Bleeding after Tooth Extraction

Profuse Bleeding during Tooth Extraction Procedure

Excessive, profuse bleeding can occur during the extraction procedure if there is accidental tearing
or cutting of the large artery or vein. Laceration of inferior alveolar artery or vein during attempted
root removal can cause profuse bleeding.
Profuse bleeding can occur during the extraction if there is injudicious use of suction apparatus or
when the wound is wiped excessively which causes continual removal of blood clots.

Management of Bleeding after Tooth Extraction

Manual pressure on gauze pack placed over the area to arrest the bleeding. The gauze size should
be small to just cover the extraction socket. The gauze which is used may be moistened so that the
blood doesnt coagulate in the gauze and blood clot is not dislodged when the clot is removed.

If a large vessel is involved, then it can be clamped with a hemostat and is tied with resorbable
stitches. If the bleeding is from bone, then absorbable haemostatic gauze or bone wax over the site
of bleeding can be placed.
After the tooth extraction procedure, the patient is advised to firmly bite (not chew) on the gauze
for at least 30mins. The gauze should be held in mouth for 30-45mins. The patient should not talk
for a minimum of 2-3 hrs after the tooth extraction.
Slight oozing of blood may occur up to 24hrs after the extraction. It is considered to be
normal. There might be some oozing of the blood at night from the extraction site and the patient
may have blood stains on pillow after the tooth extraction. There is nothing to be worried about it.
The bleeding will stop on its own.
Precautions to be taken when Bleeding is continuing
1. Till the bleeding is continuing, one should avoid vigorous rinsing of the mouth as it can
dislodge the clot formed at the extraction site. Warm saline rinses 3-4 times a day, 24hrs
after the extraction should be done which will fasten the healing process of the extraction
socket.
2. If the patient is bleeding more, then he can keep a piece of gauze at the tooth extraction
site again and keep it there for a minimum of 30mins for bleeding to stop. The patient
should gently bite on the gauze pad with equal pressure but should not irritate the
extraction socket wound. Pressure application is done to control the bleeding.
3. To control the bleeding, patient can also bite on a tea bag for 30mins. The tea bag is
moistened with water and is then folded in half and then patient can bite on that. Tannic
acid which is present in the tea will reduce the bleeding by constricting the blood vessels.

What to avoid so that the bleeding is not aggravated

1. The patient should not smoke minimum for 48 hours after the extraction which can
interfere with the healing. Smoking can further create negative pressure which can dislodge
the clot and can further lead to dry socket.
2. Patient is also advised not to suck or spit too much which creates negative pressure and
may cause mechanical irritation to the tooth extraction site and will cause blood to move
out. The patient should not drink cold drink with straw after the tooth extraction.
3. Patient is advised to take rest and not to do heavy exercises up to 24hrs after the extraction
which can elevate the blood pressure and may even stimulate the bleeding.

When to Consult Dental Surgeon for Bleeding after Tooth Extraction

1. If the patient bleeds heavily after an hour or two, then the dentist or the oral surgeon
needs to be consulted.
2. If there is prolonged oozing of the blood, bright red bleeding or in case of large clots at
the tooth extraction site after 24hrs of extraction, then the dental surgeon should be
consulted. The dental surgeon will take measures to stop the bleeding after re-examining
the area.

Steps taken by Dentist to Control the Bleeding

1. The dental surgeon will first irrigate the area with isotonic saline solution and then the
excessive clots are removed.
2. The patient is then instructed to bite on the gauze pack until the general condition has been
evaluated.
3. Patients blood pressure and pulse rate is checked.
 4. After that, anesthesia is injected to the patient. Anesthetic solution with small amount of
vasoconstrictor should be used. Larger amounts can temporarily stop the bleeding and may
result in bleeding later on.
5. Once anesthesia is obtained, the extraction wound is examined to determine the source of
bleeding. It is examined by the dentist whether the bleeding is there from the gums, the
bone or both.

Bleeding from the Bone after Tooth Extraction

If bleeding is from bone, the socket may be packed with an absorbable material and sutures or
stitches are tied over the pack. A large gauze pack is placed over it and held firmly between
patients teeth for 15 to 30mins.
Thrombin can be applied over the area. It promotes formation of the clot to stop the bleeding.
Collagen plug can also be used to control the bleeding.

Bleeding several days after Tooth Extraction

Bleeding which occurs several days after tooth extraction is known as secondary bleeding. It is
due to infection of the wound which causes loss of clot and erosion of vessels in the granulation
tissue. Before suturing or packing the socket in case of secondary hemorrhage, the extraction
socket wound is examined carefully for any foreign body. Antibiotics may be given to the patient
when the socket is packed.

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