A Bloody Mess! Achieving Haemostasis
The mouth is just so wet. Its full of saliva, then theres the drill spitting water everywhere, and THEN theres bleeding! There are more ways to stop bleeding than what we’re taught in uni, and when I learnt them it made my work so much easier.
How to stop the bleeding?
Thermacut Bur
Essentially a high-speed round bur without the diamond coating, the thermacut bur can be used in the high-speed handpiece to cut through gingival tissue/papillae. Used without the water spray on, it cauterises the tissue keeping your working field dry. Available from Dentsply Sirona
Pointed Dura-White High-Speed Bur
More widely available than the thermacut bur, most students will have had access to this bur in their student clinics. Just like the thermacut bur, it will cauterise the gingiva when cutting on high speed without the water spray. The dura-white has been slightly more risky to use than the thermacut in my experience. Its much easier to damage and nick the teeth on either side of the papilla that you’re trimming.
LA in the papilla
A handy tip taught to me by my mentor, injection of a small amount of LA into a bleeding papilla or gingival margin will quickly stop the bleeding. The LA must contain adrenaline as this is the local haemostatic agent. Slowly inject straight into the bleeding area until you see the tissue blanche, and thats all you should need!
Hemodent
This was available in the Sydney uni clinics when I did my training. I use it a fair bit now, but it tastes horrible so you need to be sure your assistant has the high speed suction very close by. Pour a small amount into a dappen dish loaded with a few cotton pellets. Using your tweezers, firmly rub the soaked cotton pellets over the bleeding area for approximately 15 seconds. The tissue will stain to a copper/brown colour. If it continues to bleed or starts again, simply repeat the process, ensuring your rub on the tissue with firm pressure. Rinse with the triplex afterwards to save the patient from tasting it.
In summary…
When faced with a subgingival restoration or a heavily inflammed gingival condition, you’ll end up with a much better result if you’ve kept your working field free of blood and other contaminants. Sometimes gingival trimming is helpful too, and I think this is something that new dentists don’t do nearly enough of. In posterior regions of little aesthetic importance, trimming of the gingiva will often give you a much better result with an uncontaminated gingival seal. In these cases, the thermacut or pointed dura-white stone burs are a great option. When no trimming is required, further use of LA or hemodent soaked cotton pellets will help you achieve haemostasis.
