What is it?
After a tooth is taken out, a clot forms in the socket. This clot both stops the bleeding and covers the bone underneath; healing runs over the top of it. In the first hours a small amount of blood mixing with saliva colours the whole mouth pink and looks far heavier than it is.
The real problem is the clot not forming at all, or coming away after it has formed. Sucking, rinsing, hot drinks, smoking and heavy exertion can lift the clot. The bleeding then starts again and has trouble stopping on its own.
Blood-thinning medicines, liver conditions, some blood disorders and uncontrolled high blood pressure all lengthen the time bleeding takes. Bleeding is also expected to last longer after a difficult extraction, from an infected area and from a large wound.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
The clot coming away
Sucking saliva, rinsing the mouth, drinking through a straw and smoking all change the pressure on the wound and lift the clot that has just formed. On the first day after an extraction, any one of these can bring the bleeding back.
- 02
Using the gauze wrongly
The gauze has to sit right over the socket the tooth came out of and be bitten on without a break. Gauze that is wedged between the teeth, taken out often to check, or held loosely applies no pressure; this is why the bleeding does not stop.
- 03
Blood-thinning medicines and clotting problems
Medicines that affect clotting lengthen the time bleeding takes. They are not stopped without asking the doctor, because stopping them carries risks of its own. Liver conditions and some blood disorders have a similar effect.
- 04
The wound and your general health
Extractions from an infected area, wide and deep wounds, areas rich in blood vessels and uncontrolled high blood pressure all prolong bleeding. Heavy exercise and alcohol also increase bleeding on the first day.
How does it progress?
- Expected
Oozing in the first hours
Pink-tinged oozing mixed with saliva is normal on the first day. It reduces with pressure from the gauze and stops on its own. No extra step is needed at this stage.
- Prolonged
Bleeding that carries on despite the gauze
If the bleeding carries on despite thirty minutes of biting without a break, the gauze is replaced and applied for the same length of time once more. If it continues after two attempts, contact your dentist.
- Late
Bleeding that starts again days later
When the clot is lost, or the area becomes infected, bleeding can start again a day or two later. This should be assessed rather than left in the hope that it settles by itself.
- Heavy
Running blood and whole-body signs
If there is red blood filling the mouth, nausea from swallowed blood, dizziness or palpitations, do not wait. Contact your dentist or go to an emergency department within the same hour.
How is it treated?
The first thing to do is apply the right pressure. Roll up a clean piece of gauze, place it right over the extraction socket and bite on it for thirty minutes without taking it out at all. Talking, checking the gauze and spitting during that time all break the pressure. If the bleeding does not reduce, replace the gauze and repeat for the same length of time.
At the clinic the source of the bleeding is identified first. The socket is cleaned and, if needed, the wound edges are tidied under local anaesthetic; sponges that stop bleeding and stitches can be used, and cautery is used where the bleeding comes from a vessel. If you take a blood thinner, you will be asked its name, its dose and the time of your last one; whether it is paused is decided together with the doctor who prescribed it.
If the bleeding keeps coming back, or whole-body signs come with it, a blood count and clotting tests may be requested; referral to hospital may be needed. If you have a known bleeding disorder, the plan for later extractions is set up together with haematology.
- Red blood filling the mouth and running despite the gauze
- Dizziness, palpitations, looking pale and feeling weak
- Nausea and vomiting from swallowed blood
- Swelling of the face or the floor of the mouth growing quickly along with the bleeding
How is it prevented?
- Before an extraction, tell your dentist about every medicine you take, particularly blood thinners and herbal supplements.
- On the first day, do not rinse your mouth, suck saliva, use a straw or smoke.
- For the first twenty-four hours, stay away from hot drinks, heavy sport, hot showers and alcohol; rest with your head raised.
- If you have high blood pressure, take your medicine as usual on the day of the extraction and have your blood pressure checked.
Frequently asked questions
- How much bleeding counts as normal?
- Pink-tinged oozing mixed with saliva is normal on the first day; a small amount of blood mixes with a lot of saliva, so it looks like more than it is. What is not expected is blood that fills the mouth and drips despite unbroken pressure.
- Should I stop my blood thinner before an extraction?
- Do not stop it on your own decision. Pausing these medicines carries a risk of clots and of stroke. Most tooth extractions can be done while the medicine is continued; whether it is paused is decided by the doctor who prescribed it together with your dentist.
- Does putting ice or a tea bag on the bleeding spot help?
- Cold applied to the outside of the cheek reduces swelling. Biting on a tea bag does apply some pressure, but it does not take the place of gauze or of the correct technique. If the bleeding does not stop after two attempts with gauze, do not wait.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.