Management (general and specific)

Bleeding sockets are often managed with combination local measures, including:

• Application of damp gauze
• Application of gauze soaked in tranexamic acid or adrenaline (or adrenaline containing local anaesthetic)
• Use of heamostatic agents such as hemocollagen or surgicel
• Use of resorbable sutures (these are best placed by experienced operators and is beyond the scope of this module to teach how to suture intra-orally). Readers should note that suturing intra-orally can be challenging due to the limited space available for manoeuvring of instruments
• Local infiltration of adrenaline (often with a local anaesthetic)
• Review of anticoagulation regimes if appropriate. Note that the bleeding risk must be weighed up with the risk of thrombo-embolic event. Reversal of these agents can be considered, but there is a poor evidence base for reveral of factor Xa and factor 2 inhibitors (e.g. rivaroxaban, dabigatran)
• Use of devices such as bipolar machines (although this is often not required)
• Consider the use of a 5% tranexamic mouthrinse to be used 4x daily as a prophylactic measure afterwards.

Dry sockets are best managed by irrigating the area with saline, and then placing aveogyl, which is a dressing material containing eugenol, which helps relieve pain and aid healing. It should be noted that the use of chlorhexidine as a direct socket irrigant has results in 2 deaths in the UK due to previously unknown allergy, and therefore current guidance is not to use chlorhexidine for socket irrigation.