If the patient returns three to six weeks following the surgery with a postoperative infection, the diagnosis is typically a chronic or subperiosteal abscess. It is often a lingering, slow, chronic infection that develops below the periosteum, usually at the base of the surgical flap. This condition develops if small bone chips and/or debris were not removed by thorough debridement at surgery or because the patient’s postoperative oral hygiene was poor. Thus, proper irrigation and good oral hygiene are essential to help prevent chronic infection. A chronic or subperiosteal abscess requires the same type of treatment as acute infection. Thorough irrigation requires the retractor to be moved back and forth as irrigation progresses so that no debris is left at the base of the flap. Ecchymosis is typically seen in older patients, given their ease of bruising. The ecchymotic discoloration changes from black and blue to greenish yellow. Within one week, the sequela usually resolves. The practitioner should take steps to reassure the patient that the situation will resolve itself. If the slow bleed persists, however, it must be located and addressed. pressure. However, when the cellulose is packed in the socket, it almost always causes delayed wound healing. Thus, packing the socket with cellulose is used only for more persistent bleeding cases. If bleeding is arising from the bone, the dentist may apply direct pressure or crush the foramen with the back of a periosteal elevator and/or curette, occluding the bleeding vessel. The practitioner may also use sterile bone wax to burnish the bony area. However, bone wax is poorly absorbed and thus may act as a nidus for a postoperative infection. Electrocautery, laser, pressure or isolation, and application of a hemostat with ligation can be employed to curb soft-tissue hemorrhage. Local anesthetic with a vasoconstrictor can be employed, but it will cause vessels to constrict if used locally, and the dentist then may not be able to locate the source of the bleeding. Sometimes the patient experiences rebound hemorrhage with recurrent, bothersome bleeding. In this case, a hemostat should be used to clamp off the vessel and tie it with suture material. When a wound is closed, bleeding should already be under control because the sutures used to create pressure on the surface area cause tissue necrosis. Problems can often be averted when the patient is informed ahead of time of what to expect with regard to normal bleeding and oozing. If slight problems occur, the need for pressure should be emphasized. The patient can apply pressure to the site by biting down on a gauze pad or by manually pressing on the site with a hand or finger. The patient can also bite down on a soaked tea bag. This old- fashioned yet effective home remedy helps control bleeding in the mouth. The tea bag acts like a sponge, and the tea leaves release tannic acid, which promotes vasoconstriction (Abraham et al., 2016). In cases of more severe bleeding requiring the patient to be seen after hours, it is important to debride the area. Then the dental practitioner can locate the source of the bleeding, apply pressure, and employ one of the previously outlined modalities to control the problem.
(Aiyaka & Techakehakij, 2019; Picard et al., 2019). Among patients who report penicillin allergies, an average of 2% will react if given a cephalosporin (Shenoy et al., 2019). However, medical history should be taken into consideration when assessing risk if a skin test has not been conducted. “In practice, only 5% to 10% of persons who have hypersensitivity reactions to penicillins have them with cephalosporins. In general, if a patient has had only a non-urticarial rash as the manifestation of penicillin hypersensitivity, then using cephalosporins is safe. For patients who have had urticaria or an anaphylactic reaction in response to penicillins, cephalosporins should be used with great caution” (Wynn et al., 2016). Ecchymosis Extravasation of blood in the tissue planes, if sufficiently superficial, presents as ecchymosis. In the patient’s face, ecchymotic areas drop into the tissue planes and become dispersed in the cervical areas, and sometimes they are drawn down onto the anterior chest wall. This sequence occurs occasionally as a complication of extractions when postoperative hemorrhage is inadequately controlled. Hemorrhage Often, hemorrhage can be averted by accurate and thorough medical history taking, evaluation, and questioning of the surgical patient before the procedure. Patients with a history of uncontrolled high blood pressure, bleeding complications, or genetic bleeding disorders, or those on anticoagulant therapy for conditions such as past stroke, atrial fibrillation, or blood clots in the legs, are at risk of hemorrhage. The dentist should consult the patient’s physician before scheduling surgery if there are concerns. If necessary, the patient’s physician can order appropriate blood tests, including a prothrombin time, partial thromboplastic time, bleeding time, clotting time, and platelet count. If the patient’s blood pressure is uncontrolled, their physician may need to treat the patient with appropriate hypertension medication before the oral surgery takes place. Diastolic pressure is of concern because the patient will tend to have more postoperative oozing than normal. Hemorrhagic activity can be divided into two main types: Soft tissue or bony, which can be arterial, venous, or capillary in origin. Regardless of whether the bleeding is soft tissue or bony, it is crucial to locate the area, debride it of any excessive clots, and apply appropriate pressure. If hemorrhage persists and thorough inspection of the socket reveals no arterial hemorrhaging, the dentist should take additional measures. Several commercial preparations designed to help control hemorrhage by application directly into the socket are available. An effective and inexpensive option is the use of an absorbable gelatin sponge (Passarelli et al., 2018). When placed into the socket and held in place with a suture, the sponge forms a scaffold that in turn forms a clot. Because the sponge becomes friable once in contact with blood or saliva, it must be compressed into compact pieces before placement. Sutures help maintain the sponge in position during coagulation. The practitioner then places a gauze pack and holds it in position to maintain pressure at the site. Another material used to control hemorrhage is oxidized regenerated cellulose (Ali et al., 2022). This substance promotes coagulation more than the absorbable gelatin sponge does. It can also be packed into the socket under
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