Interventions for treating post-extraction bleeding

  • Review
  • Intervention

Authors

  • Sumanth Kumbargere Nagraj,

    Corresponding author
    1. Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Department of Oral Medicine and Oral Radiology, Melaka, Malaysia
    • Sumanth Kumbargere Nagraj, Department of Oral Medicine and Oral Radiology, Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Jalan Batu Hampar, Bukit Baru, Melaka, 75150, Malaysia. sumikn@rediffmail.com. sumikn@yahoo.co.in.

  • Eachempati Prashanti,

    1. Faculty of Dentistry, Melaka-Manipal Medical College, (Manipal Academy of Higher Education), Department of Prosthodontics, Melaka, Malaysia
  • Himanshi Aggarwal,

    1. King George's Medical University, Department of Prosthodontics, Lucknow, Uttar Pradesh, India
  • Ashok Lingappa,

    1. Bapuji Dental College and Hospital, Oral Medicine & Radiology, Davangere, Karnataka, India
  • Murugan S Muthu,

    1. Faculty of Dental Sciences, Sri Ramachandra University, Paediatric Dentistry, Porur, Chennai, India
  • Salian Kiran Kumar Krishanappa,

    1. Faculty of Dentistry, Melaka Manipal Medical College (Manipal Academy of Higher Education), Department of Prosthodontics, Melaka, Malaysia
  • Haszelini Hassan

    1. International Islamic University Malaysia, Department of Oral Maxillofacial Surgery & Oral Diagnosis, Kulliyyah of Dentistry, Kuala Lumpur, Malaysia

Abstract

Background

Post-extraction bleeding (PEB) is a recognised, frequently encountered complication in dental practice, which is defined as bleeding that continues beyond 8 to 12 hours after dental extraction. The incidence of post-extraction bleeding varies from 0% to 26%. If post-extraction bleeding is not managed, complications can range from soft tissue haematomas to severe blood loss. Local causes of bleeding include soft tissue and bone bleeding. Systemic causes include platelet problems, coagulation disorders or excessive fibrinolysis, and inherited or acquired problems (medication induced). There is a wide array of techniques suggested for the treatment of post-extraction bleeding, which include interventions aimed at both local and systemic causes. This is an update of a review published in June 2016.

Objectives

To assess the effects of interventions for treating different types of post-extraction bleeding.

Search methods

Cochrane Oral Health’s Information Specialist searched the following databases: Cochrane Oral Health’s Trials Register (to 24 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 24 January 2018), Embase Ovid (1 May 2015 to 24 January 2018) and CINAHL EBSCO (1937 to 24 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We searched the reference lists of relevant systematic reviews.

Selection criteria

We considered randomised controlled trials (RCTs) that evaluated any intervention for treating PEB, with male or female participants of any age, regardless of type of teeth (anterior or posterior, mandibular or maxillary). Trials could compare one type of intervention with another, with placebo, or with no treatment.

Data collection and analysis

Three pairs of review authors independently screened search records. We obtained full papers for potentially relevant trials. If data had been extracted, we would have followed the methods described in the Cochrane Handbook for Systematic Reviews of Interventions for the statistical analysis.

Main results

We did not find any randomised controlled trial suitable for inclusion in this review.

Authors' conclusions

We were unable to identify any reports of randomised controlled trials that evaluated the effects of different interventions for the treatment of post-extraction bleeding. In view of the lack of reliable evidence on this topic, clinicians must use their clinical experience to determine the most appropriate means of treating this condition, depending on patient-related factors. There is a need for well designed and appropriately conducted clinical trials on this topic, which conform to the CONSORT statement (www.consort-statement.org/).

Plain language summary

Interventions for managing bleeding after tooth removal

Review question

We conducted this review to assess different interventions for treating bleeding after tooth removal.

Background

After tooth extraction, it is normal for the area to bleed and then clot, generally within a few minutes. It is abnormal if bleeding continues without clot formation, or lasts beyond 8 to 12 hours; this is known as post-extraction bleeding (PEB). Such bleeding incidents can cause distress for patients, who might need emergency dental consultations and interventions. The causes of PEB can be local, a systemic disease, or a medication. To control this bleeding, many local and systemic methods have been practised, based on the clinician's expertise. To inform clinicians about the best treatment, evidence is needed from studies where people have been randomly allocated to one of at least two different groups, which receive different treatments, or no treatment (i.e. 'randomised controlled trials' or RCTs).

Study characteristics

Authors working with Cochrane Oral Health updated this review of RCTs that assess interventions to treat bleeding after tooth removal. The original review was published in June 2016. For this version, we searched the medical and dental literature to 24 January 2018. We found no RCTs that met the inclusion criteria for our review.

Key results and quality of the evidence

This review revealed that there is no RCT evidence for the effectiveness of any available intervention for treating post-extraction bleeding. High quality RCTs are needed to help clinicians and patients make informed choices about treatment options.

Резюме на простом языке

Вмешательства для лечения кровотечения после удаления зуба

Вопрос обзора

Мы подготовили этот обзор с целью оценки различных вмешательств для лечения кровотечения после удаления зуба.

Актуальность

Кровотечение в зоне удаления зуба, прекращающееся в течение нескольких минут за счет образования сгустка – нормальное явление. Отклонением является продолжение кровотечения без образования сгустка в течение 8-12 часов; это состояние известно как постэкстракционное кровотечение (ПЭК). Подобные случаи являются стрессовыми для пациентов, которым могут потребоваться неотложные стоматологические консультации и вмешательства. Причины ПЭК могут быть местными, а также связанными с системным заболеванием или приемом лекарств. Для установления контроля над кровотечением на основе опыта врача применяются различные местные и системные методы. Для того чтобы информировать врачей о лучшем варианте лечения, необходимы доказательства из исследований, в которых людей в случайном порядке распределяют в одну из двух или более групп для получения различных вмешательств или же отсутствия лечения (т.е. рандомизированных контролируемых испытаний (РКИ)).

Характеристика исследований

Авторы, работающие с Группой Кокрейн по здоровью полости рта, обновили этот обзор РКИ, посвященных оценке вмешательств для лечения кровотечения после удаления зуба. Первоначальный обзор был опубликован в июне 2016 года. Для этой версии обзора мы провели поиск медицинской и стоматологической литературы вплоть до 24 января 2018 года. Мы не нашли РКИ, отвечавших критериям включения в наш обзор.

Основные результаты и качество доказательств

При подготовке этого обзора было обнаружено отсутствие доказательств из РКИ эффективности любых доступных вмешательств для лечения постэкстракционного кровотечения. Для того чтобы помочь врачам и пациентам принимать информированные решения о вариантах лечения, необходимы РКИ высокого качества.

Заметки по переводу

Перевод: Кукушкин Михаил Евгеньевич. Редактирование: Юдина Екатерина Викторовна. Координация проекта по переводу на русский язык: Cochrane Russia - Кокрейн Россия (филиал Северного Кокрейновского Центра на базе Казанского федерального университета). По вопросам, связанным с этим переводом, пожалуйста, обращайтесь к нам по адресу: cochrane.russia.kpfu@gmail.com; cochranerussia@kpfu.ru

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