| Tooth extraction is the most basic and common technique of oral surgery,and the postoperative hemorrhage is one of the common complications.The reasons of postoperative hemorrhage after tooth extraction have both local and systemic factors.The local factors include gingival mucosa laceration,alveolar bone fracture,improper postoperative nursing,foreign matter residue in socket,local inflammation and infection,which are also the main reasons.The postoperative hemorrhage usually makes the patients and their family members suffering with anxiety or pain.The improper treatment could even lead to a large amount of bleeding and other complications.Although systemic factors of hemorrhage after extraction were rare,the causes were complicated and the treatment was relatively difficult.Therefore,oral surgeons should pay much attention to them.Some patients who suffering from cardiac and cerebrovascular diseases need take oral antithrombotic drugs to prevent and treat the thrombus,which is the main systemic factor.However,Antithrombotic drugs can affect the body’s normal blood clotting mechanism,and lengthen the time of the blood coagulation,which increases the risk of intraoperative and postoperative bleeding.To avoid and reduce the risk of postoperative hemorrhage after tooth extraction,previous views suggest the patients to stop taking the antithrombotic drugs for several days before extraction.However,the serious complications such as thrombosis and embolism by the withdrawal of the drugs should be paid more attention.Thus,for these patients taking oral antithrombotic drugs,further research and discussion need to be done based on these questions: how to evaluate the risks of hemorrhage after extraction,how to enhance the feasibility of keeping taking antithrombotic drugs,as well as what kind of topical hemostatic measures should be taken to effectively reduce the patients’ risk of hemorrhage after extraction with continuing taking oral antithrombotic drugs.This study collected 113 tooth extraction cases in the Department of Oral Surgery of our hospital.All the cases received the Department of General Dentistry and Emergency because of hemorrhage after tooth extraction from October 2010 to October 2015.And we selected 120 patients taking aspirin long-term,120 patients without using any antithrombotic drugs and 100 patients taking warfarin long-term in Department of Oral Surgery of our hospital as the research object from January 2016 to December 2016.Firstly,we reviewed and analyzed the bleeding reasons,features and treatment results from 113 postextraction bleeding patients receiving emergency treatment.Secondly,we investigated and analyzed the risk factors of postoperative hemorrhage after tooth extraction in middle aged and elderly patients taking aspirin long-term and the feasibility of keeping taking antithrombotic drugs.At last,we discussed and analyzed the effects of oxidized regenerated cellulose(Surgicel)which was packed in the sockets to reduce the risks of postoperative hemorrhage after tooth extraction,with continuing taking warfarin.The study was divided into three parts:Part 1 The clinical analysis of postoperative bleeding emergency treatment:This study included 113 patients who had tooth extraction in Department of Oral Surgery of our hospital.All the cases received the treatment in the Department of General Dentistry and Emergency because of hemorrhage after tooth extraction from October 2010 to October 2015.As the results showed:1.90.27% of hemorrhage after tooth extraction were local factors,while the systemic factors were 9.73% including 6 cases with oral antithrombotic drugs(5.31%).2.The local reasons of post-extraction bleeding included gingival mucosa laceration,alveolar bone fracture,improper postoperative nursing,foreign matter residue in socket,local inflammation and infection.The systemic factors included oral antithrombotic drugs,coagulation disorders,etc.3.In this study,75.22% of the patients were below 45 years old and 24.78% were middle aged and elderly patients including 10 cases aged 45-59 years,11 cases aged 60-74 years and 7 cases over 74 years.4.98.22% cases were complicated or impacted/embedded teeth.83.19% of the bleeding occurred in molar area with trauma large,and the embedded third molar accounted for 46.90%.And 48.67% of the teeth were extracted by the surgeons lack of clinical experience.5.110 cases were given effective hemostatic measures after compression,suture,gauze packed and other emergency local treatment.The other 3 cases were transferred to further medicine treatment.Part 2 Risk factors analysis of postoperative hemorrhage after tooth extraction in middle aged and elderly patients taking long-term aspirin:Middle aged and elderly patients taking aspirin long-term(120 cases)and without the uses of antithrombotic drugs in recent 6 months(120 cases)were separately assigned as the experimental group and the control group from January 2016 to June 2016.The difference of hemorrhage rate after tooth extraction between two groups were analyzed on the gender,age,international normalized ratio(INR),number of platelets,the number of tooth extraction,tooth position,the complexity of surgery and operation time,respectively.As the results showed:1.The hemorrhage rate of the experimental group(13.33%)was significantly higher than the control group(3.33%)(P <0.05).2.In both gender and age groups,the hemorrhage rate of the experimental group was higher than the control group.However,only the result of 75-80 years’ group had statistical significance(P <0.05).3.There was no significant difference in the hemorrhage rate between the experimental group and the control group in the INR and the platelet count groups.4.Cases concerning extraction of more than 3 teeth,the molar and complicated tooth or impacted/embedded tooth groups,and operation time between 5-10 min,the hemorrhage rate of experimental group was significantly higher than the control group(P < 0.05).The results of Logistic regression analysis showed that the number of tooth extraction,tooth position and the complexity of surgery had a significant correlation of the hemorrhage after tooth extraction(P < 0.05).Part 3 Clinical analysis on the effects of oxidized regenerated cellulosein reducing risks of post-extraction hemorrhage in patients taking long-term warfarin:One hundred patients taking warfarin long-term were selected and randomizedly divided into the experimental group and the control group from January 2016 to December 2016.Surgicel was packed inside the extraction socket in the experimental group,while absorbable gelatin sponge in the control group.The differences of hemorrhage rate after tooth extraction between two groups were analyzed from the gender,age,INR,tooth position and the complexity of surgery.As the results showed:1.The hemorrhage rate of the experimental group(2%)was significantly lower than the control group(16%)(P <0.05).2.There was only 1 case of hemorrhage after tooth extraction in the experimental group.The male group of hemorrhage after tooth extraction rates were higher than the female in the control group,but there was no statistically significant difference(P>0.05).The rate of control group of hemorrhage after tooth extraction had a rising trend as the increase of age and INR(P <0.05).3.There was only 1 case of hemorrhage after tooth extraction in the maxillary molar in the experimental group.In the control group,the molar group had a higher rate than the premolar group which was also higher than the anterior group,and the complicated tooth group was higher than the simple tooth,which had significant differences(P < 0.05).Conclusion:The local factors of hemorrhage after tooth extraction are more common than the systemic factors.The improper treatment measures may lead to a large amount of bleeding and serious complications.Thus dental surgeon should attach great importance to it.In addition to the traumatic factors such as the number of tooth extraction,tooth position and the complexity of surgery,aspirin can increase the hemorrhage rate after tooth extraction in middle-aged and elderly patients who taking it for a long-term,which is one of the risk factors for the hemorrhage after tooth extraction.It is relatively safe for the patients without interrupting of taking aspirin when having less than 4 simple teeth extraction with less trauma.It is relatively safe to have simple teeth extraction without interrupting in the patients taking long-term warfarin whose INR is no more than 3.5.Surgicel can effectively reduce the rate of hemorrhage after tooth extraction in these patients. |
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