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Available online at ajdhs.com 

Asian Journal of Dental and Health Sciences 
Open Access to Dental and Medical Research 

Copyright  © 2025 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided 

the original author and source are credited  

 

 

Comparative Evaluation of Hemostatic Gel vs Gelatin Sponge on Bleeding and 
Pain After Primary Teeth Extraction: An In-vivo Comparative Study 

Singh Utkarsh 1* , Gupta Sonal 2 , Saket Antra 1 , Pathak Shalu 3 , Abraham Nayana 3  

1 JR3, Department of Pediatrics & Preventive Dentistry, KD Dental College & Hospital, Mathura 

2 HOD & Professor, Department of Pediatrics & Preventive Dentistry, KD Dental College & Hospital, Mathura 

3 JR2, Department of Pediatrics & Preventive Dentistry, KD Dental College & Hospital, Mathura 

Article Info: 
_____________________________________________ 
Article History: 

Received   02 Dec 2024     
Reviewed  06 Jan 2025 
Accepted   31 Jan 2025 
Published 15 March 2025 

_____________________________________________ 
Cite this article as:  

Singh U, Gupta S, Saket A, Pathak S, Abraham 
N, Comparative Evaluation of Hemostatic Gel 
vs Gelatin Sponge on Bleeding and Pain After 
Primary Teeth Extraction: An In-vivo 
Comparative Study, Asian Journal of Dental 
and Health Sciences. 2025; 5(1):58-66              
DOI: 
http://dx.doi.org/10.22270/ajdhs.v5i1.124        
_________________________________________ 

*Address for Correspondence:   

Singh Utkarsh, JR3, Department of Pediatrics 
& Preventive Dentistry, KD Dental College & 
Hospital, Mathura  

Abstract 
_________________________________________________________________________________________________________________ 

Background- In pediatric dental practice, extraction is one of the common procedures whether it’s 
a case of over-retained deciduous teeth or carious and traumatic teeth with poor prognosis. In pre-
cooperative patients or patients with special health care needs, post extraction bleeding must be 
managed very effectively and quickly too, as such patients are unable to follow the post-extraction 
pack instructions properly. Hence, aim of this study was to compare the efficacy of hemostatic gel 
and gelatin sponge on post-extraction bleeding and pain following extraction of primary teeth and 
whether the root length of the primary teeth draws any impact over the post-extraction bleeding 
time and flow. 

Materials & Methodology- It was a prospective, randomised clinical trial of sample size 20 teeth 
in each group. Inclusion criteria were ASA class-I patients in the age group 6-12 years, patients with 
at least 1 primary tooth to be extracted under LA local infiltration. After extraction, a pressure pack 
of normal saline soaked gauge was given for 2 minutes and then hemostatic agent was applied as 
per the groups allocated either hemostatic gel or gelatin sponge to the extraction socket. 

Results- Gelatin sponge performed better in controlling the bleeding from extraction socket at 5 
minutes and 10 minutes interval as the mean data of bleeding code was statistically significant but 
it was not significant at 15 minutes interval means both the material performed equally better at 
the end of 15 minutes in controlling bleeding. 

Conclusion- Placing Gelatin sponge pack post primary teeth extraction significantly reduces the 
bleeding time at 5 minutes and 10 minutes interval and hastens the blood clot in comparison with 
hemostatic gel. 

Keywords- Post-Extraction Bleeding, Gelatin Sponge, Hemostatic Gel 

 

INTRODUCTION 

In pediatric dental practice, extraction is one of the 
common procedures whether it’s a case of over-retained 
deciduous teeth or carious and traumatic teeth with poor 
prognosis. Post-extraction bleeding following extraction 
is a well identified and frequent complication which 
causes several difficulties like stress, pain & agony to the 
patients and apprehension to the care-takers as well. 1 

Hemophobia is the fear of blood which may instills a 
negative attitude in pediatric patients if doesn’t control 
adequately and quickly following the extraction. Post-
Extraction Bleeding (PEB) can be defined as obvious 
evidence of bleeding beyond the pressure pack time 
limit. 2 This PEB may interfere in moisture sensitive 
procedures like restoration and cementation prolonging 
the chair-side and anesthesia time. This breakthrough 
bleeding may require hemostatic treatment, and 
emergency intervention in severe cases. In a study 
conducted by Henderson et al 3, it was concluded that 
total blood loss ranged from 2.5-57mL in extraction of 

primary teeth. PEB depends upon the number of teeth 
extracted, the pathological status of the teeth, the length 
of the root preserved and underlying systemic diseases 
of the patients like bleeding or clotting disorders and 
liver diseases.  

In pre-cooperative patients or patients with special 
health care needs, post extraction bleeding must be 
managed very effectively and quickly too, as such 
patients are unable to follow the post-extraction pack 
instructions properly.  

Management of PEB includes both local as well as 
systemic measures. Local methods of controlling PEB are 
common saline pressure pack, sutures, acrylic surgical 
splints, and local hemostatic agents like oxidized 
cellulose, resorbable gelatin sponge, bone wax, calcium 
alginate, tannic acid, and hemocoagulase. 4-5   

Systemic measures include oral or parenteral 
administration of anti-fibrinolytic agents like tranexamic 
acid and α-amino caproic acid.  

                     Open Access                                                                                                                                                                                                        Research Article                                                                           

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Ideal properties of a hemostatic agents include lightness, 
stability, and the ability to be easily inserted into the 
bleeding site. It should not cause tissue irritation or 
destruction, must not get dissolved in the blood and can 
be easily removed after the arrest of the bleeding or 
whenever required. 6 

Gelatin sponge is one of the commonly used hemostatic 
agents in oral surgical procedure which has property to 
swell up and arrest the bleeding by compressing the 
blood vessels.7 Hemostatic gel typically contains 
Aluminium Chloride, glycerine and purified water are 
being used in dentistry for arresting bleeding during 
minor gingival retraction procedures and treating pulpal 
bleeding during pulp therapy. There have been various 
studies conducted so far to evaluate the efficacy of gelatin 
sponge and resorbable packs after extraction of primary 
teeth in patients with bleeding disorder and anti-platelet 
therapy, but, there is a scarcity of literature in evaluating 
the efficacy of gelatin sponge and hemostatic gel in 
bleeding control following extraction of primary teeth. 
Hence, aim of this study was to compare the efficacy of 
hemostatic gel and gelatin sponge on post-extraction 
bleeding and pain following extraction of primary teeth 

and whether the root length of the primary teeth draws 
any impact over the post-extraction bleeding time and 
flow.  

MATERIALS AND METHODOLOGY 

It was a prospective, randomised clinical trial of sample 
size 20 teeth in each group. Inclusion criteria were ASA 
class-I patients in the age group 6-12 years, patients with 
at least 1 primary tooth to be extracted under LA local 
infiltration. Exclusion criteria were patients with any 
systemic or bleeding disorders or extraction requiring 
surgical procedures like gingival reflection or elevation 
and pressure packs dislodged during 15 minutes post-
extraction.  Informed consents were obtained from each 
child’s legal parent or guardian. Each patient was 
randomly assigned to one of two study groups which 
after the extraction supposed to receive the Group I- 
Gelatin sponge (GelatinoR Gamma Sterile, Ready to Use) 
and Group II- Hemostatic Gel (Waldent). Tooth 
extractions were performed using forceps after local 
infiltration of Local Anesthesia and retraction of attached 
gingiva.

  

                              

Figure 1: Gelatin Sponge         Figure 2: Hemostatic Gel    Figure 3: Armamentarium 

Pulse rate and oxygen saturation was recorded using 
pulse oximeter prior to LA administration and 30 
minutes after extraction to evaluate the difference in the 
patient’s apprehension on using these two different 
packs.  

Anxiety and pain level on the patients were recorded 
using Facial Image Scale prior to LA administration and 1 

hour post extraction to compare if there is any difference 
if these two different post-extraction packs.  

Root resorption stages of the tooth to be extracted was 
evaluated using radiographs and code was assigned 
using modified Fanning Scale for root resorption.

  

Stage Designation for this study Diagram 

Root intact 0  

Root shows blunting or rounding at apex  1  

Root resorbed 1/4 2  



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Root resorbed 1/3 3  

Root resorbed 1/2 4  

Root resorbed 2/3 5  

Root resorbed 3/4 6  

Root entirely resorbed 7  

 

After extraction, a pressure pack of normal saline soaked gauge was given for 2 minutes and then hemostatic agent was 
applied as per the groups allocated either hemostatic gel or gelatin sponge to the extraction socket. 

                               

             

 

 

At 5 minutes, 10 minutes, and 15 minutes post-extraction, bleeding was scored according to a scale developed by Shayna 
Mattox et al. Existing blood, if any, was wiped using gauge and the socket was observed for 3 seconds prior to rating each 
socket.  

Code Description Diagram 

0 No active bleeding/ Fully clotted  

1 Active bleeding which fills the socket, but no oozing outside of 
the socket onto the alveolar ridge.  

 

 

 

Figure 4: Placement of hemostatic gel 

in extraction socket 

Figure 5: Placement of gelatin sponge 

in extraction socket 



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2 Active bleeding which is oozing outside of the socket, but 
limited to immediate alveolar ridge.  

 

3 Active bleeding which is oozing outside of the socket, over the 
alveolar ridge into the working field.  

 

 

At 15 minutes, it was noted if any portion of hemostatic agent was completely removed from the socket or not and if 
completely removed the sample was excluded from the study. After 15 minutes, a saline soaked gauge was placed in the 
socket for another 15minutes to avoid spitting or chewing anything by the child.  

RESULTS 

Data were entered in Microsoft Excel Version 2012 and SPSS software version 20.0 and following results were obtained. 

1. Comparison of Oxygen Saturartion pre and post extraction (After 30 min) between Gelatin Sponge and Hemostatic 
Gel 

Time  Group  Mean oxygen 
saturation Std. Deviation 

Mean diff T value P value 

Pre-op  Gelatin sponge 98.50 1.606 -.350 -.856 .39 

Hemostatic gel 98.85 .875 

Post-op (30 min) Gelatin sponge 97.45 1.849 -.450 -.931 .35 

Hemostatic gel 97.90 1.119 

Test used- independent t test, p>0.05 insignificant 

 

Mean ±SD of oxygen saturation at pre-op in gelatin sponge and hemostatic gel was 98.50±1.606 and 98.85±.875 while at post-op it 
was 97.45±1.849 and 97.90±1.119 respectively respectively. Results were found to be statistically insignificant 

2. Comparison of Mean pulse rate pre and post extraction (After 30 min) between Gelatin Sponge and Hemostatic Gel 

Time  Group  
Mean pulse rate Std. Deviation 

Mean diff T value pvalue 

Pre-op  Gelatin sponge 81.15 15.500 -7.00 -1.203 .23 

Hemostatic gel 88.15 20.914 

Post-op  

(After 30 min) 

Gelatin sponge 92.85 7.989 -4.850 -1.573 .12 

Hemostatic gel 97.70 11.239 

Test used- independent t test, p>0.05 insignificant 

96.5

97

97.5

98

98.5

99

Pre-op Post-op (2hours)

Oxygen saturation pre and post-op 

Gelatin sponge

Hemostatic gel



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Mean ±SD of pulse rate at pre-op in gelatin sponge and hemostatic gel was 81.15±15.500 and 88.15±20.914 respectively and post-op 
was 92.85±7.989 and 97.70±11.239 respectively. Results were found to be statistically insignificant.  
 

3. Comparison of Pain perception pre and post extraction (After 2 hours) between Gelatin Sponge and Hemostatic Gel 

Time  Group   Mean pain score Std. Deviation Mean diff T value P value 

Pre-op  Gelatin sponge 4.10 .718 .350 1.406 .16 

Hemostatic gel 3.75 .851 

Post-op  

(After 1 Hour) 

Gelatin sponge 4.65 .489 .200 1.265 .21 

Hemostatic gel 4.45 .510 

Test used- independent t test, p>0.05 insignificant 

 

Mean ±SD of pain score at pre-op in gelatin sponge and hemostatic gel was 4.10±.718 and 3.75±.851 respectively and post-op was 
4.10±.718 and 3.75±.851 respectively. Results were found to be statistically insignificant 

 

4. Comparison of Bleeding at 5 min, 10 min and 15 min post extraction between Gelatin Sponge and Hemostatic Gel 

Time  Group  Mean bleeding code Std. Deviation Mean diff T value P value 

5 min Gelatin sponge 1.40 .598 -.600 -2.854 .007** 

Hemostatic gel 2.00 .725 

10 min Gelatin sponge .60 .598 -.550 -2.437 .020* 

Hemostatic gel 1.15 .813 

15 min Gelatin sponge .05 .224 -.150 -1.435 .16 

Hemostatic gel .20 .410 

Test used- independent t test, p*<0.05 significant and p>0.05 insignificant 

0

20

40

60

80

100

120

Pre-op Post-op (2hours)

Pulse rate pre and post-op 

Gelatin sponge

Hemostatic gel

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Pre-op Post-op (2hours)

Pain score pre and post-op 

Gelatin sponge

Hemostatic gel



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Mean ±SD of bleeding code at 5 min, 10 min and 15min in gelatin sponge and hemostatic gel was 1.40±.598 and 2.00±.725,  60±.598 
and 1.15±.813 and 05±.224 and .20±.410 respectively. Results were found to be statistically significant when comparing gelatin sponge 
and hemostatic gel of bleeding code at 5 min and 10min but insignificant at 15min.  

 

5. Comparison of bleeding code at 5 min with root resorption stage in gelatin sponge 

Root resorption stage of 
gelatin sponge 

              Bleeding code Total  Chi value 

 

P value 

code 1 code 2 code 3 

0 15.4% 33.3% 0 20% 8.803 .72 

2 7.7% 0.0% 0.0% 5.0% 

3 0.0% 16.7% 0.0% 5.0% 

4 7.7% 0.0% 0.0% 5.0% 

5 15.4% 16.7% 0.0% 15.0% 

6 30.8% 0.0% 100.0% 25.0% 

7 23.1% 33.3% 0.0% 25.0% 

Total  100.0% 100.0% 100.0% 100.0% 

Test used- chi square, p>0.05 insignificant 

 

 

Results were found to be statistically insignificant when comparing bleeding with root resorption stage in gelatin sponge. 

0

0.5

1

1.5

2

2.5

5 min 10 min 15 min

Bleeding code at differnt time period 

Gelatin sponge

Hemostatic gel

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

0 2 3 4 5 6 7

root resorption stage with bleeding code in gelatin sponge

bleeding code 1

bleeding code 2

bleeding code 3



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6. Comparison of bleeding code with root resorption stage in hemostatic gel 

Root resorption stage of 
hemostatic gel 

              Bleeding code Total  Chi value P value 

code 1 Code 2 code 3 

0 0.0% 0.0% 20.0% 5.0% 17.222 .07 

1 0.0% 0.0% 20.0% 5.0% 

4 0.0% 0.0% 20.0% 5.0% 

5 0.0% 30.0% 20.0% 20.0% 

6 60.0% 10.0% 0.0% 20.0% 

7 40.0% 60.0% 20.0% 45.0% 

Total  100.0% 100.0% 100.0% 100.0% 

Test used- chi square, p>0.05 insignificant 

 

 

Results were found to be statistically insignificant when comparing bleeding with root resorption stage in gelatin sponge. 

 

DISCUSSION 

Extraction of primary teeth is a common procedure 
encountered in routine pediatric dental practice. Reason 
for primary teeth extraction include trauma, serial 
extraction for interceptive orthodontics, over-retained 
teeth, grossly decayed teeth which can’t be restored or 
treated endodontically.8 After primary tooth extraction, a 
gauze pack is placed over the socket and patient is 
directed to bite on the pack for half an hour, exerting firm 
even pressure.9 Pre-cooperative children and those with 
intellectual disabilities don’t comply with the pressure 
packs advice and they tend to remove the pack, before 
the time of pressure pack retention lasts. Due to lack of 
cognitive development in such patients, there is search of 
a proper hemostatic agent since long times that too in 
primary extraction socket, to hasten the clotting time and 
reduction in pressure packs timing as well. Many 
hemostatic agents like gelatin sponge, gelfoam (Gelatin 
sponge with glutaraldehyde), hemostatic gel and snake 
venom (batroxobin) 10 have been used as post-extraction 
hemostatic agent but mostly in cases with bleeding and 

clotting disorders, such patients require additional care 
to avoid excessive bleeding.  

Gelatin sponge is a water insoluble, resorbable material 
which is flexible in nature and made from animal skin. [7]. 

It is hemostatic in nature and can be used to control 
bleeding after exodontia.11  It can be used dry or in 
combination with saline solution. The mechanism behind 
using the sponge is water absorption and formation of 
clots, protecting the wound, reducing complications and 
hastening recovery.12 Mahmaudi A et al (2023) 
advocated the use of gelatin based dental sponge in 
primary molar extraction in order to reduce bleeding 
pain and post-operative infection.13 Similarly, in a study 
conducted by Pattabhi A et al (2024),14 they showed that 
using gelatin sponge in the extraction sockets of 
impacted third molars, when excessive bleeding is not 
present, reduces postoperative pain. 

Hemostatic gel basically contains Aluminim Chloride and 
Ferric Sulfate which acts by constricting blood vessels 
and helping in formation of clot. 15 In a systemic review 

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

0 1 4 5 6 7

root resorption stage with bleeding code in hemostatic gel

bleeding code 1

bleeding code 2

bleeding code 3



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by Gupta G et al (2018) 4, clinical outcomes of topical 
hemocoagulase was compared with placebo in extraction 
socket sites of adults and found that topical 
hemocoagulase led to a significant differences in 
bleeding stoppage time, pain, swelling, wound healing, 
and other postoperative complications. In adult patients, 
particularly after 3rd molar extractions, such hemostatic 
agents are used to avoid excessive bleeding as well as dry 
socket. There is paucity of literature regarding use of 
gelatin sponge and hemostatic gel in primary extraction 
socket. Thus, this study was carried out to compare the 
efficacy of bleeding control between gelatin sponge and 
hemostatic agent after primary teeth extrcation.   

In this study, Gelatin sponge performed better in 
controlling the bleeding from extraction socket at 5 
minutes and 10 minutes interval as the mean data of 
bleeding code was statistically significant but it was not 
significant at 15 minutes interval means both the 
material performed equally better at the end of 15 
minutes in controlling bleeding. Gelatin sponge 
performed better due to its characteristic to effectively 
absorb blood at a rate that is 45 times its own weight. The 
hemostatic action is associated with the consistent 
porosity of the gelatin sponge, which facilitates platelet 
adhesion and subsequent degradation, resulting in the 
release of thrombokinase. It’s neutral pH, rendering it 
compatible for moistening with thrombin or antibiotic 
solutions without compromising its integrity.16 The 
result was in accordance with the conducted by Shayna 
Mattox et al (2020)17, in which they concluded that use of 
hemostatic pack in maxillary primary extraction socket 
reduces the bleeding time at 5 minutes and 10 minutes 
post extraction compared to the controls. 

In this study, we also tried to co-relate the difference in 
Oxygen saturation, pulse rate and pain perception of the 
children after use of these two haemostatic packs but 
result revealed that the difference in data were 
statistically insignificant. The data was not in accordance 
with the study by Shayna Mattox et al (2020) in which 
they claimed that there is an odd of increasing bleeding 
by 9% for increase in heart rate per beat every minutes. 

 In another parameter, the study also tried to rule out 
whether there is any impact of root resorption stages of 
primary teeth on post extraction bleeding in which 
results revealed the data as insignificant too which was 
in accordance with the Shayna Mattox et al’s study. In this 
study, root resorption stage was evaluated using vertical 
resorption and lateral root resorption was not taken into 
account. Again, periodontal status and mobility of the 
primary tooth plays a significant role in the post-
extraction bleeding which was not measured in the study 
and these might be the reason behind the data to be 
statistically insignificant.  

This study had certain limitations like smaller sample 
size, location and status of root resorption stage of the 
tooth to be extracted and lack of blood profile tests for 
International Normalized Ratio (INR) prior to extraction. 
But, as this study is a pioneer in its own terms as one of 
the first study to be conducted in India as role of two 
different haemostatic packs after extraction of primary 
teeth, it will provide a backbone for further research and 

studies specially in terms of providing a quick 
performing haemostatic pack after primary teeth 
extraction specially in un-cooperative patients and 
paediatric patients with intellectual disabilities.  

Importance of the study 

In uncooperative and intellectual disability patients, who 
don’t comply with the post-extraction pack instructions, 
Gelatin sponge can be used on chair side to arrest the 
bleeding from primary teeth extraction site. 

Use of gelatin sponge can be used in pediatric patients 
with bleeding disorders in order to hasten the clotting of 
primary teeth extraction bleeding site and to avoid post-
operative complications.  

CONCLUSION 

Placing Gelatin sponge pack post primary teeth 
extraction significantly reduces the bleeding time at 5 
minutes and 10 minutes interval and hastens the blood 
cloting in comparison with hemostatic gel.  

There is no any difference in impact on oxygen 
saturation, pulse rate and pain perception by pediatric 
patients between these two hemostatic agents used.  

Root resorption stage doesn’t play a major role in post-
extraction bleeding in primary teeth.  

Acknowledgements- None 

Conflicts Of Interest- Nil 

Author Contributions: All authors have equal 

contribution in the preparation of manuscript and 

compilation. 

Source of Support: Nil 

Funding: The authors declared that this study has 

received no financial support. 

Informed Consent Statement: Informed consent was 

obtained from all subjects involved in the study.  

Data Availability Statement: The data presented in 

this study are available on request from the 

corresponding author.   

Ethical approval: Not applicable. 

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