Bleeding refers to loss of blood or escape of blood which occurs from the circulatory system. Bleeding after tooth extraction procedure is normal. Gauze pack is given by the dentist after the tooth extraction to control the bleeding. The patient is instructed to bite on the gauze pad for 30-45 minutes after the tooth extraction procedure. 

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.

The bleeding is also profuse in region of inflammation where the tissues are excessively hyperemic.

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.

Patients with high blood pressure and those with bleeding disorders bleed profusely after the tooth removal. That’s why in cases of elevated blood pressure and bleeding disorders, tooth extraction procedure is not performed.

Management of Bleeding after Tooth Extraction

Manual pressure on gauze pack placed over the area can be used by the dentist 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 doesn’t coagulate in the gauze and blood clot is not dislodged when the clot is removed.

Gauze pack placed on tooth extraction site

If a large vessel is involved, then it can be clamped with a hemostat and is tied with resorbable stitches (3-0 cat gut sutures) If the bleeding is from bone, then absorbable haemostatic gauze or bone wax over the site of bleeding can be placed.

A small amount of blood is mixed with the saliva (Or spit).  So the patient should not freak out about the amount of blood loss he is having.

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.

After the wisdom tooth removal, bleeding may occur up to 3 days. Bleeding and oozing of blood from the extraction site, 3 days after the wisdom tooth removal is considered as normal. However after 3 days, the bleeding should be very less or barely noticeable. 

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.

In case of wisdom tooth extraction or in cases of surgical extraction, bleeding up to 3 days after the tooth extraction procedure is considered as normal. However after 3rd day, the quantum of bleeding should go down and should be very less and barely noticeable.

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. Patient’s 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, it may be arrested by approximation of the gums over the socket. 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 patient’s 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.