Procedure
Post-Tooth Extraction Bleeding
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Post-Tooth Extraction Bleeding
, Post Extraction Bleeding, Hemorrhage Following Tooth Extraction
See Also
Tooth Extraction
History
Procedure performed
Time and Date of procedure
Name of dentist or orofacial surgeon
Locations of teeth extracted
Complications from procedure
Other
Trauma
Spitting or gargling
Drinking through a straw
Tobacco
use
Manipulating extraction site (with
Tongue
or finger)
Medical history contributing to bleeding risk
Bleeding Disorder
s (e.g.
Hemophilia
,
Von Willebrand Disease
)
Anticoagulant
s (e.g.
Warfarin
,
Factor Xa Inhibitor
or
DOAC
)
Antiplatelet Agents (e.g.
Aspirin
,
Clopidogrel
)
Broad spectrum antibiotics
Chemotherapy
Heavy
Alcohol
use or liver disease
Severe Hypertension
Exam
Ensure adequate lighting (head lamp or spot light)
Identify bleeding sites
May be challenging (use suction, pressure on suspected bleeding sources)
Observe for bleeding causes
New granulation tissue
Gingiva
l
Laceration
s or tears
Bones spurs
Injured vessel
Labs
Not needed in most cases
Consider in refractory cases with heavy bleeding
Complete Blood Count
with
Platelet Count
Coagulation studies (INR, PTT)
Management
Gene
ral
ABC Management
Maintain NPO status until
Hemorrhage
is controlled
Intermittent suction with yanker suction catheter or similar
Irrigate the socket as needed
Management
Hemorrhage
Control
Apply Local Pressure (first-line)
Apply direct pressure to area by biting on gauze or tea bag for at least 20 minutes (tannins promote coagulation)
Apply gauze soaked in
Tranexamic Acid
(TXA) and held in position (typically with biting) for at least 20 minutes
Consider soaking gauze in
Topical Thrombin
instead of TXA (esp. if patient taking
Warfarin
)
May alternatively moisten with
Normal Saline
if TXA and
Thrombin
are unavailable
Absorbable Dressing (refractory cases)
Pack socket with absorbable dressing (may soak in TXA or
Thrombin
)
Gelfoam
(absorbable gelatin sponge)
Preferred for ease of use and absorption
Surgicel
(oxidized and regenerated cellulose)
Risk of delayed tooth socket healing
Chitosan Dental Bandage (e.g. HemCon)
Not widely available in Emergency Departments
Secure packing
Gauze (2x2) placed over socket and patient bites on gauze for 20 minutes OR
Oversew the socket with figure of eight to hold the absorbable dressing in place (preferred)
Use 4-0 or 5-0
Absorbable Suture
(e.g. plain gut)
Anesthetize area if not already performed
Suture
a figure of 8, with entry and exits along each side of the tooth and crossing over the center
Other measures in refractory cases
Suture
Gingiva
l tears
Injection of
Epinephrine
in
Local Anesthetic
Cauterization
Electrical cautery
Silver Nitrate
Monsel's Solution
(
Ferric Subsulfate Solution
)
Management
Disposition
Observe patient for 30 to 60 minutes after bleeding has stopped
Home Instructions
Avoid liquids or solids for 2 hours after discharge
Avoid spitting or gargling
Avoid drinking through a straw
Avoid
Tobacco
Avoid chewing gum or other sticky foods
Maintain soft diet
Avoid very hot or very cold foods or liquids
Hold antiplatelet agents (e.g.
Aspirin
),
Anticoagulant
s for 1-2 days (if not contraindicated)
Recurrent Bleeding at Home
Apply direct pressure to area by biting on gauze or tea bag for at least 20 minutes (tannins promote coagulation)
Return if bleeding persists despite pressure
Follow-up
Dentist or orofacial surgeon who performed
Tooth Extraction
(call when office opens)
References
Nisi (2022) Appl Sci 12(11017)
https://www.mdpi.com/2076-3417/12/21/11017/pdf
Chapter 179. Post-Extraction Bleeding Management. In: Reichman EF. eds. Emergency Medicine Procedures, 2e. McGraw Hill; 2013. Accessed January 30, 2023
https://accessemergencymedicine.mhmedical.com/content.aspx?bookid=683§ionid=45343828
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