Patient Information Sheet.

Persisting bleeding following a dental extraction

Persisting bleeding following a dental extraction is an uncommon, but well-reported post-
operative complication of dental surgery.
This can be associated with a number of medical conditions, E.g. blood disorders and liver
disease; and with certain medications E.g. warfarin and aspirin.
Usually patients are aware that their medical condition or medication places them at some
risk, and in any case these matters are usually identified when patients complete the medical
history questionnaire prior to treatment.
Occasionally there are undisclosed or unidentified problems, but more usually post
extraction bleeding problems are chance events that occur for no particular reason.

The usual presentation is of a large blood clot that forms over the tooth socket without
actually stopping the bleeding.
This leads to a red, jelly-like mass, which gradually increases in size as the socket continues
to ooze blood underneath it.
For as long as the large clot remains in place the socket will not stop bleeding.

ACTION

The blood clot on top of the socket must be wiped entirely away.
This can be done with tissue paper or a cotton handkerchief.
The clot tends to be quite sticky, so it may take several attempts to clear the clot away.
Ideally remove any clot within the tooth socket using a cotton bud.

Moisten a clean cotton handkerchief. (Do not use tissue paper or cotton wool at this stage)

Wrap this into a wad so that it is narrow enough to fit between teeth on either side of the
socket, but wide enough to cover the whole socket. It should be sufficiently bulky so that
when the teeth are closed together, the wad exerts a lot of pressure on the socket.

Bite hard on the swab for a minimum of thirty minutes. This should be constant pressure.

If it is difficult to maintain pressure in this way, press hard on the swab with a finger, again
for thirty minutes.

If bleeding persists after thirty minutes of constant pressure contact the dental practice for
advice. If the practice is closed contact the on-call dentist. (see emergency treatment)

If the bleeding stops, avoid strenuous exercise for 24 hours, do not rinse your mouth for 24
hours. Advise your dentist of the situation when you next visit the practice