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No bleeding disorder history, advanced periodontitis. General clean. Bleeding issue. Tried pressure pack mesial, tranexamic. Possible suggestion

Hello, I am a dentist in Sydney, I saw a patient ( young women in mid twenties wuth no bleeding disorder history or any medication taken) with advanced periodontitis in particular around upper left molar region! I did a general clean and was all fine! She started to have bleeding issue a few hours after the clean at one site only, I had tried to ask her to keep a pressure pack mesial of the second molar and also prescribed some tranexamic acid mouthwash, so far it has been almost 2 days and it does not seem to be able to arrest the bleeding (oozing)! I am asking for possible suggestion of causes and treatment alternatives? Was there a possible blood vessel in bone that was exposed via even a general clean? Please help!
Asked On : Mon, 29 Apr 2013
Answers:  5 Views:  47
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Dentist 's  Response
First an OPG should be taken to rule out there is any other problem in the region. If there is bone loss a flap surgery and bone grafting should be done. It could mainly associated with the advanced periodontitis. Or it could be a sinus problem which can be detected by an ENT specialist. Ask the patient to take saline gargle 3-4 times a day.
Answered: Tue, 30 Apr 2013
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Dentist Dr. Shefali Gupta's  Response
Thanks for asking query,
The bleeding is due to sever periodontitis in a particular area ,you should take the xray and consult the ent surgeon as there is a possiblity of sinus involvment.For the mean time ask her to apply ice pack,ointment metrogyl locally , tab oflox ornidazole bd to cover the infection part.
Answered: Wed, 1 May 2013
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Dentist Dr. Qazi Ammara's  Response

Thanks for asking the query,

I would suggest you to take an x-ray of the region which will give you the clear idea,
Can be due to sinus infection, if present refer the patient to ENT surgeon to start the treatment.
Go for the lesion biopsy which will give the correct diagnosis and it will get confirmed by taking x-rays.
Apply pressure packs to the affected area.
Presribe the patient with metrogyl ointment to apply topically on the area,
Ask the patient to take lukewarm saline and antiseptic mouthwash rinses.
It can also be due to hormonal changes.

Hope this helps out.

Answered: Tue, 30 Apr 2013
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Dentist Dr. Bindiya Bhaskar's  Response
Thanks for posting your concern.
Bleeding from a particular site is usually due to localized periodontitis which is involved with a specific tooth.
A thorough clinical as well as radiological examination is necessary for exact diagnosis.
Chances of alveolar bone loss,periodontal pocket ,tooth mobility associated with gingival recession usually occurs.
Apply ice packs for 2-3 hours at the bleeding socket.
Drink plenty of water and fluids.
please be careful while toothbrushing to avoid plaque accumulation at the site of bleeding.
Vitamin-c,iron and folic acid supplements can be taken.
Hope this helps.
Answered: Tue, 30 Apr 2013
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Allergist and Immunologist Dr. Suman Kumar's  Response
look to be sinus infection which might have gone to sinuses through perodontal conditios
it is very common for sinuses to bleed and if you get xray done pns waters view you will have found sinuses
mwetrogyl is best to clwar sinus and teeth
so can start metrogyl 200 mg bd for 5 days
local antibacterial like betadine mouth washes
if xray is ositive for sinuses tret the sinuses and bleeding will slowly go
Answered: Tue, 30 Apr 2013
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