Bleeding after Tooth Extraction

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.
 

 

 User Comments on -  Bleeding after Tooth Extraction


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Posted By : eldon on 26-Feb-2014 12:35 PM
I had a tooth pulled on monday a lower molar. it kept bleeding and i found out i have high blood pressure they put a stitch in the next day and now its wed and when i use salt water and only roll my head around with it, and let it drain out after i noticed that it makes it ooze a little bright red blood. is this ok? im now on hbp medicne. blood test showed bleed time is normal and platelet count is normal. and wbc is slightly up its 11.6 which i showed to the dentist and he said i should be fine. I was wondering your opinion? every now and then i get some little throbing pains from it but the clot looks intact and starting to turn white grainy red
 


Posted By : Joshua C on 23-Oct-2013 07:06 AM
Hello doctor. I know this is late but i have a question and if i should be concerned. Okay so i had all of my wisdom teeth taken out on October 17th, 2013. After 6 days of surgery, the bottom left side of my gum is still bleeding but its on and off. Its along next the gum line on my second molar and near the stitch, two days in a row i woke up tasting blood.. Should i be concerned? The swelling though is very small.. Its almost gone.. But still.
 


Posted By : Shara on 22-Oct-2013 06:30 PM
I just had my right upper molar at the back of my mouth removed a few hours ago. I'm still bleeding somewhat heavily and I have tried tea bags, but the taste makes me feel ill. I have bin biting down on gauze and changing it after about 45 minutes. Is there anything else I can try to get the bleeding to stop?
 


Posted By : obi on 24-Jul-2013 05:28 PM
Hello Doctor, I had my first top molar extracted on Friday. Its not painful, just irritation around the site, but slightly swollen. I have just experienced slight bleeding. should I worry?
 


Posted By : Krystal on 19-Jul-2013 02:07 PM
I had two teeth pull Tuesday and I am still bleeding I am in a lot of pain and I have been to the doctors twice now and they say everything looks fine I am anaemic and feel sick but I can't seem to get the bleeding to stop what should I do if gauze and salt water isn't helping
 


Posted By : Dr. Rtiz on 30-May-2013 08:22 PM
Channel, If you donot have any pain or swelling in the extraction wound then that means wound is healing well. Slight oozing is normal, may it is due to some irritation. Do take care even while brushing not to irritate the wound. Maintain good oral hygiene and do warn saline rinses. Follow all after care instructions given by your dentist.
 


Posted By : Chanel on 30-May-2013 07:37 AM
I just extracted 2 premolar tooth last 2 days ago. Today marks the 3rd day of extraction. Until now, the wound is completely painless but however during my brushing, I notice there is some blood at the corner oozing out. It's been on and off for the day. Is this consider un normal? I don't wan to get neither of the dry socket and infection. Please help me!
 


Posted By : melvin on 13-Mar-2013 01:42 AM
i have learned so many impt. tips on how to manage bleeding from you.thanks Godbless.
 


Posted By : Dr.Ritz on 21-Jan-2013 10:22 PM

If after 72 hours of surgery you have profuse bleeding then that is not normal. Oozing of blood from the surgical sight is normal. If the swelling is increasing and the bleeding is there then it is better you consult your dentist.

 


Posted By : KEN on 16-Jan-2013 05:35 AM
Hi, I had a Periodontal related tooth extraction and a bone graph on my lower molar On 1/14/13. The tooth was severely abscessed. The infection was huge. Is it normal to have this kind of bleeding?. This was a long and difficult procedure for me. Today is Wednesday, and my Periodontists office is closed. Should I wait until Thursday, or seek emergency care?
 


Posted By : Dr.Ritz on 05-Oct-2012 10:19 PM

Hi MICHELLE,Bleeding can occur up to 3 days after wisdom tooth removal.After third day, quantum of bleeding goes down and bleeding is very less or barely noticeable. Till the bleeding is continuing,you should avoid vigorous rinsing of mouth.To control bleeding,you can bite on a gauze pack with equal pressure without irritating the tooth extraction socket area too much. After biting on gauze pack for half an hour,gauze pack can be changed.You can also bite on moist ice tea bag for bleeding to stop.Tea bags have tannic acid present which will cause vaso-constriction and will stop the bleeding.Bleeding which occurs several days after extraction is due to infection of the wound which causes loss of clot and erosion of vessels in the granulation tissue.You should visit your dentist as soon as possible for clinical evaluation of the wound.In the mean time.maintain good oral hygiene.You should avoid smoking.Hope this helps.Good luck!!!!

 


Posted By : Michelle on 05-Oct-2012 07:31 PM
Hello, I had my lower left wisdom tooth removed las Friday 9/28..yesterday It started bleeding profusely as I was driving.. I tried gauze and tea bags and it wouldn't stop..these huge clots kept forming it was gross. Finally I went to the ER and the injected me with anesthetic with adrenaline. I'm a teacher and went back to work Tuesday, which I spend all day talking and yelling to my middle schoolers, also I ate some steak before the bleeding then brushed my teeth. Also Tuesday I took aleve all day. Not sure if any of this had anything to do with it. It was so much blood that we couldn't see where the blood was coming from. So far today no bleeding but I was wondering why this happened..could I have bled to death?? I'm still nervous about the whole ordeal!! Is this normal??
 


Posted By : Dr.Ritz on 09-Sep-2012 10:18 PM

Dear AMANDA,The most important thing after the extraction of wisdom teeth is the formation of clot at the extraction site. Till then the bleeding and oozing of blood from there is common. This bleeding can occur up to 3 days after the removal of wisdom tooth; however after 3rd day its quantum goes down and should be very less or barely noticeable.During the period of formation of clot in the exposed extraction site of wisdom tooth and coupled with presence of bacteria in the mouth, one can have bad smell coming from there shortly after the surgery. Further this can be accompanied by bad tasting fluid seeping from extraction site. This bad smell and fluid can continue upto maximum 2 weeks after the surgery.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.You can use warm saline rinses or the mild antiseptic mouth wash as prescribed by your dentist. Warm saline rinses and mouthwash should be done gently and not vigorously.Another more effective way is to take iced tea bag instead of gauze piece as the tannic acid in the tea bag helps more in reducing the bleeding from wound. All the steps help in reducing the bleeding and oozing. Try taking soft and liquid food options such as soups, mashed potatoes, yogurts, milkshakes, smoothies etc. Avoid hot drinks, spicy foods, sodas, etc. Remember to take plenty of fluids.Also,rest, relax, give it some time,I'm sure you'll be fine!

 


Posted By : Amanda on 08-Sep-2012 11:10 AM
i had my wisdom tooth removed 11 days ago. Yesterday, blood started flowing profusely from the site. I went back to the doctor today and he said the site looks fine and it was a fluke. But I went to sleep tonight and woke up in a pool of blood. This is about 26 hours from the last episode. I'm biting down on a gauze now to stop it. This time it was bleeding through many many gauze non-stop and I also bled out a very large clot. After the clot passed, the profuse bleeding stopped after about 30 minutes of biting down on a gauze. But what is going on? If the doctor said it's "fine and there's no infection" an did an xray to rule out anything left, which was "clear", why am I bleed so heavily from the area. I am a bit swollen and the area is sore. I almost feel like the extracted area is filling with blood and eventually when it has no where to go, it starts flowing out the socket.
 


Posted By : Dr.Ritz on 03-Sep-2012 09:12 PM

Dear WILL, The size of the clot depends upon the tooth extracted and the space left after extraction site. More is the space left after extraction, more larger will be the size of the clot. So, you don't need to worry and maintain a routine oral hygiene as told to you by your dentist. Take liquid diet and stay away from chewy, spicy stuff for at least a week.

 


Posted By : Will on 03-Sep-2012 06:33 AM
I had both of my wisdom teeth out in the left side 10 hours ago. The blood clot on the upper extraction site is huge! It looks like jelly. It covers whole of my left wall. Is it normal to have such a big blood clot? If not what can i do?
 


Posted By : Dr.Ritz on 31-Aug-2012 02:49 AM

Dear JOEY, It is common to experience bleeding for a couple of days post extraction. Follow the course of medicines prescribed and start doing warm saline gargles from today itself. Continue placing a damp gauze pack over the extraction socket (it can be replaced with tea bag) on rotatory basis till the bleeding is stopped. Hopefully these methods should prevent bleeding but even if it continues then it is advised to visit a physician.

 


Posted By : joey on 30-Aug-2012 09:02 AM
i just have 1 extraction yesterday morning. It was just 3 small root fragment on my upper first left molar. Until now it is still bleeding but not heavy. I went back to my dentist this afternoon and he put some absovable cotton on the socket and was given antihemorragic meds. What will i do next if the bleeding dont stop?
 


Posted By : Dr.Ritz on 25-Aug-2012 12:14 AM

Dear RICK, Did your wife had something prior to extraction? Here are the causes of vomiting post extraction: 1. Getting tooth extracted empty stomach 2. Not taking adequate rest post extraction 3. Sensitive to anesthesia or codeine ( component in Anesthesia) 4. Swallowing of the blood ( i think this is the cause of vomitting in case of your wife) The first thing i would advise you to stop the bleeding by putting gauze packs (ofcourse sterile) and asking her to bite gently. Also start with warm saline garlges 24 hours post extraction. Also consult a physician if the vomiting continues or is in excess.

 


Posted By : rick on 24-Aug-2012 02:17 PM
Hi My wife had four wisdom teeth removed about 6 hours ago. She was napping and when i came to check on her there was a trickle of dark red blood out of her mouth. Is that normal? She did vomit when we were driving home.
 


Posted By : Dr.Ritz on 23-Aug-2012 01:08 AM

Dear MARY, Bleeding post extraction depends upon how tough the extraction was. Slight amount of intermittent bleeding for couple of days post extraction is common but heavy bleeding after a day of extraction should be notified to the surgeon. However if you are following all the post extraction instructions as given in the link http://www.identalhub.com/article_do's-and-don'ts-after-tooth-extraction-153.aspx then there shouldn't be any bleeding.

 


Posted By : Mary on 22-Aug-2012 07:32 AM
Had a lower tooth pulled and it was fine but next afternoon I choked up some blood. Is that normal?
 


Posted By : Dr.Ritz on 21-Aug-2012 09:52 PM

Dear JENNI, I would recommend you to put a gauze piece and bite on it gently to stop bleeding. If the bleeding doesn't stop then you can also place a tea bag. It contains tannic acid that reduces bleeding. Also if you encounter any of the below written symptoms 3-4 days post extraction then visit a dentist immediately:

1. Pain on the extraction site which is radiating

2. Foul Smell coming from the mouth

3. Inability to open the mouth

4. Fever

For more information of after care instructions post extraction you can visit the link....http://www.identalhub.com/article_do's-and-don'ts-after-tooth-extraction-153.aspx

 


Posted By : Jenni on 21-Aug-2012 02:14 AM
Hello, I just had my wisdom tooth removed and I had the gauze in for about 20 minutes (was told 15) but I had to talk during this time. I took the gauze out and I'm spitting out quite a bit of blood (stopped spitting when I read this ) did I not bite down hard enough or talked too much with the gauze in? Scared to put another one in incase I damage something further
 


Posted By : Dr.Ritz on 15-Aug-2012 09:49 PM

Dear TERONICA, I suppose you should immediately plan a visit to dentist as there are chances of getting dry socket. Since the chances of dry socket in case of mandibular extraction is quite common so you shouldn't take a risk. The symptoms of dry socket are foul smell from mouth, severe radiating pain, bleeding from the socket and inability to open the mouth.

 

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