Prolonged bleeding after tooth extraction – no evidence on treatment from trials

Tooth extraction is one of the commonest surgical operations undertaken and bleeding normally stops within a few minutes. Post-extraction bleeding (PEB) is a recognised complication where bleeding continues beyond 8 to 12 hours after dental extraction. The incidence of PEB varies 0% to 26% and it can lead to complications ranging from soft tissue haematomas to severe blood loss.

The aim of this review was to assess the effects of interventions for treating different types of post-extraction bleeding.

Methods

Searches were conducted in the Cochrane Oral Health Group Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL the US National Institutes of Health Trials Register, the WHO Clinical Trials Registry Platform and the reference lists of excluded trials.

Randomised controlled trials (RCTs) with participants of any age and either gender, evaluating any intervention for treating post-extraction bleeding (PEB) were considered. Quasi-RCTs, crossover trials and preventive trials were excluded. The primary were bleeding measured by, amount of blood loss, complete cessation of bleeding, as assessed clinically by the investigator, time required for the control of bleeding. Standard Cochrane methodological approaches were planned.

Results

No published or ongoing randomised controlled trials that evaluated interventions for treating post-extraction bleeding was identified.

Conclusions

The authors concluded

We identified no published or ongoing randomised controlled clinical trials on interventions to treat post-extraction bleeding, so it is not possible to present evidence to clinicians or patients. In the absence of any evidence from randomised controlled trials, clinicians should base their decisions on clinical experience, in conjunction with evidence from preventive trials.

Comments

Given that tooth extraction is such a common procedure it is perhaps surprising that no trials have been conducted on the best method of managing PEB. It is not that interventions have not been applied for aside from suturing of the bleeding site a wide range of local non-surgical agents have been used together with the application of local pressure these include (as listed by the review’s authors); gel foam, thrombin, collagen fleeces, cyanoacrylate glue, acrylic or surgical splints local antifibrinolytic solutions, such as tranexamic acid mouthwash fibrin glue or adhesive resorbable gelatin sponge, collagen sponge, gauze soaked with tranexamic acid chlorhexidine bio-adhesive gel, calcium alginate Haemocoagulase, Ankaferd Blood Stopper, green tea extract , Chitosan-based dressings and bone wax. A range of systemic interventions have also been used for those patients with a systemic cause for bleeding.

The authors note that future RCTs should be well designed and reported according to the CONSORT statement . They also highlight vaiarion in the way in which PEB is defined and highlight the need to standardise PEB terminology and its definition.

Links

Primary paper

Sumanth KN, Prashanti E, Aggarwal H, Kumar P, Lingappa A, Muthu MS, Kiran Kumar Krishanappa S. Interventions for treating post-extraction bleeding. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD011930. DOI: 10.1002/14651858.CD011930.pub2.