- Do not inject epinephrine subcutaneouly, that may, it is absorbed very slowly.
- If the patient`s heart has stopped completely, emergency external heart massage should be introduced, if the breathing has also stopped, artificial respiration should be given until emergency help arrives.
- All the personnel in the dental office should recive training periodically in cardiopulmonary resuscitation (CPR) produces so that they can assume an active role in an emergency situation.
If the patient shows signs of agitation and chest pain, oxygen should be administered and the emergency service called, since these symptoms may indicate a heart attack. Administration of epinephrine would be contraindicated for such patient.
- Of shock like symptoms may be hypoglycemia of insuline shock in diabetes.
Individual with hypoglycemia may require a suger containing beverage prior to and during periodontal surgery.
Shock may also be the result of loss of blood. Internal hemorrhage or cardiovascular accidents. The most important action in any shock like reaction are called in emergency help immediately and to adminiter supportive emergency therapy.
If the patient starts to become abnormally pale perspire heavily and is restless, place the chair in horizontal position with the head below the level of the body.
If the pulse become noticeable weaker than normal, record the blood pressure.
Aromatic ammonia may help to prevent syncope.
If the patient is in deep syncope and making slow recovery, oxygen should be administered.
While the patient is regaining consciousness, he should be kept in horizontal position and should not be allowed to sit up until his normal color has returned and is fully recovered from a feeling of dizziness and nausea.
Because periodontal surgery ordinarily reverse only small blood vessels, significant hemorrhage is not a frequent complication of periodontal surgery when local anesthetics and vasoconstrictor drugs are used.
Average amount of blood loss during one session of periodontal surgery has been reported to be 37ml.
Periodontal surgery has usually been ruled out during the treatment planning for the patient while bleeding disorders.
- The secondary type post surgical hemorrhage may starts from 24 hours to 10 days postoperatively. The patient should be instructed to contact the dentist, who did the surgery immediately if intermediate or secondary hemorrhage occurs.
First to reassure the Patient and control the patient’s emotional concern about the bleeding .
A mild oozing type of bleeding can usually be controlled by a pressure pack , using gauze moistened in sterile saline solution and held firmly in position for 2-3 minutes . Injection of LA along with 1:50,000 vasoconstrictor drug may also be helpful in controlling bleeding
If the bleeding is arterial spouting of light red blood as may be seen with encroachment on the palatal anterior , one may try to crush the cut artery with a hemostat. Hold the hemostat in position for several minutes and remove it carefully . If there is not enough soft tissue to grasp the hemostat one may attempt to seal the vessel by crushing the bone of nutrient bone channel . If the cut are surface is in soft tissue, cautery may be tried either by a hot instrument or a ball electrode from an electrosurgical machine.
If the bleeding is severe, it may have to be stopped by tying a suture around the bleeding vessel.
A slow , oozing , venous bleeding (dark blood) may be stopped by the use of Gelfom or oxygel.
These preparation are somewhat irritating and definitely have to be removed before a periodontal dressing is placed over the wound.
The placement of periodontal dressing helps to stop bleeding , and there is no need to have an absolutely dry surgical field with complete stoppage of all bleeding , prior to the placement of dressing.
The patient should never be allowed to leave the dentist office until all gross hemorrhaging has stopped.
If intermediate or secondary hemorrhage occurs , administration of local anesthetic with vasoconstrictor centrally to the wound is recommended . The remove periodontal dressing, clean and inspect the wound and treat the bleeding similarly to a primary type of bleeding .
The patient should be placed on systemic antibiotic therapy. Fever and soreness of the teeth to percussion may indicate a developing osteomyelitis and the patient should be treated with large doses of antibiotics, preferably PENICILLIN .
Doubling the normal dosage for atleast 10- 14 days is recommended for osteomyelitis .s
Periodontal surgery Periodontal surgery Exposure of part of alveolar process. Severe trauma to the bone or heavy direct pressure on the bone from the periodontal dressing Development of bare bone Resorption of necrotic bone by inflammatory process. Sequestrem formation
During this time the area should be kept covered by a periodontal dressing to minimize the infection and discomfort.
The chance of bare bone developing is much greater following gingivectomy with electrosurgery . If excessive granulation tissue develops as a result of poorly fitting periodontal dressing or loss of the dressing shortly after surgery , the granulation tissue should removed with sharp instrument . A well fitting periodontal dressing then should be placed over the wound and left for one week.
The patient should be told at time of the surgery of the possibility of such symptom occurring and instructed to contact the dentist on experiencing them.
If the dressing is not removed , the reactionm progress from erythema to vesicle formation and edema ( which is especially in relation to the tongue ) may be serious complication, since epiglottal edema interfere with air passage.
If the patient is not treated a generalized allergic reaction may develop , including a dermatitis and the patient may become seriously ill .
It is therefore very important that the surgical dressing be removed completely as soon as any of the initial symptoms of allergic reaction appear .
If a new dressing is needed a non eugenol- containing type of dressing, such as coe-pack or peripak may be used .
The root surface of the teeth that have been exposed to the oral environment as a result of periodontal surgery sometimes become extremely sensitive to heat and cold , as well as to mechanical and chemical stimuli.