Bleeding dental socket

Background

Diagram of the tooth displaying the enamel, dentin, and pulp

Dental Numbering

Classic dental numbering.
  • Adult (permanent) teeth identified by numbers
    • From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
  • Children (non-permanent) teeth identified by letters
  • Common landmarks:
    • 1: Right upper wisdom
    • 8 & 9: Upper incisors
    • 16: Left upper wisdom
    • 17: Left lower wisdom
    • 24 & 25: Lower incisors
    • 32: Right lower wisdom

Clinical Features

  • Bleeding from dental socket

Differential Diagnosis

Dentoalveolar Injuries

Odontogenic Infections

Other

Evaluation

  • Clinical diagnosis
  • Slight oozing normal for up to 24 hours post-extraction [1]
  • Evaluate for bleeding disorder if bleeding not controlled with simple pressure (post-extraction bleeding often initial manifestation of coagulopathy) [2]
    • CBC
    • PT/INR

Management

  • Direct pressure on site of bleeding (can have patient bite on gauze or tea bag)
    • Pressure should be applied for 20 minutes
    • Smaller gauze with focal pressure better than larger gauze that covers adjacent teeth occlusal surface
    • Large clots should be wiped away prior to applying gauze
  • If direct pressure unsuccessful:
    • Lidocaine with epinephrine injection; reapply gauze
    • Apply small piece of absorbable gelatin sponge (e.g. - Surgicel)
    • Consider Tranexamic acid (TXA): soak gauze in solution and apply to socket, with pressure
    • Flaps may be sutured closed

Disposition

  • Discharge

See Also

References

  1. ↑ Hupp J, Tucker MR, Ellis E. Contemporary oral and maxillofacial surgery.6th ed. Mosby, 2013.
  2. ↑ Tintinalli, Emergency Medicine, 4th edition, pg. 1109
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