Prolonged Bleeding from the Extraction Site
Incidence: 0.6 – 5% with higher incidence in older age groups.
Most patients with a bleeding disorders are diagnosed early in life and their medical history is available to the oral surgeon. Nevertheless, cases are still occasionally diagnosed for the first time following dental extraction.
The majority of patients who bleed after extractions do not have any underlying hæmatological disorder and they generally have had extractions previously without complication, suggesting a purely local factor in the hæmorrhage.
Pre-operative screening of patients with no relevant history for blood-clotting disorders is not an effective means of identifying patients who may bleed postoperatively.
There exists a small group of patients who bleed after dental extractions on each occasion but do not bleed after extra-oral trauma and do not show any abnormality on hæmatologic testing. It has been suggested that oral fibrinolysis, probably of salivary origin, may be responsible for destruction / lysis of the blood clots and consequent hæmorrhage in such patients. Fibrin-stabilising factors, such as ε-aminocaproic acid and transexamic acid may be helpful in these cases.