Post-extraction bleeding occurs after removal of a tooth. It
is a common problem. It is often seen in the Emergency Department
in the late evening or night when the patient is unable to contact their
Dentist. The application of direct pressure over the bleeding site
by having the patient bite down on a folded piece of moist gauze
almost always controls post-extraction bleeding. Many patients,
however, will report that they have been doing this prior to coming
to the Emergency Department and request additional assistance.
A careful history may reveal that the patient inadvertently caused
the extraction site to bleed by drinking through a straw, spitting,
gargling, or smoking. All these activities will produce negative pressure
within the oral cavity and remove the clot from the extraction site.
Ask the patient if they are touching the extraction site with their
tongue, causing a mechanical disruption of the clot. Obtain information
about any significant medical history, any history of bleeding,
and current medications. This includes use of aspirin products,
anticoagulants, broad-spectrum antibiotics, alcohol, and anti-neoplastic
medications, all of which may contribute to prolonged bleeding.
Ask about the symptoms and examine for the signs of liver disease,
hypertension, or hematologic disorders.1,2 Post-extraction
bleeding may be a sign of an underlying and undiagnosed coagulopathy.
All post-extraction bleeding must be managed carefully and methodically.
The techniques are easy to perform, simple, and straightforward.
There are no contraindications to the management of post-extraction
- 2×2 gauze squares
- Irrigating syringe
- Dental mirror, optional
- Local anesthetic solution containing 1:100,000 epinephrine
- 23 to 25 gauge, 1.5 inch needle
- 5 mL syringe
- Silk or plain gut sutures, 4–0 or 5–0
- Absorbable gelatin sponge (Gelfoam)
- Oxidized regenerated cellulose (Surgicel)
- Suture set
- Dental forceps
- Tea bag, optional
- Bone rongeur
- Bone wax
- Yankauer suction catheter
- Suction source and tubing
- Silver nitrate matchsticks
- Electrocautery unit
Explain the risks, benefits, potential complications, and aftercare
to the patient and/or their representative. Document this
discussion in the medical record. A signed consent form is usually
not required for these procedures. Consider obtaining a radiograph
of the affected area to rule out a retained root or a bony spur.
Position the patient to visualize the extraction site. Place
the patient in a multipositional dental chair, if available, or
on a gurney. Do not place the patient in a chair as they may become
pre-syncopal and require being placed supine to prevent injury.
An overhead light source or a headlamp is ideal to illuminate the
field. Suction any blood and oral secretions from the mouth. Visualize
the extraction site for any signs of bleeding. Thoroughly irrigate
the site with saline and remove all clots with the aid of suction.
It may be necessary to perform a dental block if the patient complains
of pain upon irrigation. Refer to Chapter 154 for the complete details
regarding dental anesthesia and analgesia.