Management of Hemorrhage in Minor Dental Operations- A Systematic Review

Introduction: Hemostasis is the physiological process where in bleeding is stopped at the site of an injury while maintaining normal blood flow elsewhere in the circulation. Hemostatic plug formation is the first step in this process. Blood is maintained in its fluid state by endothelium, but in case of a damaged vessel, components of the subendothelial matrix are exposed to the blood. Many components activate the two main processes of hemostasis to initiate blood clot formation, composed primarily of fibrin and platelets. This process is activated in seconds of injury but must remain localized to the site of injury. Hemorrhage can be a deterrent during surgical procedures and controlling it could be a challenging proposition. Causes for intraoperative hemorrhage may vary considerably and may be dependent on various factors from anatomical to physiological to iatrogenic. Aims: This review focuses on various strategies to manage expected and unexpected bleeding during minor oral surgical procedures. Clinically relevant anatomy, physiology, pharmacology, and surgical and interventional radiology techniques to manage bleeding will be outlined and an algorithm for management of major vessel injury will be presented. Methods: We conducted a search on pubmed, saudi digital library and the cochrane central register of controlled trials databases applying relevant MESH terms from the year 2000 to 2020. We identified studies by screening independent reviewers using the following selection criteria: bleeding, patients undergoing a minor dental operation, original studies and hemostatic intervention Results: 475 articles were featuring the terms we used for search. 40 articles were shortlisted. Ten articles were included in the final review, after evaluation. We found that recent studies believe that HDD is a very effective material of dressing for hemostasis. Along with its hemostatic action, it acts as a pain reliever and also increases the ability to heal. Conclusion: Any minor dental procedure can cause bleeding as a complication post-operatively. Management of the complication is based on how correct the diagnosis is. Referral to a local emergency unit is indicated in some cases when the bleeder is not apparent and the dentist cannot manage the case. So, a good practitioner should know the local services in the region of his work.