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.