dental disorders
Postextraction Problems
Bleeding
Postextraction bleeding usually occurs in the small vessels. Any clots extending out of the socket are removed with gauze, and a 4-inch gauze pad (folded) or a tea bag (which contains tannic acid) is placed over the socket. Then the patient is instructed to apply continuous pressure by biting for 1 hour. The procedure may have to be repeated 2 or 3 times. Patients are told to wait at least 1 hour before checking the site so as not to disrupt clot formation. They also are informed that a few drops of blood diluted in a mouth full of saliva appear to be more blood than is actually present. If bleeding continues, the site may be anesthetized by nerve block or local infiltration with 2%lidocainecontaining 1:100,000epinephrine. The socket is then curetted to remove the existing clot and to freshen the bone and is irrigated with normal saline. Then the area is sutured under gentle tension. Local hemostatic agents, such as oxidized cellulose, topicalthrombinon a gelatin sponge, or microfibrillar collagen, may be placed in the socket before suturing. , direct-acting oral anticoagulants) need not stop therapy before dental surgery ( References ). In those who are at increased risk of bleeding due to comorbid disease or in those undergoing more extensive procedures, consulting with their patient's physician about timing of antiplatelet or anticoagulant dosing or a brief 24- to 48-hour interruption in therapy is indicated 