18 December 2023

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The role of hemostatic agents in dental extractions

Lara Figini

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Dental extraction, simple or complex, is a common procedure in oral and maxillofacial clinical practice and is characterized by various possible complications, both peri- and post-operative. Bleeding is one of the potential post-extraction complications and requires correct and timely management. It can be resolved with conventional hemostatic measures (i.e. pressure via gauze or suture); however, these methods may be insufficient to achieve hemostasis in patients who are at increased risk of bleeding, such as those on oral antithrombotic therapy (OAT) or with bleeding disorders.

Therefore, it is important that dentists and surgeons adopt the safest and most effective measures for managing bleeding in tooth extractions, using additional approaches that provide better bleeding control.

Materials and methods

In a systematic review, published in the Journal of the American Dental Association, the authors evaluated the benefits of topical hemostatic agents in controlling bleeding after tooth extraction, especially in patients undergoing antithrombotic therapy. A literature search was conducted – via Medline (PubMed), Scopus and the Cochrane Central Register of Controlled Trials – of randomized clinical trials on humans in which the authors had compared the effectiveness of haemostatic agents compared to conventional methods, reporting also the time required to achieve hemostasis and post-operative bleeding events.

Results

Seventeen articles met the inclusion criteria. Hemostatic agents were shown to have a significantly greater effect in shorter times both in healthy patients and in patients taking antithrombotic drugs (standardized mean difference –1.02; 95% CI, –1.70 to –0.35 ; P ¼ .003 and mean difference –2.30; 95% CI, –3.20 to –1.39; P < .00001, respectively). 

There were significantly fewer bleeding events when hemostatic agents were used (hazard ratio, 0.62; 95% CI, 0.44 to 0.88; P ¼ .007).

All forms of hemostatic agents (i.e., mouthwashes, gels, hemostatic plugs, and gauze soaked in the agent) had better efficacy in reducing the number of postoperative bleeding events than conventional hemostasis measures, with the exception of hemostatic sponges.

However, these data are based on a small number of studies for each subgroup.

Conclusions

From the data of this review, which must be confirmed in other similar studies and reviews, it can be concluded that the use of hemostatic agents offers better control of bleeding after dental extractions in patients on chronic therapy with antithrombotic drugs compared to conventional methods.