From: Rachna
Sent: Wednesday, November 30, 2005 4:42 PM
To: ROOTS
Subject: [roots] Bleeding

Any suggestions on causes of bleeding in 35 which has already been opened and cleaned and shaped to size 40. ??
The tooth was diagnosed with irreversible pulpitis and was vital . It was very hard to achieve anesthesia .
The bleeding just continues , might stop for  a few seconds and each time the canal is filed to the working length
it starts and keeps going. I have used Na hypochlorite and no perforation is noted on the x ray. Any advice on how
to proceed??  - Rachna

Closely evaluate and re-evaluate your working length…
Use paper points and the EAL many many times….
Place caoh in the canal to wl and then see patient back in a few days/weeks or so……
Maybe you are long…..
Maybe you have a huge lateral canal
Or
Both…..
Most likely you are long on the WL…. - Craig

Show us the x ray. pre op and operative. pack CaOh and wait for few weeks.
may be you are over preparing also. take a WL xray with a file - Vipin

Bleeding is caused by 3 things:

WL Too long – over- instrumented.  Confirm WL again using EAL, Radiographs and paper point ( if you can dry it enough) 
WL Too short – Pulp stump remnants are bleeding – Confirm WL again as above. Don’t be short. 
Big lateral canal – Use paper point and try to determine location (which side of the root).
Use sharply precurved file to try to drop in to the lateral. Removing the tissue in this area often stops the bleeding.

In 95 % of the cases, the reason is #1 or # 2.  and NaOCL won’t help that. 

In very tough cases cases, you can try hemostatic agents (I prefer H2O2 and paper point apical pressure). Some clinicians
use an intrapulpal LA injection with Epi or other hemostatic agent applied with a paper point. 

Obviously, you can also close the case with CaOH and have that work on the remaining tissues until the next appointment - Rob

Lots of possibilities, some of which are over instrumentation, perforation, over 'extension' of files and on -  Alan 

Hi, Rachna! There was a thread on this IN DT. Mark Dreyer suggested there 
might be some vital pulp tissue ar the apical 2mm. so taking a larger file 
45 or 50 , and cleaning and shaping the area might be prudent  - Vimal

Here is my idea how to stop bleeding
Regards - Michal, Poland








Great idea McGiver!  - Terry

Intermediate dressing in the canals with a mixture of ledermix paste and calcium hydroxide will help as well.
At the next appointment it will be normal working conditions - Stephen Day