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BackgroundThere is a lack of evidence-based practice regarding the duration of pressure pack placement following tooth extraction. This study aimed to compare the incidence of post-extraction bleeding following 60 minutes versus 10 minutes of pressure pack placement. MethodologyA randomized controlled trial was conducted at a tertiary care hospital and included patients requiring intraalveolar tooth extractions. Patients were randomly allocated into the experimental group or control group by a permuted block randomization method. A blinded observer noted the incidence of post-extraction bleeding. Categorical variables were summarized as frequency and percentage. The chi-square test was used for intergroup statistical analysis. P-values <0.05 were considered statistically significant. ResultsThere were 528 participants, 264 of whom were allocated to each group. The incidence of post-extraction bleeding was 8% and 6.8% in the experimental and control groups, respectively. On bivariate analysis, there was no statistically significant difference between the two groups (p = 0.618; relative risk with 95% confidence interval = 1.0). ConclusionsIn the majority of cases, hemostasis was achieved in 10 minutes. Therefore, removing the pressure pack after 10 minutes may be advised to ensure hemostasis and, ultimately, save chairside time.

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Obstructive parotitis usually occurs as a painful, unilateral swelling of the cheek with a decreased salivary flow and pus discharge, when secondarily infected. The known causes for this condition include commonly, sialoliths, strictures, and/or stenosis of the duct. Imaging in patients with obstructive parotitis has multifactorial benefits ranging from diagnosis to localisation thus, enabling preoperative planning. A 43-year-old female patient presented with features suggestive of obstructive parotitis with secondary infection. The diagnosis was confirmed by Ultrasonography (USG) and a Radiovisiograph (RVG) was performed to localise the sialolith. The patient was admitted and treated with supportive therapy in the form of intravenous antibiotics, milking of the gland, and adequate hydration. Sialolithotomy was scheduled following the resolution of the acute phase of infection. Repeat USG and RVG were performed on the day of surgery to confirm the position of the sialolith but the sialolith could not be located. A panoramic radiograph was performed to confirm the absence of the sialolith. The planned procedure was cancelled, and the patient was continued on systemic antibiotic therapy and anti-inflammatory medication for three more days. On follow-up, copious serous saliva could be expressed from the duct. This highlights the importance of repeating preoperative imaging in patients who have received supportive therapy including gland massage.

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