CLINICAL PEARLS AND PITFALLS Home remedies for postextraction bleeding including direct pressure to the site of bleeding and application of a moist tea bag Tannic acid in tea may initiate or accelerate coagulation and assist in achieving hemostasis Alveolar osteitis (dry socket) and postextraction infections are very rare in children Hemorrhage It is possible for an extraction site to ooze for to 12 hours, and perhaps longer for a permanent tooth Systemic hematologic abnormalities can often be ruled out through a thorough bleeding history (see Chapter 93 Hematologic Emergencies ), though a complete blood count (CBC) and coagulation profile may be indicated in some cases Rarely is blood loss significant enough to cause hemodynamic changes or risk of airway obstruction; however, the goal of management is to achieve hemostasis as rapidly as possible Emergency treatment to control bleeding may include the following steps: Place a folded 2×2 gauze sponge directly over the open socket, and apply biting pressure directly onto the site for 30 to 60 minutes Avoid the temptation to remove the gauze until the bleeding has stopped, as removal of the material can disrupt any forming clot and may worsen bleeding Most postprocedure bleeding can be successfully treated with this approach If bleeding continues despite effective direct pressure, consider the following approaches: A Suture closure—The aim is to tamponade bleeding by physically closing the socket with sutures First infiltrate local anesthesia (2% lidocaine with 1:100,000 epinephrine infiltration), then approximate the extraction site with 4-0 or 5-0 chromic gut sutures B Topical hemostatic agents or antifibrinolytics can be applied to the site of bleeding Depending on availability and practice patterns, materials such as an absorbable hemostatic agent (e.g., Surgicel), absorbable gelatin compressed sponge (e.g., Gelfoam), fibrin glue, topical thrombin, or tranexamic acid may be used locally Infection Postextraction infection is rare in children If it occurs, it may present as localized swelling or edema surrounded by a zone of erythema, often with purulent exudate within the socket Emergency treatment includes the application of moist heat,