When is Bleeding After Extraction a Dental Emergency?

I’m wondering at what point bleeding becomes a dental emergency after having teeth pulled. My girlfriend had two teeth pulled yesterday (molars) and they haven’t really stopped bleeding since. She got upset by it and I called the office for her, but they kind of brushed me off and said it was normal and that she should be doing a better job of keeping the gauze in. Well, she is keeping it in. It’s just not doing anything. On top of that, the paper they gave us said that swallowing it can make her sick, so she should spit it out. She’s been doing that, but she’s up every few minutes dealing with it. Do I need to take her back to the office and insist that the dentist take a look or is there a chance this really is normal and I’m being overprotective?

Thank you,

Christopher

Dear Christopher,

Generally speaking, post-operative bleeding should stop by about the 24-hour mark, though some dentists give it 36 hours. This is roughly how long it normally takes for a blood clot to form in the socket, which will aid in her healing. That naturally means it has stopped bleeding, but it’s also worth noting that the clot provides a layer of insulation and protects the bone below, so it’s important that it be left intact.

During the day of the extraction, it’s normal to have pink saliva. It can sometimes look messier than it is because of the amount of saliva mixed in. During this stage, it’s important to use the gauze pads to apply pressure to the socket. It’s not just about keeping the gauze in to collect blood; she should be biting down on it to help stop the bleeding, leaving it in place for 20-40-minute stints. Using tea bags in place of the gauze can also help because tea has tannic acid, which will help the clots form.

She’s now on day two, which is starting to push it in terms of bleeding. However, you said she’s getting up a lot to spit. That suggests she’s still bleeding and not using the gauze correctly. She could also be adding pressure/ suction to the sockets when she spits, which can cause a problem with dislodging the blood clot. It’s not good to swallow lots of blood, but the stomach can handle some. Particularly if she’s eating, and if she’s using the gauze, she shouldn’t have an amount that will be irritating to her digestive system. It’s also worth noting that if she’s up and exerting herself, she could also be increasing her bleeding. Right now, she should just be laying low, using the gauze/ tea bags, and taking it easy. If she’s doing all that and is still bleeding (not just a little pink), it’s a good idea to touch base with the dentist today. She could still be within the normal range, but usually about this time (or by the end of today) is when dentists start to investigate ongoing bleeding.

What’s Considered a Dental Emergency After an Extraction

• Heavy bleeding that doesn’t respond to pressure
• Unexplained bleeding after 24-36 hours
• Severe pain (not controlled by prescribed pain medication)
• Signs of infection (fever, chills, redness/ swelling/ oozing at extraction site)
• Nausea/ vomiting, chest pain, shortness of breath

Of course, you can and should reach out to the dentist anytime you have concerns after treatment. If you’re not sure if it’s a dental emergency, it’s always best to err on the side of caution and talk to the doctor. It’s unfortunate that you felt you were getting brushed off by the office. If it happens again, you may have better luck by being a little firm and explaining, “These are the symptoms she has and I’d feel more comfortable if you’d inform the dentist and get back to me with what he advises.” Oftentimes, the staff will field basic questions they know the answer to so you get an answer right away and the dentist stays on schedule, but if you specifically request that they inform the doctor about what’s happening, they shouldn’t have a problem doing so.

This blog is sponsored by Dr. Steve Sirin. Dr. Sirin’s Elgin, Illinois dental office provides comprehensive care and offers same-day appointments for dental emergencies.