STUDY - Technical - New Dacian's Medicine
Gum
(gingival) bleeding (Classical / Allopathic Medicine)
Gum bleeding
(gingival bleeding) usually results from a dental disorder;
less commonly, it may stem from blood dyscrasia or the effects
of certain drugs. Physiologic causes of this common sign
include pregnancy, which can produce gum swelling in the first
or second trimester (pregnancy epulis); atmospheric pressure
changes, which usually affect divers and aviators; and oral
trauma. Bleeding ranges from slight oozing to life-threatening
hemorrhage. It may be spontaneous, or it may follow trauma.
Occasionally, direct pressure can control it.
ALERT:
If you detect profuse, spontaneous bleeding in the oral cavity:
- quickly check the patient's airway and look for signs of cardiovascular collapses, such as tachycardia and hypotension
- apply direct pressure to the bleeding site, if able
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
If you detect profuse, spontaneous bleeding in the oral cavity:
- quickly check the patient's airway and look for signs of cardiovascular collapses, such as tachycardia and hypotension
- apply direct pressure to the bleeding site, if able
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Ask the patient when the bleeding began and if it has been continuous or intermittent. Does it occur spontaneously or when he brushes his teeth? Have the patient show you the site of the bleeding, if possible.
Review the patient's medical history for bleeding tendencies and a history of liver or spleen disease. Also, ask him if there's a family history of such disorders.
Check the patient's dental history. Ask him how often he brushes his teeth and visits the dentist.
Ask the patient about his normal diet to evaluate his nutritional status.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient when the bleeding began and if it has been continuous or intermittent. Does it occur spontaneously or when he brushes his teeth? Have the patient show you the site of the bleeding, if possible.
Review the patient's medical history for bleeding tendencies and a history of liver or spleen disease. Also, ask him if there's a family history of such disorders.
Check the patient's dental history. Ask him how often he brushes his teeth and visits the dentist.
Ask the patient about his normal diet to evaluate his nutritional status.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Perform a complete oral examination. Examine the gums to determine the site and amount of bleeding.
Check for inflammation, pockets around the teeth, swelling, retraction, hypertrophy, discoloration, and gum hyperplasia.
Note obvious decay; discoloration; foreign material, such as food; and absence of teeth.
Perform a complete oral examination. Examine the gums to determine the site and amount of bleeding.
Check for inflammation, pockets around the teeth, swelling, retraction, hypertrophy, discoloration, and gum hyperplasia.
Note obvious decay; discoloration; foreign material, such as food; and absence of teeth.
SPECIAL
CONSIDERATIONS:
Warfarin and heparin interfere with blood clotting and may cause profuse gum bleeding. Abuse of aspirin and nonsteroidal anti-inflammatory drugs may alter platelet function, producing bleeding gums. Localized gum bleeding may occur with mucosal “aspirin burn,” caused by dissolving aspirin near an aching tooth.
Warfarin and heparin interfere with blood clotting and may cause profuse gum bleeding. Abuse of aspirin and nonsteroidal anti-inflammatory drugs may alter platelet function, producing bleeding gums. Localized gum bleeding may occur with mucosal “aspirin burn,” caused by dissolving aspirin near an aching tooth.
PEDIATRIC
POINTERS:
In neonates, bleeding gums may result from vitamin K deficiency associated with a lack of normal intestinal flora or poor maternal nutrition.
In infants who primarily drink cow's milk and don't receive vitamin supplements, bleeding gums can result from vitamin C deficiency.
In neonates, bleeding gums may result from vitamin K deficiency associated with a lack of normal intestinal flora or poor maternal nutrition.
In infants who primarily drink cow's milk and don't receive vitamin supplements, bleeding gums can result from vitamin C deficiency.
AGING ISSUES:
In patients who have no teeth, constant gum trauma and bleeding may result from using a dental prosthesis.
In patients who have no teeth, constant gum trauma and bleeding may result from using a dental prosthesis.
PATIENT
COUNSELING:
Teach the patient proper mouth and gum care. If he has a chronic disorder that predisposes him to bleed - such as chronic leukemia, cirrhosis, or idiopathic thrombocytopenic purpura - make sure he's aware that bleeding gums may indicate a worsening of his condition, which would require immediate medical attention.
Teach the patient proper mouth and gum care. If he has a chronic disorder that predisposes him to bleed - such as chronic leukemia, cirrhosis, or idiopathic thrombocytopenic purpura - make sure he's aware that bleeding gums may indicate a worsening of his condition, which would require immediate medical attention.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)