Tooth extractions are very common dental procedures. They are often necessary when a tooth is damaged beyond repair or affected by advanced gum disease. While extractions are routine, they still involve surgery and the removal of part of the body – the tooth and surrounding tissues.
As a result, some bleeding is to be expected after an extraction. While a little blood mixed with saliva is normal, excessive or prolonged bleeding needs to be controlled.
Dentists use various techniques and materials to stop bleeding and help the extraction site clot after removing a tooth. This prevents complications like dry socket and infections.
Why does bleeding occur after a tooth extraction?
When a tooth is removed, it leaves behind an open socket in the bone where the tooth roots were embedded. The socket contains blood vessels that previously supplied blood to the tooth and surrounding tissues.
During an extraction, some of these vessels get damaged or severed. This results in bleeding from the socket while the area starts healing. The amount of bleeding depends on several factors:
- Number of blood vessels damaged – More vessels cut = more bleeding
- Size of the tooth extracted – Larger teeth disturb more bone and vessels
- Patient’s health – Bleeding disorders or medication increasing bleeding
- Difficulty of extraction – More trauma = more bleeding
Techniques used by dentists to stop bleeding
Dentists use the following techniques, often in combination, to control bleeding after extractions:
Applying pressure
Applying firm pressure on gauze placed over the extraction site is often the first step. Pressure helps the blood clot by sealing damaged vessels. Patients are advised to bite down on gauze for 30-60 minutes after extraction.
Suturing
Stitches can close the gum flaps together over the extraction socket. This protects the clotting blood and stops further bleeding. Sutures may be dissolvable or need removal.
Cauterization
Heat can seal bleeding vessels. A tool applies heat to the socket, coagulating proteins in blood and sealing vessels. Electrocautery is a common method.
Hemostatic agents
Hemostatic gels, pads, powders or pastes help clotting when applied inside the socket. Common active ingredients are collagen, cellulose, thrombin, etc. Examples are Gelfoam, Surgicel, HemCon.
Fibrin glues
These sticky substances mimic the final stages of natural blood clotting. They act as sealants over the wound when applied. Contains fibrinogen and thrombin.
Materials used to control bleeding
In addition to techniques, dentists also use specialized materials to stop bleeding after extractions. These include:
Gauze
Rolled, sterile gauze is the most common. Patients bite down on this for pressure application. May be soaked in tranexamic acid.
Oxidized cellulose
Plant-based hemostatic fibers that facilitate clotting. Examples are Surgicel, Gelita-Cel.
Collagen particles
Microscopic collagen fragments aggregate platelets and accelerate clotting. Examples are Helistat, Instat.
Gelatin foams
Spongy, modified gelatin materials that facilitate clotting. Example is Gelfoam.
Cyanoacrylate adhesives
Instant glues that bind gum flaps together over extraction socket to protect clot. Example is LiquiBand.
Technique | How it Helps |
---|---|
Applying pressure | Seals damaged vessels by compression |
Suturing | Holds gum flaps together over clot |
Cauterization | Seals vessels by coagulating blood proteins |
Hemostatic agents | Facilitate and accelerate clot formation |
Fibrin glues | Mimics final stages of natural clotting |
When is bleeding after extraction considered excessive?
Minor oozing and pink or blood-tinged saliva is normal for a day or two after extraction. But any of the following is considered excessive bleeding:
- Bleeding that does not reduce with pressure application for over 2 hours
- Bleeding that keeps recurring and needs repeated gauze changes
- Heavy bleeding filling the mouth with blood
- Formation of large clots
- Bleeding accompanied by pain or bad odor
- Signs of infection like swelling, pus, fever
Such uncontrolled bleeding may need professional medical attention to look for underlying causes like clotting disorders or to treat resulting complications.
What to do for bleeding that won’t stop?
If bleeding persists despite pressure and other efforts:
- Don’t panic, but don’t ignore it either.
- Rinse mouth gently with cool water to clear blood clots.
- Apply fresh gauze and bite down firmly again for 30-60 minutes.
- Sip on cold drinks to promote vasoconstriction.
- Limit physical activity to prevent dislodging the clot.
- If bleeding continues, call your dentist’s office for advice.
- Seek professional medical help if excessive bleeding lasts over 2 hours.
Tips to prevent prolonged bleeding
You can reduce chances of bleeding issues after extractions by:
- Informing dentist about any bleeding disorders or blood thinner medications.
- Avoiding smoking, alcohol and NSAIDs before surgery as they hamper clotting.
- Biting firmly on gauze for the recommended time after extraction.
- Avoiding disturbing or dislodging the clot by limiting activity.
- Not rinsing vigorously or touching tongue to socket.
- Eating only soft foods for a few days.
When to call the dentist about bleeding?
Contact your dentist if:
- Bleeding does not reduce after biting on gauze for over 1 hour
- Bleeding starts again with bright red blood after initially stopping
- You have throbbing pain, bad taste/odor indicating dry socket
- Swelling, pus, fever indicating infection
- Bleeding is very heavy, making you lightheaded
The dentist can check for issues like infection, dry socket or dislodged clot and treat accordingly. They may prescribe tranexamic acid mouthwash, stronger hemostatic agents or antibiotics if required.
Conclusion
Though bleeding is common after extractions, dentists have a variety of techniques and hemostatic agents to control it. Applying adequate pressure with gauze is the first step. Sutures, cautery, gelatin foams and other aids also facilitate clotting.
Mild oozing can continue for a day or two after extraction. But bleeding that persists for over 2 hours despite pressure is considered excessive and may need professional evaluation. Maintaining precautions like avoiding smoking, strenuous activity and NSAIDs can also prevent bleeding issues after extractions.