Bleeding Socket (Dento-Alveolar Hæmorrhage)

A degree of blood oozing will occur from the extraction
site for the first 24 hours.

If fresh bleeding occurs, pressure should be applied to
the extraction site with a pack. This is achieved by
placing a rolled hankie, cotton wool or linen directly over
the site and biting hard.  Pressure should be applied for >
20 minutes (some authorities suggest 45 - 60 minutes)
and this should stop the bleeding.

It is both firm pressure and maintaining this pressure over
a prolonged period of time that are important factors
when this technique is used.

Don't keep changing the gauze, just put some in and then
clamp down on it for a period of time.

If the bleeding seems to persist, a slightly moistened tea
bag can be a very effective substitute for gauze.

Black tea contains
tannic acid. Tannic acid can aid in the
formation of blood clots and this technique can be very
effective. (Same instructions as above, just substitute the
tea bag for the gauze).

If heavy bleeding is still present then contact your dentist
/ Oral Surgeon or attend A&E.


Bleeding usually comes from 1 of 3 sources:

  1. Small gum (gingival) blood vessels (capillaries)
  2. Blood vessels in the bone of the socket
  3. A large vessel under a flap or in bone such as the
    inferior alveolar artery


Persistent bleeding from a tooth socket after dental
extraction may be due to:

  • reactionary hæmorrhage (2 - 3 hours as the local
    anæsthetic wears off).

  • secondary hæmorrhage (48 - 72 hours and is
    always indicative of infection).  This is more likely if
    the oral hygiene has been bad.


Management:

  • Reassure patient and take a good history (including
    medical such as blood dyscrasias such as leukæmia
    or myelodysplastic syndrome, Hæmophilia and von
    Willebrand's Disease or platelet disorders and drug
    history such as use of aspirin, warfarin, heparin or
    dipyramidole).
  • The patient's pulse, blood pressure and any signs of
    shock (if the bleeding has been significant) should be
    checked.
  • Wear gloves and an apron.
  • In good light and using suction, clean the area and
    try to identify the source of the bleeding.
  • Squeeze the edges of the socket together (this will
    stop gingival bleeding).  Local Anæsthetic and
    stitching of the socket will stop the bleeding in this
    case.
  • If bleeding continues, it is from vessels in bone,
    which need some form of pack.


There is a hierarchy of treatment.  If one treatment fails,
the next one is moved on to.

Bleeding from the tooth socket can be reduced / stopped
by:

  • Pressure (gauze)

  • ± soaked in adrenaline / transexamic acid

  • Stitches ± LA

  • Stitches ± LA



  • ± diathermy (cautery)

Exodontia.Info
Bleeding Sockets /
Dento-Alveolar Hæmorrhage
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Last Updated 30th August 2010