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16.7 Post Extraction Bleeding

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Commonly due to disturbing the blood clot by the patient through rinsing or inadequate compression on the gauze, though at times may be due to bony/tooth remnants.

Diagnostic Criteria

Bleeding socket can be primary (occurring within first 24 hours post extraction) or secondary occurring beyond 24 hours post extraction.

Primary Bleeding Socket

  • Active bleeding from the socket
  • The socket may or may not have blood clot
  • Patient may be dehydrated and pale if has lost significant amount of blood
  • Features of decreased pulse rate and volume, hypotension also if patient has lost significant amount of blood
  • Examine the socket for trauma in surrounding bone

Secondary bleeding socket may show features of infection or trauma

Non-Pharmacological Treatment 

  • Ensure the patient airway, breathing and circulation are restored if required
  • Check blood pressure and pulse rate and take quick history
  • Give local anesthesia (lignocaine 2% with adrenaline 1 in 80,000 IU)
  • Clear any clot available and examine the socket to identify source of bleeding
  • If the bleeding was from soft tissue (which is common) remove any foreign body like bone spicule if found, smoothen any sharp edges
  • Suturing of the wound only when necessary (like significantly traumatized gingiva)
  • Check and repack the socket with gauze.
  • Give proper instructions to follow (bite on gauze pack for 30 minutes, not to rinse or eat hot foods on that day at least for 12 hours and avoid disturbance to the wound)
  • Packing can be done with materials which stimulate blood clotting like oxidized cellulose (e.g. surgicel/gauze) or thrombin-containing gel foam sponges

Pharmacological treatment  Analgesics may be needed:

A: Paracetamol (PO) 1gm 8 hourly for 3 days

OR

C: Diclofenac (PO) 50mg 8 hourly for 3 days

OR

A: Ibuprofen (PO) 400mg 8 hourly for 3 days

AND

C: Tranexamic acid 500 mg (PO/IV) 8 hourly for first 24 hours.

Intravenous fluid especially Normal saline 0.9% or Ringer’s lactate in case of dehydration then followed by blood transfusion in case of hemoglobin below 7 g/dl in a patient who was otherwise healthy before tooth extract.

Note: Rule out bleeding disorders: if bleeding continued after 24 hours despite the steps above, consult a hematologist or available physician for further management

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