Bleeding That Won't Stop After an Extraction: What to Do

Most bleeding that seems unstoppable after an extraction is a pressure problem rather than a bleeding problem, and it settles with a firm gauze pad held directly over the socket, bitten on continuously for a full 20 to 30 minutes without lifting it to look. A small amount of blood mixes with a lot of saliva and looks far worse than it is.

If the technique below has been tried properly and the bleeding is still brisk, that is the point to ring.
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How much bleeding is normal?

Oozing for several hours after an extraction is ordinary. Pink-tinged saliva for the rest of the day is ordinary. A small dark clot sitting in the socket is what should be there.

The reason it looks alarming is dilution. A few millilitres of blood mixed through saliva will colour a whole mouthful and stain a pillowcase in a way that suggests a much larger volume than has actually been lost.

What is not ordinary is bright red blood flowing steadily and filling the mouth faster than it can be swallowed, or bleeding that restarts and will not respond to pressure.

The technique, step by step

This is the part that matters most, because the majority of calls about unstoppable bleeding turn out to be pressure applied in the wrong place, for too short a time, or interrupted.

• Make a firm pad. Roll or fold a clean gauze swab into a pad about the size of the socket. A damp black tea bag works well as an alternative, and the tannins in black tea assist clotting.
• Place it directly over the socket. This is where most attempts fail. The pad must sit on the socket itself, not float between the upper and lower teeth. It should be pressed against the gum where the tooth was.
• Bite firmly and continuously for 20 to 30 minutes. Steady, hard pressure. Not on and off.
• Do not lift it to check. Every look releases the pressure and disturbs whatever clot has begun to form, which resets the clock.
• Sit upright. Head above the heart. Lying flat raises the pressure in the vessels of the head.
• Stay calm, and stay quiet. Anxiety raises blood pressure and talking moves the jaw and the pad. Do not spit.
• Repeat once with fresh gauze if needed. One more full 30-minute attempt with a clean pad is reasonable before ringing.

Done properly, this resolves the great majority of post-extraction bleeding.

What makes bleeding worse?

• Rinsing the mouth, which washes away a forming clot.
• Spitting, which applies suction directly to the socket.
• Straws, for the same reason.
• Smoking and vaping, both chemically and because of the suction involved.
• Hot drinks, which dissolve and soften a clot.
• Alcohol, which dilates blood vessels.
• Exercise, heavy lifting and bending forward.
• Lying flat.
• Checking the socket repeatedly, prodding it with a tongue or finger, or picking at it.

Almost every item on that list is something people do while trying to help. The instruction that covers all of them is to leave the socket alone and hold pressure.

A call to describe what is happening is often quicker than working it out alone at home.
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When should the practice be called?

Ring the practice if any of the following apply:

• Bleeding is still brisk after two proper attempts at 20 to 30 minutes of continuous pressure.
• Blood is filling the mouth quickly and needs swallowing or spitting out repeatedly.
• Large soft dark clots keep forming and being displaced. These are sometimes described as liver clots, and they tend to sit over the socket without sealing it, so the bleeding continues underneath.
• Bleeding starts again several days after the extraction.
• The socket is bleeding alongside increasing pain, which may point to something other than a bleeding problem.

Emergency appointments are generally in the afternoon, and every call from someone in pain is treated as urgent. The emergency page sets out how that works. No question is a bad question here, and a call that turns out to be ordinary oozing is not a wasted call.

When is it a hospital or 000 situation?

Bleeding after a dental extraction is rarely dangerous, but the following mean an emergency department, or 000 if the person is seriously unwell:

• Feeling faint, dizzy or close to passing out.
• Shortness of breath.
• A racing or pounding heartbeat.
• Pale, cold or clammy skin.
• Confusion or unusual drowsiness.
• Bleeding that is genuinely heavy and unrelenting despite correctly applied pressure.

These are signs of significant blood loss rather than of a stubborn socket, and they should not be waited out at home overnight.

What if you take a blood thinner?

Anticoagulant and antiplatelet medication changes the picture, and it is one of the reasons medical history is taken before an extraction rather than after it. Common examples include warfarin, apixaban, rivaroxaban, clopidogrel and low-dose aspirin.

Bleeding disorders and liver disease also affect clotting, as do some supplements. All of them are worth mentioning at the planning appointment.

The important point: do not stop, skip or alter a prescribed blood thinner because of dental bleeding. Those medications are prescribed to prevent strokes and clots, and stopping them without instruction carries its own serious risk. Any change is a decision for the prescribing doctor, not something to make at the kitchen table at 11pm.

Where a patient takes one of these medications, that has generally been discussed before the extraction, and the socket is managed accordingly on the day. If the bleeding is not settling, ring for advice rather than adjusting medication.

What can the practice do?

Several things, and they are quick. The socket is cleaned and inspected so the source of the bleeding is identified rather than guessed at.

A haemostatic dressing, a material that promotes clotting, can be packed into the socket. Sutures can be placed to bring the gum edges together and support the clot. Local measures such as a local anaesthetic containing a vasoconstrictor can be used to help the vessels close.

A review is then arranged, and where there is a broader medical reason behind the bleeding, that is communicated back to the treating doctor.

Quick answers

Is swallowing some blood harmful?

Swallowed blood commonly causes nausea and can look dark in the stomach contents if someone is sick. It is unpleasant rather than dangerous in small amounts, but it also makes it very hard to judge how much has actually been lost, which is a further reason to control the bleeding rather than wait it out.

Does a tea bag really work?

A damp black tea bag, squeezed out and used in place of gauze, is a reasonable and widely used substitute. The tannins assist clotting. It has to be black tea and it still requires the same firm continuous pressure.

Why did it start again three days later?

Late bleeding can follow disturbance of the clot, physical exertion, or a socket that is not healing as it should. It warrants a call rather than another night of pressure packs.

How much blood loss is actually significant?

Far more than most people imagine, which is why the symptom list above is based on how the person feels rather than on the appearance of the pillowcase. Feeling faint or breathless matters. A stained pillowcase on its own does not.

Where to go from here

For the ordinary healing sequence and what should be happening on each of the first two days, read the first 48 hours after an extraction. If the problem is worsening pain rather than bleeding, dry socket and how to reduce the risk covers that pattern. The extractions page explains how extractions are planned, including the medical history discussion and the written quotation given before treatment begins. General health information is available from healthdirect.

Bleeding that has not settled after two proper attempts at pressure can be packed, dressed or sutured at the practice.
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Written and reviewed by Humzah Aly, Oral Health Therapist. This article is general information only and is not a substitute for personalised dental advice. Please see a dental practitioner to discuss what is right for you.