No evidence from randomized controlled trials on how to treat bleeding after tooth extraction

After tooth extraction, it is normal for the area to bleed and then clot, generally within a few minutes. It is abnormal if bleeding continues without clot formation, or lasts beyond 8 to 12 hours; this is known as post-extraction bleeding (PEB). Such bleeding incidents can cause distress for patients, who might need emergency dental consultations and interventions. The causes of PEB can be local, a systemic disease, or a medication. To control this bleeding, many local and systemic methods have been practised, based on the clinician’s expertise. To inform clinicians about the best treatment, evidence is needed from studies where people have been randomly allocated to one of at least two different groups, which receive different treatments, or no treatment (i.e. ‘randomised controlled trials’ or RCTs).

What was the research?

A systematic review of the evidence to to assess different interventions for treating bleeding after tooth removal.

Who conducted the research?

The research was conducted by a team led by Kumbargere N Sumanth from Melaka-Manipal Medical College, Malaysia, on behalf of Cochrane Oral Health. Eachempati Prashanti, Himanshi Aggarwal, Ashok Lingappa, Murugan S Muthu, Salian Kiran Kumar Krishanappa and Haszelini Hassan were also on the team.

What evidence was included in the review?

We searched medical and dental literature up to 24 January 2018. We found no RCTs that met the inclusion criteria for this review.

This review revealed that there is no RCT evidence for the effectiveness of any available treatment for treating post-extraction bleeding. High quality RCTs are needed to help clinicians and patients make informed choices about treatment options.

What are the implications for dentists and the general public?

It is not possible to present evidence from RCTs to clinicians or patients. In the absence of any evidence from randomized controlled trials, clinicians should base their decisions on clinical experience, in conjunction with evidence from preventive trials.

What should researchers look at in the future?

There is a need for robust clinical trials to evaluate the effects of interventions for the treatment of post-extraction bleeding. Future randomized controlled trials should focus on interventions to control bleeding in patients after the extraction, and in whom no preventive interventions have been advocated. This will help us understand the best intervention strategy to be used if an emergency situation arises post-extraction. Any future trials should be well designed and reported according to the CONSORT statement (http://www.consort-statement.org/).

Link

Sumanth KN, Prashanti E, Aggarwal H, Kumar P, Lingappa A, Muthu MS, Kiran Kumar Krishanappa S. Interventions for treating post-extraction bleeding. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD011930. DOI: 10.1002/14651858.CD011930.pub2.

This blog post is based on the review’s plain language summary and was compiled at the Cochrane Oral Health Editorial Base by Anne Littlewood