Wound healing following dental extractions in rabbits: effects of tranexamic acid, warfarin anti-coagulation, and socket packing

We have investigated the importance of the coagulation and fibrinolytic systems for wound healing following dental extractions. Four front teeth were extracted in rabbits; wound healing was measured as time until complete epithelial closure. The antifibrinolytic agent tranexamic acid shortened duration of wound healing in normal rabbits. Anti-coagulation with warfarin delayed epithelial closure, which was, however, normalized by simultaneous administration of tranexamic acid, whereas complete packing of the socket with oxidized cellulose had no corrective effect. Apical packing together with tranexamic acid gave normal healing. It is concluded that the quality of the fibrin network within the dental socket determines the rate of wound healing; oxidized cellulose is not an adequate substitute for fibrin.     

Influence of anticoagulation on blood loss following dental extractions.

The coagulation activity level at which oral surgery procedures can be performed in anticoagulated patients without triggering bleeding complications and without enhancing the risk of developing thrombo-embolic events remains controversial. The objective of the present study was to evaluate blood loss following dental extractions at different levels of anticoagulation and to determine its effect on wound closure rates. Blood loss was measured following the removal of four front teeth in warfarinized rabbits. Immediate blood loss was evaluated by determining the tooth socket bleeding times and by using a technique based on hemoglobin determinations. Long-term blood loss was assessed by comparison of labeled red-blood-cell disappearance curves. The results showed that blood loss following dental extractions was significantly greater in animals anticoagulated at a therapeutic level than in non-anticoagulated control animals. Determination of blood loss at different levels of anticoagulation clearly demonstrated that complete correction of the coagulation activity was unnecessary. Partial correction (INR values of 1.6-1.8) allowed extractions to be performed without extensive blood loss. With this technique of partial correction, the period of interruption of the anticoagulation could be kept very short, and the risk of postoperative bleeding complications was minimal. Wound closure rates were negatively influenced in anticoagulated animals.     

Blood loss following dental extractions in anticoagulated rabbits: effects of tranexamic acid and socket packing

The present study demonstrates the feasibility of chronic anticoagulation in rabbits and of estimating the resulting increase in blood loss following extraction of four front teeth from labeled red cell disappearance curves. This setup proved useful for the evaluation of hemostatic techniques. Socket packing with oxidized cellulose soaked in thrombin solution or local application of cyanobutylacrylate reduced early blood loss; oral administration of tranexamic acid reduced both early and late bleeding; the combination of socket packing and oral tranexamic acid completely abolished the excessive blood loss that resulted from anticoagulation alone.     

An evaluation of complications following dental extractions using either sterile or clean gloves

This randomized prospective study aims to evaluate any differences in the postoperative infection rate from dental extraction using either sterile or clean surgical gloves and to determine any predisposing factors that may complicate socket healing. A total of 609 patients were randomly assigned to two groups, with the operators wearing either sterile or clean gloves in performing forcep extractions. 551 patients, who had 811 extractions performed, returned for the postoperative assessment visit. There was no difference in the incidence of an acutely inflamed socket, acutely infected socket and dry socket and also no significant predisposing factors found between the sterile and clean glove groups. The pre-operative diagnosis of caries, periodontal disease or retained root had a higher tendency of producing an acute-inflamed socket, whereas an acutely infected socket only developed in the cases of retained root. On the pain intensity level, an acutely inflamed socket caused mild to moderate pain, on acutely infected socket caused moderate to severe pain; and a dry socket caused severe pain in the majority of cases. The study concluded that the use of sterile surgical gloves does not offer an advantage over clean gloves in minimizing socket inflammation, infection, as well as a dry socket following dental extraction.     

The healing socket and socket regeneration

Tooth extraction is a common procedure in dentistry. The normal healing response to the procedure results in a significant loss of bone and collapse of the surrounding gingiva. In addition to normal healing, a substantial percentage of extraction sites suffer postoperative complications. This article presents histology that supports the concept that the first response to extraction is bone death and resorption of the socket wall. The stages of extraction socket healing also will be discussed. Additionally, the article will present a regenerative method that skips the resorptive phase, the clotting phase, the granulation of tissue phase, and the collagen-producing phase of normal extraction-socket healing, while avoiding extraction-socket complications.     

Experimental endocarditis following dental extractions in rats with periodontitis

This study analyzed the development of bacterial endocarditis following dental extraction in rats with periodontal disease. Periodontal disease was produced in rats by tying silk ligatures around the two maxillary first molars, and placing the animals on a high sucrose diet. Sterile aortic valve vegetations were produced by means of a transaortic catheter, and 24 hours later the maxillary first molars were extracted. The animals were killed 72 hours after the extractions. In rats with periodontal disease induced for 10 and 14 weeks, extractions resulted in an incidence of bacterial endocarditis of 24% and 50%, respectively, most of which were due to streptococcal species (two were caused by Staphylococcus [corrected] aureus). The difference, though not statistically significant (p = 0.10, chi 2 with Yates correction), shows a trend toward increased incidence of endocarditis with increasing severity of periodontal disease. This model demonstrates that one can reliably induce bacterial endocarditis after dental extractions in rats with periodontal disease.     

Prevalence, duration and aetiology of bacteraemia following dental extractions

OBJECTIVE: To investigate the prevalence, duration and aetiology of bacteraemia following dental extractions, analysing the factors affecting its development. SUBJECTS AND METHODS: The study group was composed of 53 patients undergoing dental extractions under general anaesthesia. Peripheral venous blood samples were collected at baseline and at 30 s, 15 min and 1 h after the dental extractions. Samples were inoculated into BACTEC PLUS aerobic and anaerobic blood culture bottles and were processed in Bactec 9240. Subculture and further identification of the bacteria isolated was performed by conventional microbiological techniques. RESULTS: The prevalence of bacteraemia following dental extractions was 96.2% at 30 s, 64.2% at 15 min and 20% at 1 h after completing the surgical procedure. The bacteria most frequently identified in the positive blood cultures were Streptococcus spp. (63.8%), particularly Streptococcus viridans. CONCLUSIONS: In our series, the majority of patients undergoing dental extractions developed bacteraemia, usually of a streptococcal nature, independently of the grade of oral health and of the number of extractions performed. Positive blood cultures persisted for at least 1 h after the dental procedure in a considerable number of patients, questioning the supposedly transient nature of bacteraemia following dental extractions.     

Risk of postoperative bleeding following dental extractions in patients on antithrombotic treatment

IntroductionThe risk of bleeding after dental extractions in patients taking antithrombotic medication is not well known. This study aims to investigate the incidence of postoperative bleeding following dental extractions in adult patients taking antithrombotic medication in Saudi Arabia.MethodsThis retrospective study included 539 patients aged 18–93 years who attended 840 appointments for dental extractions from January 2012 to June 2016 at a tertiary care hospital in Saudi Arabia. Patients who returned with a complaint of bleeding were treated with local hemostatic measures as outpatients.Results and Conclusion: Only 1.7% of extraction appointments were associated with postoperative bleeding. The highest risk of bleeding was noted in patients receiving warfarin (3.88%), whereas those on clopidogrel had no significant risk of bleeding. Women were found to have the highest rate of bleeding, particularly those on newer oral anticoagulant medications.Dental extractions can be safely done in adults receiving antithrombotic treatment, provided established guidelines are followed; therefore, dental professionals must exercise caution when planning invasive dental treatment for patients on continued antithrombotic therapy.     

Comparative study of the effect of warm saline mouth rinse on complications after dental extractions

The aim of the present study was to determine the effect of saline mouth rinse on postoperative complications following routine dental extractions. Patients aged ≥16 years, who were referred to the oral surgery clinic with an indication for non-surgical extraction of pathologic teeth, were prospectively and uniformly randomized into three groups. Group A (n = 40) were instructed to gargle six times daily with warm saline and group B (n = 40) twice daily; group C (n = 40) were not instructed to gargle with warm saline and served as controls. Information on demographic characteristics, indications for extraction, and the development of complications, such as alveolar osteitis, acute inflamed socket, and acute infected socket, was obtained and analyzed. There were no significant differences between patients who gargled six times daily with warm saline and those who gargled twice daily with reference to either alveolar osteitis or acute inflamed socket (P > 0.05). However saline mouth rinses at either frequency were beneficial in the prevention of alveolar osteitis in comparison with those who did not rinse. A twice-daily saline mouth rinse regimen is more convenient, and patient compliance may be better than with a six times daily rinse regimen.     

The effect of prior radiation therapy for treatment of nasopharyngeal cancer on wound healing following extractions: incidence of complications and risk factors

This is a prospective study of wound healing after extractions in patients who had radiation therapy for nasopharyngeal cancer. From 40 patients who fulfilled all the study criteria were extracted a total of 155 teeth. The demographic data were analysed, checking for factors that might affect the healing process after extraction. Wound healing was divided into three groups: normal wound healing, delayed healing and osteoradionecrosis. Logistic regression was used to analyse possible relationships. There was a low complication rate: 5.8% and 1.9% of extractions showed delayed healing and osteoradionecrosis, respectively. The age of the patient at time of extraction was the only significant factor that influenced the occurrence of delayed healing. It was observed that localized radiation absorption was considerably different from the total radiation dose. In conclusion, postradiation extractions have a low risk of complications and the results point to age as a factor that may influence wound healing.     

Oral amoxicillin/clavulanate for the prevention of bacteremia following dental extractions

This study aimed to evaluate the effectiveness of oral amoxicillin/clavulanate (AMX-CL) for the prevention of bacteremia following dental extractions. The study group (AMX-CLG) comprised 40 adults requiring dental extractions under general anesthesia who were administered a prophylactic regimen of 1875/125 mg of AMX-CL orally 1–2 h prior to the surgery. Venous blood samples were collected from each patient at baseline and at 30 s and 15 min after dental extractions. Samples were inoculated into BACTEC Plus culture bottles and processed in the BACTEC 9240. Conventional microbiological techniques were used for subcultures and further identification of the isolated bacteria. The results for the AMX-CLG were compared with those of a control group (CG; no prophylaxis) and an amoxicillin group (AMXG; 2 g of amoxicillin orally), consisting of randomly selected patients from among those participating in two clinical trials that we have previously published. The prevalence of bacteremia in the CG, AMXG, and AMX-CLG was 97%, 50%, and 15%, respectively, at 30 s after completing the extractions, and 67%, 10%, and 4% at 15 min, respectively, after the last extraction. The prevalence of bacteremia in the AMXG and the AMX-CLG at 30 s and at 15 min after completing the extractions was significantly lower than that in the CG (p < 0.001 and p < 0.001, respectively; Fisher’s exact test). The prevalence of bacteremia in the AMX-CLG at 30 s after completing the extractions was significantly lower than that in the AMXG (p < 0.001; Fisher’s exact test). Based in the results of this preliminary study, oral AMX-CL could be an excellent option for preventing bacteremia secondary to dental procedures in patients at risk.     

Densitometric analysis of the autogenous demineralized dentin matrix on the dental socket wound healing process in humans

The aim of this study was to evaluate the effects of the autogenous demineralized dentin matrix (ADDM) on the third molar socket wound healing process in humans, using the guided bone regeneration technique and a polytetrafluoroethylene barrier (PTFE). Twenty-seven dental sockets were divided into three groups: dental socket (Control), dental socket with PTFE barrier (PTFE), and dental socket with ADDM slices associated to PTFE barrier (ADDM + PTFE). The dental sockets were submitted to radiographic bone densitometry analysis and statistical analysis on the 15th, 30th, 60th and 90th days using analysis of variance (ANOVA) and Tukey's test (p < or = 0.05). The radiographic analysis of the ADDM + PTFE group showed greater homogeneity of bone radiopacity than the Control group and the PTFE group, during all the observation times. The dentin matrix gradually disappeared from the dental socket during the course of the repair process, suggesting its resorption during the bone remodeling process. It was concluded that the radiographic bone density of the dental sockets treated with ADDM was similar to that of the surrounding normal bone on the 90th day. The ADDM was biocompatible with the bone tissue of the surgical wounds of human dental sockets. The radiographic analysis revealed that the repair process was discreetly faster in the ADDM + PTFE group than in the Control and PTFE groups, although the difference was not statistically significant. In addition, the radiographic image of the ADDM + PTFE group suggested that its bone architecture was better than that of the Control and PFTE groups.     

A retrospective,single-center cohort study on complications after dental extractions in patients taking biologic agents

BackgroundAlthough biologic agents represent a growing class of therapeutics, little is known about how these agents affect the provision of dental treatment.MethodsThis retrospective case-control study analyzed patients undergoing dental extraction treated with biologic agents from 2017 through 2020. Complications within 30 days postextraction were recorded.ResultsOne-hundred twenty-one patients were treated during 147 encounters. Fifteen patients experienced complications during 16 encounters. Notable or excessive pain was most common (14/16; 88%). Patients who experienced complications were treated with 7 biologic agents: dulaglutide, belimumab, adalimumab, aflibercept, tofacitinib, ranibizumab, and ixekizumab. Complication after extraction—specifically, pain—was elevated for patients receiving aflibercept and ranibizumab. When grouped by class, complications were more common with vascular endothelial growth factor antagonism.ConclusionsThe impact of biologics on the provision of and recovery after dental treatment remains unknown. Pain was most commonly reported. Patients treated with vascular endothelial growth factor antagonists experienced an elevated rate of complications.Practical ImplicationsThis study provides preliminary data on how patients taking biologic agents heal after dental extraction. It is limited by small sample sizes. Further work will build on this data to determine appropriate management of patients taking biologics in the dental setting.     

Influence of platelet rich fibrin on post-extraction socket healing: A clinical and radiographic study

Aim

The aim of this study was to evaluate clinically and radiographically, extraction socket healing using autologous platelet rich fibrin (PRF).