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• W2013716817 abstract "Dear Editor,We read with interest the article describing the use of Povidone Iodine as a haemostyptic agent3Kumar B.P.R. Maddi A. Ramesh K.V. Baliga M.J. Roa S.N. Meenakshi Is Povidone-iodine a hemostyptic? A clinical study.Int J Oral Maxillofac surg. 2006; 35: 765-766Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar. The authors have used Povidone iodine (PI) as a haemostatic agent for routine extractions, in which there is no increased risk of bleeding and recommend it strongly to irrigate routine post extraction sockets.A degree of caution needs to be exercised as PI may not have a role to play in routine dental extractions for haemostatic purposes alone. For routine extractions, mechanical pressure and normal coagulation is all that is usually required to stop further bleeding, hence exposure to an additional drug seems unjustified.There are a number of issues that are unclear in the study. The source of bleeding, whether gingival or from the extraction socket is not specified. The definition of the end point i.e. ‘spontaneous arrest of bleeding’ is unclear. We also note that there was no case control matching for the type of extractions. The authors fail to mention the dose, the final concentration after using normal saline as a diluent and the mode of irrigation used. PI affects the microcirculation when the exposure is prolonged, but 1% solution has no effects when the exposure time is less than five minutes4Van Den Broek P.J. Buys L.M.F. Van Furth R. Interaction of povidone-iodine compounds, phagoyctic cells, and microorganisms.Antimicrob Agents Chemother. 1982; 22: 593-597Crossref PubMed Scopus (82) Google Scholar, however the authors imply that haemostasis occurred spontaneously on contact with the solution. Although the incidence of late haemorrhage was apparently lower in the PI group the figures were not stated and there is no indication as to what is the normal rate reported in the literature.PI has proven antimicrobial properties and has a definite role to play in the presence of infection, periodontitis and to reduce bacteraemia especially when the risk of infective endocarditis is high. However it should be noted that contamination of stored PI solution with pseudomonas species may occur1Anderson R.L. Vess R.W. Carr J.H. Bond W.W. Panlilio A.L. Favero M.S. Investigations of intrinsic Pseudomonas cepacia contamination in commercially manufactured povidone-iodine.Infect Control Hosp Epidemiol. 1991; 12: 297-302Crossref PubMed Google Scholar. Concentrations of greater than 0.04% are toxic to keratinocytes and may impair wound healing. Additionally PI is contraindicated in pregnancy and thyroid dysfunction. Prolonged use of PI may induce systemic toxicity, bradycardia, hypertension, deranged liver function and renal impairment2Andrews L.W. O/WM commentary: the perils of povidone-iodine use.Ostomy Wound Manage. 1994; 40: 68-73PubMed Google Scholar. PI is neither licensed by the FDA, nor covered by the manufacturer for this purpose. At this stage the recommendation of ‘unambiguous’ use by the authors cannot be justified. Further studies may be indicated to investigate the role of PI as a haemostatic agent after the application of normal haemostatic measures and perhaps in bleeding disorders. Dear Editor, We read with interest the article describing the use of Povidone Iodine as a haemostyptic agent3Kumar B.P.R. Maddi A. Ramesh K.V. Baliga M.J. Roa S.N. Meenakshi Is Povidone-iodine a hemostyptic? A clinical study.Int J Oral Maxillofac surg. 2006; 35: 765-766Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar. The authors have used Povidone iodine (PI) as a haemostatic agent for routine extractions, in which there is no increased risk of bleeding and recommend it strongly to irrigate routine post extraction sockets. A degree of caution needs to be exercised as PI may not have a role to play in routine dental extractions for haemostatic purposes alone. For routine extractions, mechanical pressure and normal coagulation is all that is usually required to stop further bleeding, hence exposure to an additional drug seems unjustified. There are a number of issues that are unclear in the study. The source of bleeding, whether gingival or from the extraction socket is not specified. The definition of the end point i.e. ‘spontaneous arrest of bleeding’ is unclear. We also note that there was no case control matching for the type of extractions. The authors fail to mention the dose, the final concentration after using normal saline as a diluent and the mode of irrigation used. PI affects the microcirculation when the exposure is prolonged, but 1% solution has no effects when the exposure time is less than five minutes4Van Den Broek P.J. Buys L.M.F. Van Furth R. Interaction of povidone-iodine compounds, phagoyctic cells, and microorganisms.Antimicrob Agents Chemother. 1982; 22: 593-597Crossref PubMed Scopus (82) Google Scholar, however the authors imply that haemostasis occurred spontaneously on contact with the solution. Although the incidence of late haemorrhage was apparently lower in the PI group the figures were not stated and there is no indication as to what is the normal rate reported in the literature. PI has proven antimicrobial properties and has a definite role to play in the presence of infection, periodontitis and to reduce bacteraemia especially when the risk of infective endocarditis is high. However it should be noted that contamination of stored PI solution with pseudomonas species may occur1Anderson R.L. Vess R.W. Carr J.H. Bond W.W. Panlilio A.L. Favero M.S. Investigations of intrinsic Pseudomonas cepacia contamination in commercially manufactured povidone-iodine.Infect Control Hosp Epidemiol. 1991; 12: 297-302Crossref PubMed Google Scholar. Concentrations of greater than 0.04% are toxic to keratinocytes and may impair wound healing. Additionally PI is contraindicated in pregnancy and thyroid dysfunction. Prolonged use of PI may induce systemic toxicity, bradycardia, hypertension, deranged liver function and renal impairment2Andrews L.W. O/WM commentary: the perils of povidone-iodine use.Ostomy Wound Manage. 1994; 40: 68-73PubMed Google Scholar. PI is neither licensed by the FDA, nor covered by the manufacturer for this purpose. At this stage the recommendation of ‘unambiguous’ use by the authors cannot be justified. Further studies may be indicated to investigate the role of PI as a haemostatic agent after the application of normal haemostatic measures and perhaps in bleeding disorders." @default.
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• W2013716817 title "Povidone iodine as a haemostatic agent" @default.
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