DENTAL DISORDERS

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

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