Tea Bags for Controlling Postoperative Bleeding after Extraction of Teeth: A Review of Literature

ABSTRACT

One of the most common invasive oral procedures performed in routine dental practice is tooth extraction, and post-extraction bleeding (PEB) is a recognized and commonly occurring complication. Many different methods have been proposed to address PEB. When compared to other topical hemostatic medicines, green tea has become an effective substitute. This article provides a brief review on the use of tea bags as topical hemostasis agent dental surgeons may wish to take advantage of.

INTRODUCTION

One of the most frequent invasive oral surgical procedures performed in a regular dental office is tooth extraction.[1] Post-extraction bleeding (PEB) is a known and common consequence.[2] It is common for the area to bleed and then clot after tooth extraction, usually in a few minutes.[3] Bleeding or oozing frequently happens right after a tooth extraction. In most situations, this bleeding is easily controllable.

PEB is abnormal if the bleeding persists for more than 8 to 12 hours or if no clot forms.[4] PEB may result from a medication side effect, a systemic disease, or a local reason.[4] Bleeding that happens within a few hours after the extraction is frequently caused by the local anesthetic solution’s vasoconstrictor effect wearing off.[5] Because the tissues of the oral cavity are extremely vascular and the open socket is exposed to the patient’s exploring tongue and fingers, it can be difficult to achieve complete hemostasis.[6]

Depending on the clinician’s experience, a variety of systemic and local techniques have been used to stop this bleeding. PEB is frequently controlled by applying direct pressure over the bleeding site by having the patient bite down on a folded piece of moist gauze.[5,6]

PEB is defined as “evidence of bleeding beyond the pressure pack” by Amer[3] (2014). In order to define PEB, Lockhart[7] (2003) suggested four criteria, which are as follows:

1. Continues for more than 12 hours;

2. Causes the patient to visit the accident and emergency room, call the dentist again, or both;

3. Causes an ecchymosis or massive hematoma to form in the soft tissues of the mouth; or

4. Necessitates hospitalization, a blood transfusion, or both.

Bleeding or oozing frequently happens right after a tooth extraction. In most situations, this bleeding is easily controllable.[5,8] It is critical to differentiate between oozing and active bleeding from the surgery site. If bleeding does not stop after the extraction of teeth, it can present as simple oozing at the extraction site to severe intraoral hematomas that compromises the airway, causing anemia and hypovolemia, which can be a life-threatening condition.[9] Prior to the patient leaving the clinic, achieving hemostasis at the dental extraction site is considered to be necessary.[2]

The timing of post-extraction hemorrhage can be used to classify it. Primary hemorrhage is the type of bleeding that happens during surgery and reactionary hemorrhage that occurs 2 to 3 hours following the procedure and is caused by the cessation of vasoconstriction, while secondary hemorrhage may occur up to 14 days following surgery. This is most likely the result of an infection.[10,11] The site of the hemorrhage can also be used to categorize it: soft tissue, bone, or vascular.[2] PEB has been classified by Abdullah as mild (oozing), moderate (bleeding that continues on the second day following extraction), and severe (any bleeding that necessitates transfer to the hospital).[12]

Numerous causes of PEB have been identified, and they can be broadly divided into two categories: local and systemic.[1,13] Local bleeding from soft tissue or bone might result from post-extraction hemorrhage. Traumatic extraction may result in soft tissue hemorrhage and rupture of the capillary, venous, or arterial blood vessels. Either the central blood vessels or the nutrient canals may be the source of bone or osseous bleeding. Platelet problems, coagulation abnormalities or excessive fibrinolysis, and hereditary or acquired problems (caused by medication) are examples of systemic causes.[1,13]

Usually, conventional procedures (such as stitches and gauze/cotton pressure) are used to control PEB.[14] The bleeding can be stopped using a variety of hemostatic procedures, including topical hemostatic medications, thermal techniques (such as electrocauterization or laser cauterization), and mechanical approaches (such as manual pressure, ligature, and suture).[9] Mechanical techniques may not be adequate, particularly for patients with coagulopathies or anticoagulant medication, whereas thermal procedures may result in bone necrosis and tissue damage or be difficult to apply in places with limited accessibility. To stop bleeding in these situations, topical hemostatic medications can be applied in conjunction with gauze packing and sutures.[9]

Oxidized cellulose, resorbable gelatin sponges, collagen sponges, fibrin glue, cyanoacrylate glue, platelet-rich plasma gel, calcium alginate, and chitosan are the hemostatic agents that are employed intra-alveolarly.[15] Tranexamic acid, an antifibrinolytic, is also utilized in mouthwashes.[16] Ankaferd Blood Stopper,[3] bone wax, green tea extract,[17] and hemocoagulase[18] are also used to control postoperative bleeding after tooth extraction. Dentists use astringents such ferrous sulfate and AlCl3 because they produce less tissue damage.[19,20]

A natural beverage produced from the Camellia sinensis plant, green tea, is consumed around the world, particularly in Saudi Arabia, China, Japan, and Morocco.[21,22] Green tea, a potent source of polyphenolic, flavonoid, and other antioxidants, is made without heating or fermenting.[23,24]

The leaves of the Camellia sinensis plant are used to make tea, which is the most popular beverage in the world after water. The amount of oxidized components determines whether it is classified as black tea, oolong tea, or green tea.[25,26] Green tea’s manufacturing procedure prevents the compounds found in green leaves from oxidizing.[27]

Numerous studies have demonstrated several therapeutic advantages of green tea, including its high anti-inflammatory, anticarcinogenic, antibacterial, and neuroprotective characteristics.[26,28,29] Many of tea’s beneficial qualities, such as its antioxidant effects, are attributed to tannins. Additionally, they may impact hemostasis, shorten the duration of bleeding, and promote the healing of wounds.[30,31,32]

This article provides a brief review of tea bags as topical hemostasis agents dental surgeons may wish to take advantage.

METHODOLOGY

The relevant literature was comprehensively searched through PubMed and google scholar from start until December 2024 using the following terms: Tea, Green Tea, Tea bags, Tannins, hemostasis, astringent agent, extraction, and minor surgery.

DISCUSSION

In the past, tanniferous plants including tea, pomegranates, and hamamelis were employed as vasoconstrictors to stop bleeding. One of their uses was to treat gingival and menstrual bleeding.[17,33]

Camellia sinensis, or tea, is one of the most widely consumed drinks worldwide and is grown in the majority of Asian nations with climates that are suitable for it. There are more than 200 components in green tea, a product of Camellia sinensis. It mostly includes flavonol glycosides, catechins, and caffeine.[25] It is an infusion derived from Camellia sinensis leaves.[26] The amount of oxidized components determines whether it falls into the category as black tea, oolong tea, or green tea.[27]

Numerous studies have demonstrated several therapeutic advantages of green tea, including its strong anti-inflammatory, anticarcinogenic, antibacterial, and antiviral actions and neuroprotective properties.[26,28,29] Additionally, they can influence hemostasis, shorten the duration of bleeding, and accelerate the healing of wounds.[34] Because tannic acid causes vasoconstriction, it prevents mucous membrane bleeding.[35]

Tannin as an astringent

Astringents are substances that cause tissues to contract or draw together. The characteristics of tannins include constricting blood arteries and open capillaries, as well as promoting blood coagulation and clotting.[36]

Tannins are bitter, astringent plant polyphenols that can shrink or bind proteins and cause precipitation. After having strong tea, one may have a dry and puckery mouth due to the astringency of the tannins.[37] Tea “tannins” differ chemically from other plant tannins, such as tannic acid.[38] There is a difference between tannins and tannic acid; tannic acid is not present in tea, and tea contains tannins other than tannic acid.[38]

Astringents are frequently used internally to decrease the discharge of blood serum and mucous fluids by constricting or contracting mucous membranes and exposed tissues. Astringents applied externally dry, harden, and protect the skin by mildly coagulating the skin’s proteins.[39] A thin layer forms on the surface of the injured tissue when an astringent comes into contact with it, and the superficial membranes and blood vessels contract, causing the tissue to shrink and causing protein precipitation.[40,41]

Soltani et al.[17] This randomized controlled experiment found that using gauzes soaked in green tea following tooth extraction considerably reduced the amount of time that the socket bled. According to the study’s findings, green tea extract greatly reduces the resulting oozing and stops socket bleeding brought on by tooth extraction.

Habibullah W[42] (2023) evaluated the effectiveness of green tea and chlorhexidine mouthwashes in reducing post-extraction complications such as pain and bleeding. It can be concluded from this study that green tea is significantly effective in reducing the time for complete hemostasis and pain after tooth extraction.

Tea bags

Any tea leaf will brew a “tart” (astringent) flavor that is typical of tannins when steeped in hot water. The catechins and other flavonoids are responsible for this.[41] To the best of my knowledge, the study by Sowmya M[43] (2024) is the only study among the four studies[17,42,44] in relation to this review, where commercially available tea bags have been used as a hemostatic agent after extraction of teeth to control the bleeding.

Abraham MA[45] (2016) advised gentle curettage of the tooth extraction socket and remove areas of old blood clot or granulation tissue, and a tea bag is placed over the previous extraction socket for 30 min for patients reporting back with post-extraction hemorrhage after tooth extraction. According to Chan M and Grossman S[46] (2021), when the patient complains of postoperative bleeding and when they had already used up all their gauze pressure packs, the use of a tea bag can successfully control their bleeding, consequently avoiding the patient from attending the Emergency Department at the hospital, especially those patients who reside in remote areas, where there is lack of medical facilities.

Ashley KF[47] (2024) and Morgan IJ[48] (2017) stressed that a damp warm tea bag will work faster than a cold one by accelerating the clotting process, especially those patients who are living in rural areas or the facilities for dental treatment are not available in their areas.

Procedure to control postoperative oozing after tooth extraction

1. Use a green tea bag as it contains the highest concentration of tannins.

2. Boil the tea bag in water for a few minutes to release the tannins.

3. Let the tea bag cool down until it is warm but not hot.

4. Place the cooled, damp tea bag directly over the extraction site.

5. Bite down on the tea bag gently to keep it in place for about 20–30 minutes.

6. Check the bleeding; if it continues, repeat the process with a fresh tea bag.

CONCLUSION

The technique of applying pressure and encouraging hemostasis of the extraction site by substituting tea bags for gauze packs can control the postoperative oozing after a tooth extraction.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.