Post-extraction haemorrhage
Brief description of the condition
Bleeding following tooth extraction.
Key signs and symptoms
- Bleeding - can be immediate due to failure to secure adequate initial haemostasis, within a few hours (reactionary) or within a week of an extraction (indicative of possible infection). The bleeding pattern can vary (e.g. intermittent or brisk and persistent or prolonged oozing) and may be influenced by factors such as the patient’s medical condition(s) and medication(s) and physical activity.
Initial management
Advise the patient to:
- place a rolled up piece of cotton or a gauze swab moistened with saline or water over the socket and to bite firmly on it
- maintain the pressure for 20 minutes before checking whether the bleeding has stopped
If the bleeding stops, advise the patient to avoid drinking alcohol, smoking or exercising for 24 hours, to keep their head raised if possible and to avoid disturbing the blood clot.
For patients taking anticoagulant or antiplatelet medication (e.g. dabigatran, apixaban, rivaroxaban, edoxaban, warfarin, aspirin, clopidogrel, prasugrel, ticagrelor), advise the patient that if the bleeding fails to stop or restarts, to seek emergency care (dental or NHS24/111) for assessment and subsequent treatment.
For patients who are not taking anticoagulant or antiplatelet medication, advise the patient that if the bleeding fails to stop or restarts, to repeat pressure once more, and if that fails to control the bleeding, to seek emergency care (dental or NHS24/111) for assessment and subsequent treatment.
Subsequent care
If application of pressure does not work, find the source of the bleeding.
Consider:
- Applying a haemostatic dressing to the socket (e.g. oxidised cellulose or collagen sponge).
- Suturing the wound to achieve good soft-tissue closure and/or to stabilize the socket edges.
If the patient is a child, consider referral to a specialist to investigate underlying pathology.