First Aid for Post – Dental Extraction Bleeding

Some amount of bleeding after extraction of a tooth is inevitable under any circumstances. However many complains of prolonged excessive bleeding after tooth extraction. This is quite common with removal of a molar tooth at the very back of the mouth as these are larger and the extraction tends to be more difficult in these.

Following an extraction of a tooth a blood clot has to from there in the opened up blood vessels that have been supplying that particular tooth. This is similar to what happens in a wound elsewhere in the body as the first line of hemostasis (i.e. causing bleeding to stop). Following the formation of clot the healing of the cavity initiates and takes up roughly about 3 – 4 weeks for the gum tissue and about 3 – 4 months for the bony defect to heal completely.

Therefore, first 24hrs following extraction is most important as it will set stage for the events to come in the healing process. Most of the prolonged bleeding cases occur due to inappropriate activities that impairs this vital process at its most vulnerable stage.

However, it has to be kept in mind that even though bleeding continued for about 24hrs and appears the patient spitting out mouthfuls of blood every 20 – 30 minutes the actual amount of blood loss it quite insignificant and within ‘easily compensated’ limits to the body. In reality its small seepage of blood that is mixed with larger volumes of saliva coming to the mouth due to the salty feel in mouth caused by blood that appears like torrential hemorrhage and hence causing all the panic.

The following few facts will be helpful not only in controlling bleeding but also in minimizing other possible complications that can arise following dental extraction.

  • As the earliest measure, brush the teeth well just before going to the dentist appointment to remove the tooth. This will help to reduce the load of bacteria in mouth hence the chance of infection later on.
  • If you are suffering from illnesses that cause uncontrollable heavy bleeding (e.g. Hemophilia), or has past incidences of such bleeds, or if you are taking medications that interferes with platelet function and/or blood clotting (e.g. Aspirin, Warfarin, Clopidogrel) remember to inform dentist beforehand as special measures has to be taken for such patients.
  • The dentist will place a wad of gauze in the socket as soon as he removes the tooth, clamp the teeth and hold this firmly for at least 45 minutes to one hour at the exact same position as it is the single most effective way of controlling the bleeding.
  • If you are to change the gauze due to heavy bleeding put a new wad quickly in the same position as the previous. It is best not to change it within first hour.
  • Sit or lie down and rest in this period as it will reduce the blood pressure.
  • Do not spit every now and then to see whether still bleeding or not as this will dislodge the clot formed creating negative pressure inside mouth cavity.
  • If you are bleeding at the end of first hour, keep a new gauze wad in the defect and repeat above for another hour.
  • If the bleeding continues, place a moist black tea bag in the defect and clamp on it as previously ( tannic acid in tea will promote clotting) for another hour.
  • If the amount of bleeding reduces notably with above step repeat them as necessary. A minute seepage of blood is not uncommon during first 24hrs.
  • But if bleeding continues heavily despite above measures contact the dentist immediately.
  • In the same time take oral pain killers (e.g. acetaminophen, ibuprofen, ketoprofen) before the pain comes with local anesthesia used to pull out the teeth waning off. This will effectively control pain compared to taking them after pain settled in.
  • Ice packs on the cheek over the corresponding area in first 24hrs will not only control bleeding but it will reduce the swelling of cheek considerably.
  • Do not rinse or brush teeth during first 24 hours. Also don’t suck liquids, probe the defect with tongue, or chew food from same side.
  • Do not smoke or take alcohol, and stick to a soft or liquid diet on first day.
  • Finish the course of antibiotics (if prescribed). Or rinse mouth with prescribed mouth wash (after 1st 24hrs) to combat infection.
  • Chew solids from opposite side of mouth for next 3 – 4 days until the gum defect healed fully.
  • Even though it’s difficult do not keep mouth shut always in next days as it may cause stiffness and inability to open mouth fully (trismus) permanently. Open the mouth as wide as possible usually to accommodate 4 fingers vertically between upper and lower teeth.

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