What is the BEST immediate management for a patient who develops a hematoma following an inferior alveolar or posterior superior alveolar nerve block?

Correct answer: B. Apply direct pressure and an ice pack to the area

• A. Analgesia may be needed, but ibuprofen inhibits platelet aggregation and is not the primary management of an active hematoma.
• B. CORRECT. IMMEDIATE management is direct pressure over the site plus COLD application. Cold causes vasoconstriction, limiting further extravasation and reducing swelling. Cold is used for the first 24 hours; WARM moist compresses begin AFTER 24 hours to promote resolution of the extravasated blood. Advise the patient about expected bruising and discoloration over 7–14 days.
• C. Incision and drainage is not indicated for a simple hematoma and risks introducing infection.
• D. Heat applied immediately causes vasodilation and INCREASES bleeding into the tissues. Heat is correct only after the first 24 hours.

Note: Ice first 24 hours, heat after. This sequencing is a favorite exam point.