To Evaluate the Duration of Pressure Pack Placement Following Tooth Extraction to Achieve Haemostasis- a Randomised Controlled Clinical Trial

Abstract

Tooth removal is one of the most common dental procedures done in routine dental practice. Often, dental surgeons are challenged with controlling inadvertent bleeding after a tooth removal. Placing a rolled bundle of moist gauze over the region and instructing the patient to apply bite pressure over the gauze pack is the most common manoeuvre to control bleeding that is routinely performed. Often, dentists advise patients to bite and hold the gauze for about an hour. There is no unanimity among practitioners regarding the ideal time duration for which the bite pressure needs to be applied. Primary control of bleeding occurs by contraction of blood vessels and platelet plug formation, which occludes the vessels lining the socket. This occurs in the first few minutes (4 to 9 minutes). The formation and stabilization of clot is an important but secondary aspect for control of bleeding which takes about an hour. This study aims at answering the question 'Does control of bleeding following tooth removal require the fibrin clot formation and stabilization or is platelet plug formation sufficient?‘ An awareness of the average time duration required for bleeding to stop after tooth removal is required in dental practice and control of bleeding is an essential skill in dentistry. This study aims at quantifying the average time required for control of bleeding from a tooth extraction socket. If bleeding stops within 5 to 10 minutes, it would be advisable for all patients who undergo tooth removal to have their sockets checked for bleeding before being sent home. The need to check for prolonged bleeding has become more necessary in recent times because more patients are on blood thinners. Sometimes they may be unaware themselves or they may misinform the dentist prior to the procedure. If the dentist could remove the pressure pack and ensure that the bleeding has stopped prior to sending the patient home, it could avoid the possible sequelae of persistent bleeding following pack removal at home. Informing the patient that the bleeding has stopped and instructing the patient of care of tooth extraction socket forms an important aspect of risk management.