Discussion
Creation of a stabilized clot is of paramount importance for
facilitating unhindered and uneventful healing of the surgical wound
created after tooth extraction. Dormant systemic abnormalities can get
easily triggered by a trivial minor procedure like tooth extraction.
This can lead to ramifications, series of events which can be life
threatening for the patient. Nowadays many patients are on anticoagulant
therapy making them susceptible to post extraction
bleeding.5Such patients invariably are aware of the
medications they are consuming. This makes extraction under controlled
environment possible. People unaware and ignorant about their health
status are like a time bomb which can land them in a state of no
reversal. Chronic alcoholism is such an exigency which requires ardent
attention. It can cause diseases like hepatitis, fatty liver and
cirrhosis. Long standing hepatocellular diseases can predispose to
deficiencies of blood coagulation factors thereby posing as a risk for
occurrence of hemorrhage.6Poor dietary intake in
alcoholics can lead to anemia secondary to folic acid deficiency. Blood
film shows oval and round macrocytes characterizing chronic liver
disease. Such patients are bound to have thrombocytopenia and
deficiencies of coagulation factors. Alcohol is detrimental for bone
marrow which could have led to suspicion of acute myeloid leukemia in
this case. Thrombocytopenia is commonly seen in patients with chronic
liver disease with reports of up to 76% patients having
cirrhosis.7
Chronic alcoholics are at high risk for developing intra-cerebral
hemorrhage due to reduced liver produced coagulation factors and
platelet abnormalities coupled with hypertension.8Instant episode of alcohol consumption along with the stress induced due
to extracted tooth could have led to acute hypertension in this case.
Reduced platelet count in conjunction with their impaired function and
deficient coagulation factors must have triggered an episode of
intra-cerebral hemorrhage.
Operating personals prior to extracting a tooth are very much concerned
about the common systemic conditions like diabetes mellitus and
hypertension. They are extremely cautious about patients on
anticoagulant therapy in wake of any hemorrhagic episode. Alcohol
consumption history is mostly not given the necessary importance and is
often skipped during routine dental extractions. In Indian circumstances
Societal taboo in deriving this history is a major hindrance. More-over
patients too are reluctant to divulge this information. Most of the
operating personal are also unaware of the catastrophic sequelae that
can unravel after a chronic alcoholic gets his tooth removed.
It becomes imperative that operating personal should have sound
knowledge of these manifestations and patients too need to be sensitized
and counselled about these possibilities to prevent any attempt of
self-extracting a tooth.
Conflict of Interest: None
Funding Source: None
Acknowledgement: None
Consent: Written informed consent was obtained from the patient
to publish this report in accordance with the journal’s patient consent
policy.