Post-extraction bleeding is a common problem after the removal or extraction of a tooth. It is often seen in the Emergency Department in the late evening or night when the patient is unable to contact their Dentist. Bleeding that occurs within a few hours of the extraction is often due to the wearing off of the vasoconstrictor effect of the local anesthetic solution used for anesthesia. 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 require 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 antineoplastic medications. These all 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 bleeding.
- 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)
- Topical thrombin
- Suture set
- Dental forceps
- Tea bag
- 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 presyncopal 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 warm saline and remove all clots with the aid of suction. It ...