39
Volume2 Issue2
|
S
upporting
Y
our
P
ractice
This articlewasoriginallycreated for
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How toManage
SPONTANEOUS
GINGIVALHEMORRHAGE
Point ofCare
Spontaneousgingivalhemorrhage
A patient presents with copious gingival bleeding:
– Bleeding is prolonged and cannot be stoppedwith pressure
– Several such episodes have occurred recentlywithout
provocation
Presentation
Population
•
Variabledemographicsdependingupon thenatureof theunderlying
disorder
•
Possible familyhistoryof ableedingdisorder
Signs
•
Hemorrhageemanating fromgingival sulciwithminimal or no
provocation (
Fig. 1
)
•
Maypresentwithanyof the following:
• Submucosal and/or subcutaneous hemorrage (petechiae,
ecchymoses, or hematoma)
• Hyperplasicgingival tissues, oral ulceration andoral infection
(e.g., herpes simplex virus, candidiasis)
• Swollen joints (hemarthrosis)
• Signsof anunderlying systemicdisease (e.g., jaundice, spider
angiomas, ascites, pallor, lymphadenopathy)
Symptoms
•
Prolongedbleedingafter injury, traumaor dental/surgical procedures
•
Bleedingepisodes
• Menorrhagiaor postpartumhemorrhage
• Epistaxis
• Gastrointestinal (e.g., hematemesis,melana)
•
Fatigue
•
Recurrent infections and fever
Investigation
1.
Obtainadetailedmedical anddental history:
a. Personal and familial historyof bleedingproblems
b.Dental history: severeor prolongedbleeding following trauma,
extractions or surgical procedures
c. Medications and illnesses thatmaybe associatedwithexcess
bleeding
HagenKlieb
DMD,MSc,FRCD(C)
Dr.Klieb is a staff oral
pathologist at Sunnybrook
HealthSciencesCentre,
aUniversity ofToronto-
affiliatedhospital, with
cross appointments in the
departments of dentistry
andanatomic pathology.
MelanieGilbert
DMD,MSc
Dr.Gilbert is a staff
dentist at Sunnybrook
HealthSciencesCentre
with interest indental
management of the
medically compromised
patient.
Theauthorshavenodeclared
financial interests.
Thisarticlehasbeenpeer
reviewed.
DentalEmergency
Scenario
