Hemostatic agents are drug treatments that contain chemicals that stop active bleeding by inducing a blood clot. In the dental office, hemostatic agents play an important role in managing bleeding during dental operations, as well as coagulation in patients with coagulation disorders. Hemostatic agents are also commonly used after tooth extraction in cases where bleeding after extraction persists past ~60 minutes.
Surgicel
CollaPlug
Gelfoam
Bone wax
Surgicel is composed of a plant-derived oxidized cellulose polymer. When placed physically on an open wound the cellulose polymer breaks down, lowering the pH of the area thereby lowering likelihood of infection. After being placed on the infection, it stimulates the production of thrombin and fibrinogen, promoting coagulation of the blood, then forms a seal that prevents bleeding. The advantages of Surgicel are its efficiency in sealing a wound, however tooth extractions treated with Surgicel have shown a higher prevalence of dry socket.
CollaPlug is an absorbable bovine-derived collagen material that can be used to full tissue voids. It is commonly used after tooth extraction to prevent bone reabsorption. It works by accumulating platelets to promote clotting, much better than many other hemostats, however is more prone to infection because it is collagen based.
Gelfoam is composed of a porcine-derived oxidized cellulose that works as a compressed gelatin sponge. It works as a physical hemostat, absorbing blood. Gelfoam is commonly used to fill space after tooth extraction (i.e. pack the wound), thereby protecting clot formation and preventing infection.
Bone wax is composed of 85-90% sterile white bees’ wax and 10-15% isopropyl palmitate. It is non-water soluble, which means it cannot be reabsorbed after application. It can be effectively used as a hemostat for those who are on anticoagulants, as it does not interfere with the drugs mechanisms.
Most hemostatic agents are insufficient when used alone to close a wound, however when used in conjunction with sutures can significantly reduce the local bleeding postoperatively. One study found that among 124 patients on anticoagulants that underwent a tooth extraction, only 4% returned with postoperative bleeding.
Below is a combined cost analysis of the above hemostatic agents.
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