Bleeding dental socket
Background
Clinical Features
- Bleeding from dental socket
Differential Diagnosis
Dentoalveolar Injuries
Odontogenic Infections
- Acute alveolar osteitis (dry socket)
- Acute necrotizing ulcerative gingivitis (trench mouth)
- Dental abscess
- Periapical abscess
- Periodontal abscess
- Ludwig's angina
- Pulpitis (dental caries)
- Pericoronitis
- Peritonsillar abscess (PTA)
- Retropharyngeal abscess
- Vincent's angina - tonsillitis and pharyngitis
Other
Evaluation
- Clinical diagnosis
- Normal oozing may occur 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 tooth occlusal surface
- Large clots should be wiped away prior to applying gauze
- If direct pressure unsuccessful:
- Lidocaine with epinephrine injection if unsuccessful; 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