Postextraction bleeding is not uncommon. Dislodgment of the clot may result in recurrent or continued bleeding. Generally, firm pressure applied to the extraction site is adequate to control bleeding. This is best accomplished by neatly folding a 2 * 2 gauze pad and placing it over the extraction site, applying firm pressure by clenching firmly with the opposing teeth. This pressure must be held firmly, not a chewing action, for 20 min or until hemostasis is complete. Also, pressure with a used tea bag aids hemostasis because the tannic acid is a natural hemostatic agent. If direct pressure is not successful, then application of Gel-Foam, Avitene, or Instat to the socket may provide a matrix for clot formation. Sutures should be used for holding such agents in place or to close the gingiva over the socket. The gingiva should not be closed under pressure, especially along the suture line, since this may result in necrosis of the gingival flap. If these methods are unsuccessful, the vasoconstrictive effect of direct instillation of lidocaine with epinephrine may aid hemostasis. Finally, if hemostasis still cannot be obtained, then oral and maxillofacial surgical consultation becomes necessary.
Bleeding may occur after periodontal surgery secondary to underlying clotting abnormalities or from dislodgment or instability of the periodontal packing. It is important that the practitioner who performed the surgical procedure be contacted to direct care because positioning of the periodontal flap is critical for successful therapy.
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