Bleeding after tooth extraction
Treatment tactics depend on the cause of the blood clotting disorder. General hemostatic therapy includes the following approaches:
- Decreased prothrombin level (in liver pathologies): menadione sodium bisulfite (Vikasol) is used.
- High fibrinolytic activity: epsilon-aminocaproic acid is prescribed.
- Increased vascular permeability or anticoagulant overdose: rutoside (Rutin) is indicated.
- Emergency arrest: etamsylate (Dicynone) is used for a rapid effect.
- Hypertension: local hemostasis is supplemented with antihypertensive therapy, as normalization of blood pressure contributes to bleeding cessation.
If the bleeding is prolonged and heavy, urgent hospitalization and transfusion of blood or its components under the control of a coagulogram are required.
Socket pain and alveolitis
Physiological pain after surgery is minor and resolves quickly. If sharp pain that is not relieved by analgesics occurs within 1–3 days, this is pathological. The main cause is alveolitis (inflammation of the socket).
Predisposing factors for alveolitis:
- Absence or destruction of the blood clot.
- Traumatic extraction.
- Infection, dental deposits, or bone fragments entering the wound.
Clinically, at the initial stage, there is aching pain, gum redness, and breakdown of the clot. Subsequently, pain increases, irradiating along the branches of the trigeminal nerve, and body temperature rises. Local treatment consists of antiseptic irrigation, blockades, and the application of therapeutic dressings until complete resolution of inflammation.
Localized osteomyelitis of the socket
If alveolitis therapy is ineffective, the process may progress to localized osteomyelitis — a purulent-necrotic inflammation of the alveolar bone tissue.
Symptoms include acute throbbing pain, weakness, elevated temperature (from 37.6 °C), soft tissue edema, and lymphadenitis. Necrotic masses with a foul odor are detected in the socket. When lower molars are affected, mouth opening may be restricted. Radiologically, small sequestra are revealed after 20–25 days.
Treatment of the acute phase includes socket revision, antiseptic treatment with enzymes or bacteriophages, wound closure with an Alvogyl dressing, blockades, and general antibacterial therapy. In protracted cases (presence of sequestra), surgical curettage is required.
Other local complications
Neuropathy of the inferior alveolar nerve occurs during the extraction of lower molars due to the proximity of the roots to the mandibular canal (elevator trauma). It manifests as numbness of the lip and chin and decreased sensitivity. Treatment includes B vitamins (thiamine, riboflavin, cyanocobalamin), physiotherapy, and bendazol injections.
Sharp edges of the alveolus cause pain in 1–2 days when the gum edges come together and are traumatized by the protruding bone. Treatment involves alveolectomy: flap elevation and smoothing of the bone with a bur.
Exposure of the alveolar bone area occurs with mucosal trauma. It is treated by trimming the exposed bone and closing the defect with a flap or packing.
Briefly: answers to topical questions
What local hemostatic agents are placed into the socket to stop bleeding?
For local hemostasis, the following are placed into the socket:
- Iodoform gauze strip (turunda) for tight packing of the socket.
- Antiseptic hemostatic sponge.
- Dry plasma.
- Oxycelodex hemostatic gauze.
- Gauze soaked in thrombin solution, hemophobin, epsilon-aminocaproic acid, or Caprofer preparation.
What specific physiotherapeutic methods are used to treat inferior alveolar nerve neuropathy?
Several specific physiotherapeutic methods are used to treat inferior alveolar nerve neuropathy.
As symptomatic therapy for severe pain, the following are prescribed:
- Pulsed current physiotherapy is used to relieve pain syndrome.
- UVD (ultraviolet irradiation) is used for a similar purpose.
To restore the function of the damaged nerve, the following are used:
- Electrophoresis is performed with a 2% lidocaine solution (5–6 procedures of 20 minutes each) or a combination of a 2% anesthetic solution and a 6% thiamine solution (5–10 procedures of 20 minutes each).
Class and exam questions
Under what conditions are teeth extracted in patients with hemorrhagic diathesis?
Extraction is performed strictly in an inpatient setting in conjunction with a hematologist, with mandatory preoperative preparation (hemostatics, plasma transfusion) and placement of a protective splint.
What is strictly prohibited to do to keep the hemostatic agent in the socket?
Suturing the gum edges is contraindicated, as punctures of the mucous membrane will become an additional source of bleeding.
How to distinguish alveolitis from a protruding sharp bone edge?
In the case of a sharp bone edge in the socket, an organizing clot is present and signs of inflammation are absent, but palpation of the protruding edge causes sharp pain.
What drugs are prescribed to stimulate immunity after acute inflammation subsides?
Multivitamins and nonspecific resistance stimulants are prescribed: dioxomethyltetrahydropyrimidine (Methyluracil), pentoxyl, sodium nucleinate.
What else to study on this topic
- Absolute and relative indications for tooth extraction
- Classification and design of dental forceps
- Indications for the use of various elevators (straight, angled, Lecluse)
- Stages of tooth extraction surgery and evaluation of hemostasis quality
- Ergonomics and correct positioning of the surgeon during molar extraction
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Other topics in "Chapter 14. Tooth Extraction"
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