Brief description of 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)
Gently rinse the mouth once with warm (not hot) water to wash out excess blood.
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 necessary, repeat once. If the patient is taking anticoagulant medication (e.g. warfarrin, aspirin, clopidogrel) send the patient for emergency care.
After the bleeding has stopped, advise the patient to avoid drinking alcohol, smoking or exercising for 24 hours and to avoid disturbing the blood clot.
If the bleeding fails to stop and is brisk and persistent, send the patient immediately to emergency care via NHS 24.
If the bleeding fails to stop, but is not brisk and persistent, send the patient for urgent dental care.
If application of pressure does not work, find the source of the bleeding.
- Applying a haemostatic dressing to the socket (e.g. oxidised cellulose such as Surgicell or haemocollagene 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.
Do not prescribe antibiotics unless there are signs of spreading infection, systemic infection, or for an immunocompromised patient.
- SDCEP. Emergency dental care: dental clinical guidance. Dundee: Scottish Dental Clinical Effectiveness Programme, 2007.
Chlorhexidine mouthwash is not suitable for children under 7 years old.