Today a patient wanted a complete new denture for herself as her present removable partial denture was causing her pain. She had few teeth approximately six teeth in her right lower arch and few root stumps on the other side of the mandibular arch. She is sixty years old and has hypertension; she is also very apprehensive and mentally disturbed.
When I recorded her medical and family history, she told she has been taking medication for hypertension since three years and had left other medications like ecosprin and tranquilizers few months back. Before starting serial extractions, I checked her blood pressure which was systolic 129Hg and diastolic 75Hg respectively. I gave her local anaesthesia in her mandibular nerves and the area surrounding the teeth which are to be removed.
She had to get one lateral incisor, one canine, one premolar and a root stump or piece extracted. While I was removing her teeth I noticed the roots were fused or ankylosed to the cortical bony plate of the alveolar bone of the lower arch. All the teeth came out easily without any problem, but the root piece gave me a tough time. It wasn’t much visible and there was no point visible externally but finally with the help of cryers elevator the root piece came out. I gave her sutures on the extraction socket so that the area will heal better and a proper bone desorption will occur.
I explained about the post extraction complications and advised her to follow the post extraction steps accurately. However, two hours after extraction, this lady called up and said that she felt blood was oozing out of the part where extraction was done. In order to avoid any major complications, I immediately asked her to come for checkup.
I noticed that the blood was coming from a point behind the suture. I compressed the socket and gave her coagulant enhancer and told her to wait for half an hour. Even after 30 minutes, I saw that her bleeding didn’t stop in spite of taking coagulant enhancing drug.
I observed that the speed at which the blood came out reduced. I gave her one more coagulant and compressed her socket with pressure for fifteen minutes so that small arteries around the teeth would get compressed.
On further enquiry, she said that she has been taking Hifenac-P which is combination of diclofenac sodium and parecatomal which increases bleeding time if taken after extraction. So I immediately advised her to stop taking any other medication except the ones which I prescribed her. I gave her antibiotic like Azithromycin as she was allergic to penicillin and Tremadol as a painkiller and streptovit as coagulant enhancer.
I advise her to have as much ice cream as she can and keep it on the wound. I also advised her to take soft and cold food. I told her not to bend or do any kind of physical activities as it might aggravate bleeding. Finally I told her to relax and keep me informed of any changes or complications.
She called me after one hour and told that the bleeding completely stopped. Gosh! This patient was really the panicky kind!