Knowledge, Attitude and Practice Regarding the Management of Bleeding after Tooth Extraction Among Dental Students, Interns and Dentists in Saudi Arabia

Exodontia is the process of using surgical equipment to remove a tooth from the alveolar socket and any supporting structures [1]. During tooth extraction surgery, bleeding is a frequent symptom and can be caused by several conditions, including hepatitis, hemophilia, high blood pressure and other illnesses [2]. Before beginning extractions, a full history is crucial so that the appropriate safety measures may be taken beforehand [3]. Inherited bleeding disorders such as hemophilia or von Willebrand disease (VWD) are characterized by spontaneous bleeding, impaired hemostasis and a high risk of intra- or postoperative bleeding [4].

Medication such as anticoagulants and antiplatelets increases the risk of bleeding after surgery [5]. After extraction, bleeding could occur due to complications and if it is not treated effectively quickly, it could not only cause intolerable pain in patients but also cause shock and other adverse reactions [6]. Several treatment plans, including pressure packs, sutures, antifibrinolytic medicines, plasma-rich platelets, fibrin sealant dressings and powder clots, have been employed to control complications following surgery [7].

Studies have been published on the knowledge, importance and management of uncontrolled bleeding in dental surgical procedures among dental professionals. This research included 166 people aged 21 and above. 92.8% of participants were aware of some of the medical problems related to uncontrollable bleeding during dental surgical procedures, whereas the remainder were uninformed or unsure. 92.2% of participants agreed that medical history is crucial in dental surgical operations, while the remainder disagreed [8]. According to the survey, 93.4% of students routinely perform extractions in their practices. Among those, 32.5% have faced issues and just 20% are confident in dealing with them. The remaining 64.8% of students who have not had issues are not confident in managing them in Prasad et al. [9]. In 2020. The study revealed that 33.33% of interns and final-year students but only 4% of third-year students, were familiar with hemostatic medications.30% of interns, 28% of final-year interns and 16.67% of third year were familiar with prophylactic FFP transfusions. This demonstrates that interns are more knowledgeable on how to deal with bleeding problems [10].

In this study, our objective is to determine the knowledge, attitude and practice regarding the management of bleeding post-extraction among dental students, interns and dentists in Saudi Arabia.

Objectives

In this study, our objective is to determine the knowledge, attitude and practice regarding the management of bleeding post-extraction among dental students, interns and dentists in Saudi Arabia.

Study Design and Setting

This is a cross-sectional study followed STROBE guidelines, conducted in Saudi Arabia between July 2024 to February 2025. The study's participants were dental students, interns and dentists, both male and female, in the Kingdom of Saudi Arabia.

Sample Size

Using an estimated sample size of 384 and a suitable error of 5%, the 95% Confidence Level. Standard deviation (= 1.96) was taken into consideration, getting the following Q: (1-0.50) = 50%.

Therefore, the expected minimum sample size required for the research is n = (1.96)^2X 0.50X0.50/(0.50)^2 = 384 persons.

Inclusion and Exclusion Criteria

For inclusion criteria were as follows: Dental students, interns and dentists who live in Saudi Arabia and agree to participate in this study. Exclusion criteria are any non-dental practitioners.

Method for Data Collection, Instrument and Score System

First of data collection was done in the form of the participants' responses to the questions. The questionnaire included demographic features such age, gender, specialty, Region and visit reasons (such as emergency or referral or checkup) Second is Awareness of bleeding disorders and their management participants were asked about them. Did the patient encounter any bleeding No disorder patient before if yes, how did you manage this Perform the procedure without the case physician consent, causes of hemophilia A and about the Von Willebrand disease classified Management of Von Willebrand disease patients is similar to patients with Hemophilia A in your opinion, what is the best measure to stop bleeding [11]. Also, they were asked about the safest analgesic for patients with Bleeding disorders [11]. The last part is an Assessment of knowledge about bleeding disorders and their management with Standard Therapeutic Target Range (STTR) for patients taking warfarin and aspirin and about the minimal duration for Aspirin and warfarin termination before the dental procedure [12]. Our questionnaire was developed after rigorous Author TAA did the Conceptualization and searched for articles of a similar kind.

Scoring System

In all, 22 statements served to assess the participants' attitudes and degree of knowledge. 6 statements for demographics, 16 for knowledge, one point was given for correct answers and zero points were given for incorrect answers. The original Bloom's cut-off points, were 80.0%-100.0%, 60.0%-79% and 59.0%, The participants were divided into the knowledge score varied from 0 to 19 points and were classified into three levels as follows: those with a score of 11 or below (≤11) were classified as having a low level of knowledge, those with scores between 12 and 14 as having a moderate level of knowledge and those with scores 15 or above (≥15) as a high level of knowledge.

Pilot Test

The questionnaire was distributed to 20 individuals and asked to fill it out. This was done in an attempt to assess the study's viability and the simplicity of use of the questionnaire. The pilot study's results were excluded from the study's final review.

Analysis and Entry Method

After being gathered, the data were loaded into an Excel sheet and statistical analysis was performed using SPSS version 20. A chi-square test was conducted. A significance threshold of p<0.05 was applied.

Table 1 displays various demographic parameters of the participants with a total number of (394). The mean age of

Table 1: Sociodemographic characteristics of participants (n = 394)

Figure 1: Illustrates knowledge about the benefits of dental awareness of bleeding disorders across Saudi Arabia

the cohort is 24.7 years, standard deviation of 3.6, implying that the sample is relatively young with the aging of 49% of the sample in the range of 23 to 24 years, i.e., 37.3%. It is almost in favor of the gender; females increased by 50.3% and males rose by 49.7%. Participants come from throughout the country, most geographically from the Southern Region (49.0%) but with a minority distribution to the Northern (6.6%) and Eastern (9.9%) Regions. The overwhelmingly majority (97.2%) are Saudi nationals, thus, a highly localized demographic. Overall, as per the academic levels, participants in their sixth year of study (31.7%) are found to be in a relatively higher proportion and participants are also classified into the majority performance category with excellent GPA (38.3%).

As shown in Figure 1, Out of 394 respondents 64.21%, 253 of them rated the knowledge they have about the benefits of dental awareness for bleeding disorders in Saudi Arabia as high. In contrast, 35.79% (141 people) rated their knowledge to be low.

Table 2 shows the data in a complete overview of what know, what attitude and what the practices done by dental students, interns and practicing dentists in Saudi Arabia consist of a sample size of 394 persons. Almost half (57.1%) of the respondents stated that they have come across patients with bleeding disorders, thus reflecting a good deal of exposure to this essential aspect of dental practice. The large majority (83.8%) knew safe analgesics for patients with such disorders and a very large proportion (84.0%) recognized direct pressure to be the primary method of managing prolonged bleeding, indicating a good basic understanding of hemostatic techniques. In addition, 80.7 percent of respondents admitted that diurnal blood pressure variation affects control of bleeding, illustrating an awareness of the patient’s physiology. While, however, 41.9% deemed their knowledge of bleeding disorders to be good, a startling 89.8% expressed that they wanted to further educate themselves through lectures and workshops.

As shown in Figure 2, The data further reveals that 75.89% (299 individuals) strongly agreed medical history has a significant role to play in dental surgical procedures. Furthermore, 19.80% (78 people) agree with this statement, making a total agreement of 95.69%. However, 4.31% (17) are still neutral (5.79%) while 2.03% (8) support right-wing populist 5.79%) and 2.27% (9) supported populist left (5.79%).

Table 2: Parameters related to knowledge, attitude, and practice regarding management of bleeding after tooth extraction among Dental students, interns and dentists in Saudi Arabia (n = 394)

*Results may overlap

Table 3: Shows knowledge regarding the management of bleeding after tooth extraction score results

Figure 2: Illustrates whether importance of medical history in dental surgical procedures among participants

Table 3 presents the data regarding knowledge of bleeding post-tooth extraction management, offers useful insight into the knowledge and preparedness with which individuals in this important area of dental care can understand and go prepared about this critical one. Interestingly, 45.9% of respondents showed a high level of knowledge of appropriate bleeding management strategies, denoting a level of understanding of the appropriate methodology. However, while 31.0% exhibited moderate knowledge, suggesting there is room for improvement through targeted educational interventions. Nevertheless, this ought to be taken as seriously as the fact that 23.1% of participants had low knowledge.

Table 4 shows that knowledge regarding the management of bleeding after tooth extraction has a

Table 4: Relation between knowledge regarding management of bleeding after tooth extraction and sociodemographic characteristics

*p-value was considered significant if ≤0.05

statistically significant relation to gender (p-value = 0.027), residential region (p-value = 0.0001), academic level (p- value = 0.011) and GPA (p-value = 0.014). It also shows a statistically insignificant relation to age and nationality.

The present study aimed to evaluate the knowledge, attitudes and practices of dental students, interns and practitioners in Saudi Arabia concerning the management of bleeding following tooth extraction. This is a very important topic as uncontrolled bleeding can cause significant morbidity and complications during dental procedures. Our findings show that dental professionals had a mixed level of awareness and preparedness in this area, in line with previous research in this area. A large share of our participants, 64.21%, rated their knowledge of bleeding disorders as high, an encouraging sign for their foundational knowledge. Despite this, the fact that 35.79% reported low levels of knowledge levels dampens a little, as there is still a huge gap to be filled here. These findings are consistent with those of Eltohami, who found that most dentists knew the correct protocols for local measures to control postoperative bleeding but a large number lacked full knowledge on how to manage patients on anticoagulant therapy, such as warfarin [13]. Additionally, our work found that only 41.9% of participants reported that they had good knowledge, similar to what Alsheef et al. [14] noted in the education needs of dental professionals managing patients on antithrombotic medications.

Significantly encouraging was exposure of our participants to patients with bleeding disorders; a staggering 57.1 percent of them should have engaged one. It is very important, for practical use and enhances theoretical. In a manner parallel to this, Kalsi et al. [15] emphasized the significance of practical fields in the management of patients with inherited bleeding disorders and believed that continued affiliation with such cases could improve dentists' fidelity and competency in managing bleeding complications. Additionally, our results show that 83.8% of respondents recognised safe analgesics for patients with bleeding disorders, which agrees with Pereira et al. [16], who state that understanding analgesic options within anticoagulation therapy is crucial.

Despite these strengths, however, our study revealed that only 45.9% of participants had a high level of knowledge concerning appropriate management strategies for bleeding post-extraction. This is an important finding, given that in a body of research by Eltohami et al. [13], 98.2 percent of the doctors they studied followed the right approaches towards local hemostatic measures. This disparity implies knowledge gaps between theory and practice that must be addressed with targeted educational interventions that bridge the gap that we found in our cohort.

Our study showed a significant association between bleeding knowledge and demographic factors (gender, residential region, academic level and GPA) by statistical analysis. The finding is by the work of Golkari et al. [17], which revealed that demographic factors significantly affected dentists’ willingness to provide treatment to patients with selected generic diseases, including those with bleeding disorders. These associations point to its implications and it probably should be tailored educational programs specific to ethnic groupsto reach the dental practitioners' competence in the professional aspect of managing bleeding complications.

Our participants strongly endorsed the importance of a comprehensive medical history in dental surgical procedures and 75.89% suggested that it was critical. This is consistent with recommendations in the literature that rigorous patient assessment is required to reduce the risk of bleeding disorders [18]. Yet the finding that a considerable portion of our participants were moderate (31.0%) or low (23.1%) in knowledge of bleeding management represents an important opportunity for improvement. The study by Dagher et al. [19] echoes that many dental practitioners have inadequate knowledge about infection control measures, similarto management of bleeding complications.

Our study results also emphasize the importance of continuous education and training in the provision of safe bleeding disorder care in dental practice. Ninety-nine-point eight percent (89.8%) of participants expressed their desire to acquire further education via lectures and workshops, which shows readiness for attending more lectures and workshops. This also fits with the propensity that Ahmad and Al-Harbi [20] determined, emphasizing that dental professionals need to continue to receive ongoing education to update their knowledge about ways to manage different dental conditions.

However, our study has several limitations in terms of our cross-sectional study design, hence limits us from making inferences about causal relationships from the data. Furthermore, a reliance on self-reported measures might also have introduced bias because participants might have overrated their knowledge and the practices they were undertaking. Additionally, the homogeneity of the sample on the demographic scale (mainly Saudi nationals) may limit the generalizability of the findings to larger populations. Our future research should be longitudinal and use a more diverse sample to validate and extend our results.

According to our study, dental students, interns and dentists in Saudi Arabia have a good, sound understanding of bleeding management fundamentals but they also suffer from large gaps in their knowledge that require further training. Incorporation of comprehensive training programs for bleeding disorders and their management may further improve the ability of dental professionals to be prepared for patients with bleeding disorders, thereby improving patient care and outcomes. The contribution of the findings in this study to the growing body of literature on the need for continuous professional development comes from the fact that they provide illustrated into the management of complex medical conditions.

Acknowledgement

We acknowledge all of the volunteers who provided samples for this research.

Conflicts of Interest

The authors declare no conflict of interest.

Ethical Approval

After fully explaining the study and emphasizing that participation is optional, each participant gave their informed consent. The information gathered was safely stored and utilized exclusively for study.

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