Objective: This study critically evaluated the role of hemostatic agents following dental extractions, and the benefits they add over conventional hemostatic measures.

Materials and methods: a literature search was conducted, including publications that fulfilled the criteria developed based on the PICOS guidelines; Population: patients who receive simple or surgical tooth extractions, Intervention: the use of hemostatic agents following dental extraction, Control: any type of conventional hemostatic measures (i.e. suture, gauze pressure), Outcome: time to achieve hemostasis following tooth removal, postoperative pain, swelling, or bleeding events, and Study design: randomized/controlled clinical trials.

Results: Twenty-eight articles met the inclusion criteria, and 24 were meta-analyzed. Several types of hemostatic agents were used, namely tissue adhesives made from cyanoacrylate or fibrin, tranexamic acid, hemocoagulase, collagen membrane, HemCon dental dressing, epsilon aminocaproic acid, Surgicel, sponges or plugs composed of gelatin, oxidized cellulose, and fibrin. Newer hemostatic agents were also applied, such as Ankaferd blood stopper, and feracrylum. Hemostatic agents demonstrated significantly shorter time to achieve hemostasis and fewer bleeding events in patients on antithrombotic drugs or with bleeding disorders (WMD= -2.12, 95% CI -2.63 to -1.61, P < 0.00001, and RR 0.61, 95% CI 0.43 to 0.86; P= 0.005, respectively). Furthermore, the use of these agents resulted in significantly less postoperative pain following 3^rd molar surgery in healthy patients (WMD= -0.33, 95% CI -0.65 to -0.02, P = 0.04). Conversely, they did not have any effect on postoperative swelling (WMD= -0.11, 95% CI -0.31 to 0.08, P = 0.26). The time needed to finish the surgical procedure when hemostatic agents were used was shorter but with no significant difference (MD= -78.93, 95% CI -187.35 to 29.49, P = 0.15).

Conclusion: Included studies differ in their methods of reporting bleeding, pain, and swelling. Thus, the results of this article should be confirmed in future research. Within these limitations, it is concluded that hemostatic agents lead to faster hemostasis and fewer postoperative bleeding incidences, compared to conventional hemostatic measures. Their use is highly recommended following dental extractions in patients on antithrombotic drugs or with bleeding disorders, who are likely to develop postoperative hemorrhage events.