Post Extraction Bleeding
Bleeding socket can be primary (occurring within first 24 hours post extraction) or secondary (occurring beyond
24 hours post extraction)
Causes
- Disturbing the blood clot by the patient through rinsing or inadequate compression on the gauze
- Bony/tooth remnants
- Physical exercise following extraction
- Bleeding disorder of patient
- Medication (e.g. aspirin or anticoagulants)
Clinical features
- Active bleeding from the socket
- The socket may or may not have a blood clot
- If patient has lost significant amount of blood; decreased pulse rate, hypotension, dehydration may be present
- Traumatic area of surrounding bone of the socket
- Features of infection or trauma in secondary bleeding
MANAGEMENT
General measures
- Restore airway, breathing and circulation if necessary
- Check blood pressure and pulse
- Clear any clot present and examine the socket to identify source of bleeding
- If the bleeding is from soft tissue (which is common) remove any foreign body like bone
spicule if found, smoothen any sharp edges - Suture the wound only if necessary
- Check and repack the socket with gauze
- Tell patient to bite on gauze pack for 30 minutes, not to rinse or eat hot foods on that day; at least
for 12 hours, and avoid touching the wound
- Tell patient to bite on gauze pack for 30 minutes, not to rinse or eat hot foods on that day; at least
Medicines
- Lignocaine 2% with adrenaline 1:80,000 IU (specialist use only)
- Paracetamol 1 g every 8 hours
- Or diclofenac 50 mg every 8 hours
- Tranexamic acid 500 mg every 8 hours for first 24 hours if bleeding is persistent
- IV fluids (0.9% sodium chloride or Ringer’s lactate) if dehydrated
- Consider blood transfusion if Hb decreases to <7 g/dL in an otherwise healthy patient before
extraction
If bleeding continues after 24 hours
- Consult a haematologist or physician for further management