Practice 10-Minute Consultation

A bleeding socket after tooth extraction

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1217 (Published 03 April 2017) Cite this as: BMJ 2017;357:j1217
  1. Isabelle J Moran, specialty trainee in paediatric dentistry1 2,
  2. Libby Richardson, dental core trainee2,
  3. Manolis Heliotis, oral and maxillofacial surgery consultant1,
  4. Alex Bewick, emergency medicine registrar3
  1. 1Oral and Maxillofacial Surgery, Northwick Park Hospital, London HA1 3UJ, UK
  2. 2Barts Health Dental Hospital, London E1 1BB, UK
  3. 3Royal London Hospital, London, UK
  1. Correspondence to: I J Moran isabellemoran{at}nhs.net

What you need to know

  • Low level oozing from a tooth socket in the first 12-24 hours after extraction is normal

  • Any active bleeding beyond this point requires investigations and treatment

  • To minimise the chances of post-extraction bleeding, patients should be advised not to rinse their mouth, smoke, or undertake strenuous activity for 24 hours and to reduce contact of the socket with the tongue

A fit and well 25 year old man attends his local emergency department concerned about a bleeding tooth socket after having had a lower wisdom tooth extracted earlier that morning.

Postoperative bleeding is a recognised complication after tooth extraction, with an incidence of up to 1.4% of patients undergoing lower wisdom tooth surgery.1 It can be difficult to achieve complete haemostasis within the oral cavity because of the highly vascular nature of the tissues and exposure of the open socket to the patient’s exploring tongue and fingers.2

In healthy patients, a low level ooze for 12-24 hours after extraction is normal as an organised clot forms in the tooth socket.23 The patient will have mildly bloodstained saliva that will decrease over time. Any active bleeding beyond this point often indicates a haemostatic problem and requires investigations and treatment.4

What you should cover

Significant, active haemorrhage must be addressed before taking a comprehensive history. It …

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