Report treatment of the most severe episode

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AVERAGE PRESENTATION

Type of bleeding                                 Tooth eruption/loss Gums, spontaneous Gums, after brushing Prolonged bleeding after

bites to lip & tongue

Hemorrhagic bullae

REPORT TREATMENT OF THE MOST SEVERE EPISODE

Required medical attention?                  Yes                                          No  If yes, please specify:

Consultation only

Surgical hemostasis                                              # of times

Antifibrinolytics                                                      # of times

Desmopressin                                                        # of times

Replacement therapy                                             # of times

Blood transfusion                                                  # of times

Notes

Tooth extraction

No

If Yes,  Trivial

Significant

Significant: Any bleeding occurring after leaving the dentist’s office or prolonged bleeding causing a delay in discharge from the dentist’s office.

Total # of teeth extracted

# of teeth extracted followed by bleeding

MOST SEVERE OCCURRENCE

Age at extraction

Type of extraction

Deciduous Permanent

Prophylaxis before extraction

?

None Antifibrinolytics Desmopressin

Replacement therapy

Bleeding after extraction?

Yes

No

Actions taken to control bleeding

None Consultation only Resuturing Packing Antifibrinolytics Desmopressin

Replacement therapy Blood transfusion

Notes

Gastrointestinal bleeding

No       Yes  (N

.B.: All GI bleeding is considered to be significant.)

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