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The management of bleeding or hemorrhage begins with local measures including pressure with gauze and socket packing (gelfoam, or collagen). Intraoperative bleeding from the surrounding soft tissues can usually be controlled with electrocautery with care taken to avoid any nearby neurovascular structures. Bone bleeding, or bleeding from extraction sockets, can be controlled through a variety of measures. Intra‐alveolar hemostatic agents such as gelfoam, surgicel, microfibrillar collagen (Avitene), Collaplug, Collatape, thrombin, TISEEL fibrin sealant, or bone wax may be used alone, or in various combinations. Oversuturing and primary closure of the extraction site can also assist in hemostasis and serve to contain the various hemostatic agents. Oral rinsing with an antifibrinolytic agent such as Amicar (epsilon‐aminocaproic acid) or Cyclokapron (tranexamic acid) can prevent fibrinolysis and aid in maintenance of an organized blood clot [16].

In the case of prolonged postoperative bleeding, the patient should be instructed to remove loose clots gently and bite firmly and continuously on a moist gauze pack for 30 minutes. If this is unsuccessful, exploration and debridement of the wound should be completed under local anesthesia without vasoconstrictor to allow for a visual diagnosis of the cause of the bleeding. Granulation tissue should be debrided, irregular sharp bony edges removed, and hemostatic agents used within the alveolus to assist in bleeding control. As with intraoperative bleeding, oversuturing and primary would closure can assist in hemostasis and maintenance of the various hemostatic agents within the extraction socket (Algorithm 2.3).