Bleeding is normal after a tooth extraction. However it should stop later that day. A non-wisdom tooth will typically ooze blood for under an hour, then form a clot. An upper wisdom tooth may ooze blood for several hours, even into the evening. However, it is important to understand that gauze will frequently have blood on it even though the bleeding has stopped. This is because the gauze picks up blood from the blood clot.
There are several key steps to facilitating clot formation:
1. Apply firm (slightly uncomfortable) pressure with gauze. The gauze must be directly over/under the extraction site. Pressure should be applied for 15 minutes continuously. The gauze must be the proper size to apply pressure (not too small), while enabling the mouth to be closed most of the way so the jaw doesn’t get fatigued (not too big).
2. “Bleeding has stopped” doesn’t mean there is no more blood in the mouth or saliva. It is normal to have some blood in saliva for a few days after an extraction. The key is blood is not welling up or dripping and making it difficult to talk, eat, breathe. Often the gauze will be somewhat pink but not deeply red and saturated. If it is somewhat pink this indicates bleeding is well controlled.
3. Maintain the blood clot. Once a clot has formed it is important to not disrupt it. This is accomplished by avoiding vigorous rinsing, sucking through a straw, or spitting. If bleeding resumes you can apply pressure again and the clot will re-form.
4. Black tea bag. Dipping a black tea bag in cold water, rolling it in a gauze or paper towel, and applying over an extraction socket can facilitate clot formation due to the tannin in tea.
5. If you run out of gauze you may use a paper towel cut to appropriate size.
If after trying these things you are still concerned about post extraction bleeding you should contact your doctor. If your doctor isn’t available or if you develop symptoms of lightheadedness, shortness of breath, dizziness, chest pain, or other concerning symptoms, you should go to the Emergency Department.
This blog topic is meant to be a source for educational material on bleeding after a dental extraction. It is not intended to be clinical advice. Real clinical scenarios require doctor-patient discussion, exam, and assessment.
Sometimes the after-effects of oral surgery are quite minimal, so all these instructions may not apply. Common sense will often dictate what you should do. However, when in doubt, please follow these guidelines or call the office for clarification. We can be reached at (415) 397-1400.
AFTER-HOURS CONTACT
If you are having a problem after regular office hours and need to speak with Dr. Rayher, please call (415) 397-1400. Please follow the prompts or wait on the line and an operator will assist you. The operator will take your name and phone number that will be forwarded to Dr. Rayher. He will return your call. Please turn off any caller ID blocking.
After extraction of teeth, a blood clot forms in the remaining socket. To prevent post-operative inflammation and infection, it is important to keep this blood clot in place.
For the first 48 hours after extraction:
- DO NOT vigorously rinse your mouth as this may rinse away the blood clot.
- DO NOT use drinking straws.
- DO NOT smoke.
- DO NOT disturb the extraction site with tongue or fingers.
Bleeding
After tooth removal, it is normal to ooze blood from the tooth socket for approximately 24 hours. To minimize bleeding, do the following:
- Bite on damp gauze for 1 hour after extraction.
- Repeat with fresh gauze every 20 minutes as needed.
- DO NOT lie flat. Elevate your head with a pillow.
- Limit activity for the first 2-3 days.
Swelling
It is normal to swell after tooth removal. The swelling is greatest 2-3 days after surgery, and may remain for an additional 3 days before it starts to resolve.
- Immediately after surgery, place ice packs over the area.
- Leave the pack on for 20 minutes and then off for 20 minutes for the rest of the day.
- After the first 24 hours, it is not necessary to continue cold packs.
Postoperative discomfort
After removal of teeth, it is normal to experience some amount of discomfort when the anesthesia wears off. Taking prescribed medication as directed should control discomfort, but may not eliminate it.
- DO NOT operate a motor vehicle or machinery while taking pain medication. It can make you drowsy.
Infection
After surgical procedures, there is always a chance that infection might develop. This does not happen in most cases. A prescription may be written for you after a procedure that has a higher incidence of post-operative infection.
- Take all prescribed antibiotics until finished.
- Women taking oral contraceptives (birth control pills) are recommended to use other methods of contraception while taking antibiotics. Penicillin and penicillin-like medications temporarily decrease effectiveness of birth control pills.
Sutures
Depending on the extent of the procedures, sutures (stitches) may be placed in order to help wound healing. If you have sutures, the doctor will inform you of this after the procedure.
- Sutures that dissolve should fall out in about 1-7 days.
- The non-dissolvable sutures need to be removed as early as 7 to 10 days. However, most are removed at 3 weeks.
Other Instructions
If you have had IV sedation or general anesthesia for your procedure, you should rest at home with moderate activity as tolerated.
For the next 24 hours following anesthesia:
- DO NOT drive a car or operate machinery or power tools.
- DO NOT drink any alcoholic beverages including beer.
- DO NOT engage in any moderate to high intensity physical activity (e.g., running, weight-lifting)
Brushing
- Begin normal hygiene the night of surgery or the next day, brush lightly as you get closer to the area of surgery.
- DO NOT spit.
Diet Suggestions
Begin with clear liquids, such as apple or cranberry juice, 7 Up® ,or ginger ale.
Advance diet the first day as tolerated, such as Jell-O®, applesauce, or milkshakes.
Soft, non-chewy foods are recommended for 1 week after surgery, such as mashed potatoes, scrambled eggs, or pasta.
DO NOT eat popcorn, peanuts, seeds, or chips for at least 2 weeks after surgery to prevent an infection in the surgical site from impacted food debris.
DO NOT rinse your mouth for the first 24 hours after surgery. After that, rinse gently with the oral rinse, if prescribed by your doctor, or with warm salt water (1/2 teaspoon salt dissolved in 8 ounces of warm water) 2-3 times a day for 1 week. Brush your teeth gently, but avoid the area of surgery for the first 24 hours.
Warning Signs
If any of the following should occur, do not hesitate to contact us during regular office hours at (702) 660-5574. During the evening or night hours call (702) 660-5574 and follow the prompts.
- Bleeding that cannot be controlled by firmly biting on a gauze for 60 minutes.
- Pain which is not controlled by the prescribed dose of medication. DO NOT take higher doses.
- Persistent nausea or vomiting.
- An increase in swelling after the first 72 hours or swelling that interferes with swallowing.
- A very foul-tasting discharge that is unrelieved by normal oral hygiene.
- Fever greater than 101 degrees Fahrenheit.
FAILURE TO FOLLOW INSTRUCTIONS MAY BE LIFE-THREATENING.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but please contact our office if you have questions about your progress.