Electrocautery, laser, pressure or isolation, and application of a hemostat with ligation can be employed to curb soft-tissue hemorrhage. Local anesthetic with a vasoconstrictor can be employed, but it will cause vessels to constrict if used locally, and the dentist then may not be able to locate the source of the bleeding. Sometimes the patient experiences rebound hemorrhage with recurrent, bothersome bleeding. In this case, a hemostat should be used to clamp off the vessel and tie it with suture material. When a wound is closed, bleeding should already be under control because the sutures used to create pressure on the surface area cause tissue necrosis. Problems can often be averted when the patient is informed ahead of time of what to expect with regard to normal bleeding and oozing. If slight problems occur, the need for pressure should be emphasized. The patient can apply pressure to the site by biting down on a gauze pad or by manually pressing on the site with a hand or finger. The patient can also bite down on a soaked tea bag. This old-fashioned yet effective home remedy helps control bleeding in the mouth. The tea bag acts like a sponge, and the tea leaves release tannic acid, which promotes vasoconstriction (Abraham et al., 2016). In cases of more severe bleeding requiring the patient to be seen after hours, it is important to debride the area. Then the dental practitioner can locate the source of the bleeding, apply pressure, and employ one of the previously outlined modalities to control the problem. help eliminate nausea. Codeine phosphate and erythromycin are common causes of drug-related nausea. Codeine can be replaced by synthetic agents, and erythromycin can be replaced with an enteric-coated version. assistant to use a sling grasp to stabilize the mandible. Should the jaw require manual reduction by the dentist, their hands should be kept off the occlusal surfaces of the teeth. As the jaw is reduced with downward and backward motions, the teeth may snap into occlusion. Thus, the dentist’s hands should remain in the oral vestibule at all times. The patient should be advised to refrain from yawning or opening their mouth widely and should remain on a soft diet for one week. length of time involved in removing the tooth should also be considered. Following the surgical procedure, the wound should be thoroughly debrided and irrigated using large quantities of sterile saline. The incidence of dry socket can also be decreased by preoperative and postoperative antimicrobial mouth rinses, such as chlorhexidine (Rohe & Schlam, 2022). Well-controlled studies indicate that the incidence of dry socket after extractions, including impacted mandibular third molar surgery, can be reduced when chlorhexidine is used (Cho et al., 2017; Halabi et al., 2018; Shaban et al., 2014). It takes between 10 and 14 days for the epithelium to migrate into and cover the exposed bony walls of the alveolus. Any interim treatment is palliative. The dentist must first irrigate the socket with saline to verify that it is devoid of a clot. Sometimes the patient must be given an anesthetic block. Thorough irrigation is critical because the clot can break down or dissolve but remain in the socket. On quick inspection, the dental practitioner may not see the clot and may mistakenly rule out fibrinolytic alveolitis. After irrigation, some form of iodoform gauze containing a sedative, such as eugenol, and a topical anesthetic may be placed to sedate and anesthetize the nerve fibers exposed in
If hemorrhage persists and thorough inspection of the socket reveals no arterial hemorrhaging, the dentist should take additional measures. Several commercial preparations designed to help control hemorrhage by application directly into the socket are available. An effective and inexpensive option is the use of an absorbable gelatin sponge (Passarelli et al., 2018). When placed into the socket and held in place with a suture, the sponge forms a scaffold that in turn forms a clot. Because the sponge becomes friable once in contact with blood or saliva, it must be compressed into compact pieces before placement. Sutures help maintain the sponge in position during coagulation. The practitioner then places a gauze pack and holds it in position to maintain pressure at the site. Another material used to control hemorrhage is oxidized regenerated cellulose (Ali et al., 2022). This substance promotes coagulation more than the absorbable gelatin sponge does. It can also be packed into the socket under pressure. However, when the cellulose is packed in the socket, it almost always causes delayed wound healing. Thus, packing the socket with cellulose is used only for more persistent bleeding cases. If bleeding is arising from the bone, the dentist may apply direct pressure or crush the foramen with the back of a periosteal elevator and/or curette, occluding the bleeding vessel. The practitioner may also use sterile bone wax to burnish the bony area. However, bone wax is poorly absorbed and thus may act as a nidus for a postoperative infection. Nausea Postoperative nausea resulting from oral surgery can occur when the patient swallows blood either during the procedure or postoperatively (Dobbeleir et al., 2018). The use of narcotics or antibiotics may also cause nausea. Patients should be instructed to take all prescribed antibiotics and analgesics with food to Dislocation of the condyles Lengthy oral surgical procedures may cause dislocation of the condyles. The shorter the time between the surgical procedure and the condylar reduction, the more likely its success. With passing time, the muscles tend to tighten, making a reduction more difficult. The potential for dislocation can be lessened by using a bite block during surgery, as well as limiting the length of the surgery. Another technique for mandibular extractions is to employ the Fibrinolytic alveolitis (dry socket) Fibrinolytic alveolitis, alveolar osteitis, or dry socket syndrome is an oral surgical complication often presenting between the first and fifth day postoperatively (Rohe & Schlam, 2022). It is usually characterized by sharp, constant, throbbing pain that often radiates into the ear and keeps the patient awake at night. Usually, the pain subsides immediately after surgery and then increases significantly on the second or third postoperative day. The etiology of dry socket appears to be the result of high fibrinolytic activity in and around the extraction site. This activity results in lysis of the alveolar blood clot, with subsequent exposure of the bone. This may be the result of trauma, subclinical infection, inflammation of the marrow space of the bone, or other factors. Contributing factors include age, gender, oral contraceptive use, tobacco use, preexisting infection or inflammation, and type and number of extractions (Garola et al., 2021; Rohe & Schlam, 2022). While ranges of 0.5%–5% and as high as 68% have been reported, it is sufficient to note that dry sockets occur at a higher rate upon the extractions of impactions of mandibular third molars compared to the routine extractions of other teeth (Garola et al., 2021; Rohe & Schlam, 2022). Prevention of dry socket syndrome requires the dentist to minimize trauma and bacterial contamination at the surgical site. The dentist should perform atraumatic surgery with clean, full-thickness incisions and atraumatic soft-tissue reflection. The
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