use of haemostatic agents and equipment is not limited to managing post-extraction haemorrhages. Give examples of other invasive procedures where haemostatic agents/equipment are useful

A
  • non surgical periodontal therapy
  • periodontal surgery
  • pulpotomy
  • preparation of teeth for indirect restorations
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16
Q

Briefly describe immediate post extraction management and why it is important

A
  • once a tooth has been removed, pressure shoud be placed on the buccal and lingual/palatal sufaces of the alveolus around the socket- this is referred to as **digitalised pressure **
  • this immediate bucco-lingual pressure reduces the dead space of the wound and is the first step to gain haemostasis
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17
Q

What is the result of the extraction of a tooth via the intra-alveolar approach?

A

expansion of the alveolus aorund the roots of a tooth

Intra-alveolar extraction is a forceps extraction (not a surgical extraction!)

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18
Q

Post-operatively, how would you manage an extraction site with an opposing edentulous area? Why would you go about it this way?

A

use finger pressure on the gauze for several minutes

this is because biting together following gauze placement may not apply enough firm pressure

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19
Q

What is the duration of time for the formation of granulation tissue following an extraction?

A

24 hours

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20
Q

Give examples of clotting factor deficiencies

A
  • haemophilia A (factor VIII)
  • haemophilia B (factor IX)
  • Von willibrand disease
  • vitamin K deficiency (Factor II, VII, IX, X)
  • Acquired liver disease- hepatitis/ cirrhosis
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21
Q

Platelet deficiencies such as thrombocytopenia can be either ________ or ___________

A

idiopathic
or
drug induced (antiplatelet therapy)

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22
Q

Give examples of vascular anomalies that put patients at high risk of post extraction haemorrhage

A
  • atriovenous malformation
  • hereditary haemorrhagic telangiecstasia
  • collagen disorders
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23
Q

Failure to give a patient clear post operative instructions for the management of the socket can lead to ____________ haemorrhage

A

secondary

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24
Q

Why is it important to provide a concise instruction leaftlet as well as verbal POI?

A
  • patients may not be able to recall a long list of instruction following extraction
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25
Q

Providing a leaflet without comprehensive verbal instructions is acceptable practice. True or fale

A

false

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26
Q

What clinical scenarios is it acceptable for a clinician to give after care instructions at a previous appointment or pre-operatively?

A

patients having treatment under IV or inhalation sedation who may have their ability to retain information significantly reduced

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27
Q

In the presence of infection, granulation tissue may form at the base of the socket. How does the presence of granulation tissue increase the risk of bleeding ?

A
  • impairs clotting
  • granulation tissue (macrophage cytokines such as VEGF encourage angiogenesis as a result there is an abundance of fragile blood vessels - prone to haemorrhage)
28
Q

What size and shape of needle is useful for suturing intra-oral wounds

A

3.0 suture
1/2 circle curved needle

29
Q

How long does polygactin (vicryl) offer wound support?

A

7-10 days

30
Q

What is in a dental clinicians armanentarium for a post-extraction haemorrhage?

A
  • sterile gauze (pressure pack)
  • suction
  • suture kit (needle holders, tissue forceps, suture material and needle)
  • haemostatic gauze
  • bone wax
  • astringent solution e.g. ferric sulphate
  • 5% tranexamic acid mouthwash
  • cautery
  • systemic monitoring equipment- blood pressure, heart rate, pulse oximeter
31
Q

Give examples of haemostatic agents that are available to a dental practitioner

A
  • tranexamic acid
  • ferric sulphate
  • silver nitrate
32
Q

List the POI following a dental extraction

A

Do not:
* rinse your mouth on the day of extraction as it may dislodge the clot
* drink alcohol/hot drinks at least 24 hours; may increase blood pressure and induce hyperaemia
* smoke or use tobacco products for at least 24 hours (causes vasoconstriction and can increase dry socket)
* chew food for 4 hours, avoid hard foods as they may disturb clot
* carry out physical activity (increased blood pressure

Do:
* sip lukewarm drinks carefully (helps avoid clot removal by washing out socket)
* bite on gauze for 10 minutes if area bleeds, sitting upright
* salt water rinces or CHX (0.2%) mouthwash after 24 hours. Continue regular mouthwash use over following weeks especially after meals
* clean teeth as normal, avoiding area of surgery for 24 hours

33
Q

What are directions of use for 5% tranexamic acid mouthwash?

A

use as a rinse 4x daily for two days post-operatively

to prevent fibrinolysis

34
Q

What are the first line management options for soft tissue haemorrhages ?

A
  • sutures
  • haemostatic gauze
35
Q

Ferric sulphate is commonly used an ____________ solution in dentistry

A

astringent solution (15.5%)

36
Q

Give instances where ferric sulphate is commonly used

A
  • gingival retraction techniques for impressions for crown and bridge work
  • haemostatic agent for pulpotomy
37
Q

In what form is silver nitrate available?

A

It is available in the form of pencil which contains 95% silver nitrate

38
Q

When are silver nitrate pencils made use of ? Give specific examples of such instances

A

to aid haemostasis in areas where suturing or finger pressure is not possible

mucosal biopsy taken from hard palate or retromolar pad

39
Q

Silver nitrate is a powerful _______ agent

A

cauterizing agent

burning flesh in order to control bleeding

40
Q

How is silver nitrate deactivated?

A

after a few minutes silver nitrate should be de-activated by genetly swabbing the area with saline solution to avoid damage to surrouding structures

41
Q

How can bleeding from within the socket be arrested in most cases?

A

it can be arrested by inserting a pack

42
Q

How can you manage a bony haemorrhage?

A

cancellous bone can be burnished with a flat plastic instrument or mitchells trimmer to help compress the bone in that area

43
Q

The use of haemostatic gauze/dressing along with the placement of suture is recommended for patients at high risk of post operative haemorrhage. Give examples of resorbable haemostatic dressing materials

A
  • surgicel
  • haemocollagen
  • Gelfoam
44
Q

Surgicel is …

A

oxidised regenerated cellulose

45
Q

Haemocollagen is a ________ sponge

A

collagen

46
Q

Gelfoam is a ________ sponge

A

gelatin

47
Q

Give examples of non-resorbable haemostatic dressing

A

Kaltostat

48
Q

What does bone wax consist of?

A
  • beeswax
  • paraffin
  • softening agent
49
Q

What is the main use of bone wax?

A

it can be used to control bleeding in cancellous bone

it is placed into spaces within the bone

50
Q

How does surgicel facilitate haemostasis ?

A

it forms a gelatinous mass upon saturation with blood which leads to the formation of a stable clot

51
Q

How does bone wax facilitate haemostasis?

A

the pressure provided facilitates haemostasis

52
Q

What are the caveats of bone wax usage?

A
  • non-resorbable and thus the host may treat it as a foreign body
  • complete removal of bone wax is difficult and thus it often remains in situ
53
Q

Wax placement is often followed by …

A

placement of haemostatic gauze and a suture to maintain pressure on the socket

54
Q

What type of haemorrhage causes the most distress to a patient?

A

vascular haemorrhage

55
Q

What sort of repair may be required for a large vessel haemorrhage?

A

ligation
(tying up an artery)

56
Q

What sort of repair may be carried our for smaller vessels?

A

cauterization
(burn)

57
Q

What is electrocautery?

A

this is the process of sealing the exposed end of a vessel with heat conduction

58
Q

When is systemic monitoring of particular importance?

A

when dealing with a secondary haemorrhage

59
Q

How should a patients blood pressure be monitored?

A

sphygmomanometer

60
Q

How is should patients heart rate be monitored?

A
  • manually
  • pulse oximeter
61
Q

When should a patient be referred to A&E following an extraction? What treatment should these patient receive ?

A
  • if it is not possible to arrest haemorrhage
  • With the following readings:
  • diastolic BP: consistently <60 in a short monitoring period
  • systolic BP: consistently <100 in a short monitoring period
  • heart rate raised- 100bpm - tachycardic

they should receive fluid replacement as these are the signs of hypovolaemic shock

62
Q

What is the quickest route to successful management of a haemorrhage?

A

the correct diagnosis

63
Q

Outline the management of a vascular haemorrhage ?

A
  • localise vessel
  • apply pressure
  • may require electrocautery or ligating
  • haemostatic gauze
  • suture
64
Q

Outline the management of a soft tissue haemorrhage ?

A
  • haemostatic gauze
  • suture
  • chemical agents if appropriate
65
Q

Outline the management of a bony haemorrhage ?

A
  • identify site of haemorrhage
  • place haemostatic gauze then suture
  • burnish if possible and or insert bone wax, pack and suture

Minor Oral Surgery (36 decks)

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