CDA Essentials 2015 • Volume 2 • Issue 2

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39 Volume 2 Issue 2 |
Supporting Your Practice
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How to Manage SPONTANEOUS
GINGIVALHEMORRHAGE
Point of Care
Spontaneous gingival hemorrhage
A patient presents with copious gingival bleeding :
– Bleeding is prolonged and cannot be stopped with pressure
– Several such episodes have occurred recently without
provocation
Presentation
Population
• Variable demographics depending upon the nature of the underlying
disorder
• Possible family history of a bleeding disorder
Signs
• Hemorrhage emanating from gingival sulci with minimal or no
provocation (Fig. 1)
• May present with any of the following:
• Submucosal and/or subcutaneous hemorrage (petechiae,
ecchymoses, or hematoma)
• Hyperplasic gingival tissues, oral ulceration and oral infection
(e.g., herpes simplex virus, candidiasis)
• Swollen joints (hemarthrosis)
• Signs of an underlying systemic disease (e.g., jaundice, spider
angiomas, ascites, pallor, lymphadenopathy)
Symptoms
• Prolonged bleeding after injury, trauma or dental/surgical procedures
• Bleeding episodes
• Menorrhagia or postpartum hemorrhage
• Epistaxis
• Gastrointestinal (e.g., hematemesis, melana)
• Fatigue
• Recurrent infections and fever
Investigation
1. Obtain a detailed medical and dental history:
a. Personal and familial history of bleeding problems
b. Dental history: severe or prolonged bleeding following trauma,
extractions or surgical procedures
c. Medications and illnesses that may be associated with excess
bleeding
Hagen Klieb
DMD,MSc, FRCD(C)
Dr. Klieb is a staff oral
pathologist at Sunnybrook
Health Sciences Centre,
a University of Toronto-
affiliated hospital, with
cross appointments in the
departments of dentistry
and anatomic pathology.
Melanie Gilbert
DMD,MSc
Dr. Gilbert is a staff
dentist at Sunnybrook
Health Sciences Centre
with interest in dental
management of the
medically compromised
patient.
hagen.klieb@
The authors have no declared
financial interests.
This article has been peer
reviewed.
Dental Emergency
Scenario