Journal List > J Korean Assoc Oral Maxillofac Surg > v.36(3) > 1032392

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Choi, Kang, Kim, Lee, and Yoo: Crown removal and endodontic drainage as a last method in active gingival bleeding with liver cirrhosis and periodontitis: a case report
Original Article

J Korean Assoc Oral Maxillofac Surg 2010;36(3):221-227.

Published online: 10 January 2010

DOI: https://doi.org/10.5125/jkaoms.2010.36.3.221

Crown removal and endodontic drainage as a last method in active gingival bleeding with liver cirrhosis and periodontitis: a case report

Young-Su Choi1, Sang-Hoon Kang1, Moon-Key Kim1, Chun-Ui Lee2, Jae-Ha Yoo2

1Department of Oral and Maxillofacial Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea

2Department of Oral and Maxillfacial Surgery, College of Dentistry, Wonju Christian Hospital, Yonsei University, Wonju, Korea

Young-Su Choi Department of Oral and Maxillofacial Surgery, National Health Insurance Corporation Ilsan Hospital 1232, Baekseok1dong, Ilsandonggu, Goyang, Gyunggi, 410-719, Korea TEL: +82-31-900-0623 FAX: +82-31-900-0622 E-mail: youngdent@naver.com

Received 7 April 2010       Revised 13 May 2010       Accepted 23 May 2010

Copyright © 2010 Korean Association of Oral and Maxillofacial Surgeons

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The most common local cause of active gingival bleeding is the vessel engorgement and erosion by severe inflammation. Abnormal gingival bleeding is also associated with the systemic disturbances. Hemorrhagic disorders in which abnormal gingival bleeding is encountered include the following: vascular abnormalities (vitamin C deficiency or allergy), platelet disorders, hypoprothrombinemia (vitamin K deficiency resulting from liver disease), and other coagulation defects (hemophilia, leukemia). There are many conventional methods for gingival bleeding control, such as, direct pressure, electrocoagulation, direct suture, drainage, application of hemostatic agents and crushing and packing. If the active continuous gingival bleeding is not stopped in spite of the application of all conventional bleeding control methods, the life of patient is threatened owing to upper airway obstruction, syncope, vomiting and hypovolemic shock. Therefore, the rapid and correct hemostatic method is very important in the emergency dental care. This is a case report of active gingival bleeding care via dental crown removal and emergency primary endodontic drainage as a last method in liver cirrhosis patient with advanced periodontitis.

Keywords: Active gingival bleeding, Liver cirrhosis, Dental crown removal, Emergency primary endodontic drainage

References

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Fig. 1.
Abnormal gingival bleeding view in maxillary left first and second molars.(＃26, 27)
jkaoms-36-221f1.tif
Fig. 2.
The crown removal and primary endodontic drainage view on ＃26, 27 teeth.
jkaoms-36-221f2.tif
Fig. 3.
Removed crown view of ＃26, 27 teeth.
jkaoms-36-221f3.tif
Fig. 4.
Wet gauze biting view in the gingival bleeding sites of ＃26, 27 teeth.
jkaoms-36-221f4.tif
Fig. 5.
The pulpal disease progression view toward the periodontal disease.
jkaoms-36-221f5.tif
Fig. 6.
The periodontal disease progression view toward the pulpal disease.
jkaoms-36-221f6.tif
Table 1.
Classification of gingival bleeding disorders

  • 1. Nonthrombocytopenic purpuras

    • a. Vascular wall alteration

      • (1) Scurvy

      • (2) Infections

      • (3) Chemicals

      • (4) Allergy

    • b. Disorders of platelet function

      • (1) Genetic defects

      • (2) Drugs

        • (a) Aspirin

        • (b) NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

        • (c) Alcohol

        • (d) Antibiotics

      • (3) Allergy

      • (4) Autoimmune disease

      • (5) von Willebrand's disease

      • (6) Uremia

  • 2. Thrombocytopenic purpuras

    • a. Primary-idiopathic

    • b. Secondary

      • (1) Chemicals

      • (2) Physical agents (radiation)

      • (3) Systemic disease (leukemia)

      • (4) Metastatic cancer to bone

      • (5) Splenomegaly

      • (6) Drugs

        • (a) Alcohol

        • (b) Thiazide diuretics

        • (c) Estrogens

      • (7) Vasculitis

      • (8) Mechanical prosthetic heart valves

      • (9) Viral or bacterial infections

  • 3. Disorders of coagulation

    • a. Inherited

      • (1) Hemophilia A

      • (2) Hemophilia B

      • (3) Others

    • b. Acquired

      • (1) Liver disease

      • (2) Vitamin deficiency

        • (a) Biliary tract obstruction

        • (b) Malabsorption

        • (c) Excessive use of broad-spectrum antibiotics

      • (3) Anticoagulation drugs

        • (a) Heparin

        • (b) Coumarin

        • (c) Aspirin and NSAIDs

      • (4) DIC (Disseminated Intravascular coagulopathy)

      • (5) Primary fibrinogenolysis
Table 2.
Neuroendocrine response to stress
Adaptive (acute) (Sympathetic dominant) Maladaptive (acute) (Parasympathetic dominant) Maladaptive (chronic) (Psychophyslologic disorder)
Increased heart rate Decreased heart rate Neurodermatitis
Increased blood pressure Decreased blood pressure Peptic ulcer
Increased ventilation Decreased ventilation Ulcerative colitis
Decreased gut motility Increased gut motility Bronchial asthma
Decreased salivation Increased salivation Raynaud's disease
Decreased sweating Increased sweating Dysmenorrhea
Increased skeletal muscle tone Decreased skeletal muscle tone Hypertension
Peripheral vasoconstriction Peripheral vasodilatation Rheumatoid arthritis
Pupillary dilation Pupillary constriction Migraine
Urinary retention Urinary release Paroxysmal tachycardia
Increased blood sugar Decreased CO2 sensitivity Herpetic stomatitis
Dysphoria, alertness Agitation, confusion Myofibrositis syndrome
Table 3.
Gingival bleeding control methods

  • 1. Superficial (slight) gingival bleeding

    • a. Direct digital pressure

    • b. Application of periodontal pack

    • c. Ultrasonic cautery

    • d. Electrocoagulation

  • 2. Moderate gingival bleeding

    • a. Direct suture pressure

    • b. Application of periodontal pack

  • 3. Severe Gingival bleeding

    • a. Clamping and tying of vessels

    • b. Crushing and packing into osseous vesse
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