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:

  • Small gum (gingival) blood vessels (capillaries)

  • Blood vessels in the bone of the socket

  • 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:


  • 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.
Exodontia.Info
Bleeding Sockets /
Dento-Alveolar Hæmorrhage
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National Center for Emergency Medicine Informatics
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)

Armamentarium for Post-Extraction Haemorrhage
Last Updated 15th May 2015