Local Hemostatic Agents are used in Oral cavity after performing dental procedures such as Tooth Extractions, Dental Implants and other Surgical procedures to control excess bleeding from the surgical site. Attaining Hemostasis is very important after any Dental surgical Procedure to make sure proper healing starts, stopping bleeding is very important for primary healing. Hemostasis is the process which involves interactions between multiple factors such as platelets, endothelium and coagulation factors which form a plug to seal the damaged blood vessels to stop bleeding.
There are 4 stages of Hemostasis: Constriction of the blood vessel -> Formation of a temporary platelet plug -> Activation of the coagulation cascade -> Formation of the final clot or fibrin plug.
In some cases such as Hemophilia or lack of Von Willerbrand factor normal clotting of Blood is hindered which leads to excess uncontrolled bleeding from the Surgical site, this is where external Hemostatic agents are needed to help in creating a Final Clot. Let us look at the various types of Local Hemostatic agents which can be used to control or halt the Bleeding. There are other medicines such as Tranexamic Acid (Oral or IV) which is a antifibrinolytic agent to control bleeding which should be used in addition to the local hemostatic agents. Tranexamic acid is also available in the form of a mouthwash.
Types of Hemostatic Agents used in Dentistry:
Absorbable Gelatin Sponge (methylcellulose):
- Trade Name: (Gelfoam)
- Action: Scaffold for blood clot formation
- Used as: Placed in extraction socket and suture the socket to keep it in place
Oxidized regenerated methylcellulose:
- Trade Name: Surgicel
- Action: Binds platelets and chemically precipitates fibrin through low pH
- Used as: Placed in extraction socket (should not be mixed with thrombin)
Highly cross-linked collagen:
- Trade Name: CollaTape
- Action: Stimulates platelet adherence and stabilizes clot, it takes around 4-6 weeks to dissolve
- Used as: Ribbon should be packed into socket and sutured to keep it in place
Preshaped, highly cross-linked collagen plugs:
- Trade Name: CollaPlug
- Action: Stimulates Platelet adherence and stabilizes clot, it takes around 4-6 weeks to dissolve
- Used as: Just place in socket and leave it
Microfibrillar Collagen:
- Trade Name: Avitene
- Action: Stimulates Platelet adherence and stabilizes clot, it takes around 4-6 weeks to dissolve
- Used as: It is available as powder and mixed with saline into desired consistency to place in socket
Bovine thrombin (5000 to 10000 units):
- Trade Name: Thrombostat
- Action: Causes cleavage of fibrinogen to fibrin and faster coagulation cascade
- Used as: It is available as fine powder and mixed with CaCl2 and should be sprayed into the area, it can also be mixed with Gelfoam before application
Thrombin, Gelfoam, CaCl2 and sucralfate:
- Trade Name: Glynns Glue
- Action: Combination of Gelfoam and Thrombin plus sucralfate’s adherent properties
- Used as: Mix the contents and place directly in socket, the socket needs to be sutured to prevent dislodgement
Bovine thrombin, human fibrin, CaCl2 and Aprotinin:
- Trade Name: Tissee
- Action: Antifibrinolytic action of aprotinin
- Used as: Difficult to use as it requires Heating, mixing and a delivery system to be placed into the socket.
Along with the above mentioned hemostatic agents, there are other methods to stop bleeding such as Electric Cautery to ligate the blood vessel to prevent bleeding.
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