Control of Bleeding During Tooth Removal
lntraoperative (primary) control of bleeding when extracting teeth is predicated upon gaining control of all factors that may prolong bleeding. Surgery should be as atraumatic as possible. Carefully placed incisions and gentle management of soft tissue is paramount in this endeavor. Great care should be taken to avoid crushing soft tissue, because crushed tissue can lead to prolonged periods of oozing. Sharp bony edges should be smoothed, trimmed or removed. All granulation tissue should be carefully removed from the socket, necks of adjacent teeth and on the internal aspect of soft tissue flaps. The soft tissue, especially the periosteum, should be carefully inspected for the presence of specific bleeding vessels. If identified, the bleeding should be controlled with direct pressure. If this fails, clamping the bleeder with a hemostat followed by suture ligation is necessary. An alternate means for soft tissue hemostasis is discrete use of cautery to coagulate the bleeding vessels.