What do we do when a tooth is pulled out? Even under the office, many examine the traces of the operation, fearing for its consequences. The fear intensifies after the end of the painkillers: how long should the wound hurt, and when will the bleeding stop?
Blood clot after tooth extraction
On the first day, a blood clot appears at the site of the pulled out tooth - an important condition for high-quality wound healing. In order for recovery to proceed without serious consequences, it is important to know what the wound should look like during extraction, what should and should not be done with it during the recovery period.
A few words about the procedure
Tooth extraction is a full-fledged surgical procedure. The operation consists of four stages.
- Treatment of the area around the tooth that is to be removed.
- Anesthetic injections - ampoules in carpules, where an anesthetic is combined with drugs to constrict blood vessels. Usually local anesthesia is used in the area where the nerve that innervates the problem tooth exits; if this is not enough, anesthetics are added without additional effect. When the medicine is injected into the inflamed gum with an acidic environment, part of it is inactivated, so additional anesthesia is used.
- Tooth extraction after the anesthesia has started working (the gums become numb, the blood vessels narrow). A scalpel is used to cut off the ligaments that fix the tooth. The choice of instruments and duration of the procedure depend on the condition of the tooth.
- Treatment of the oral cavity after removal: sutures (if the wound is torn or its edges are located far from each other) and a gauze swab soaked in a hemostatic agent (it must be held in the teeth for 20 minutes, since the effectiveness of the hemostatic drug increases compression of the wound). Do not rush to remove the tampon.
Gum section
Preparing for removal
Removal of a tooth
Installing a tampon
Stitching
Bleeding from the hole itself does not pose a mortal danger. In medical practice, only one case of death was recorded when blood from a wound entered the respiratory tract because the patient was intoxicated. The bleeding was complicated by cirrhosis of the liver, which interferes with clotting, and the woman had three teeth removed at once.
Causes of bleeding
As a rule, hemorrhage (hemorrhage) occurs as a response to damage during soft tissue surgery or as a result of exposure to certain medications. Such problems usually go away within a few hours after the procedure.
If an ordinary tooth can be pulled out without much difficulty and a cotton swab applied to the wound, then removing third molars is much more difficult. During the manipulation process, it is often necessary to saw the crown of the tooth and pull it out in parts. With deep and curved roots, it is almost impossible to extract them without damaging bone and soft tissue.
In addition, there are also other reasons why the bleeding does not stop after a wisdom tooth has been removed:
- high blood pressure;
- mechanical injuries of a large vessel;
- the patient is taking blood thinning medications, for example, Heparin, Aspirin and others;
- low blood clotting;
- the use of anesthetics, after which the blood vessels dilate. This increases bleeding and slows down the process of clot formation;
- the presence of concomitant diseases can cause heavy bleeding. These include hepatitis, scarlet fever, leukemia, hemophilia and others;
- Overheating of the body or high physical activity immediately after removal increases the risk of hemorrhage.
If immediately in the postoperative period the patient abuses alcoholic beverages or smoking, bleeding can occur as complications.
If wisdom tooth extraction cannot be avoided, then the patient needs to understand that bleeding after such a procedure is a natural and normal process. But even with relative safety, the release of blood requires careful monitoring by both the doctor and the patient himself.
After operation
After three hours, the painkillers are still strong, so patients do not feel pain or it is mild. All this time, pure blood or ichor may be released from the hole. If a figure eight was removed, this can last all day, since the surgical area of the wisdom tooth is larger than that of other teeth.
Bleeding from the socket
On the second day, the hole has an unattractive appearance: a blood clot with a grayish coating. It looks like pus, but you shouldn’t be afraid of it: it’s fibrin, a substance that facilitates wound restoration. If everything goes well, the pain will be aching and will subside by the end of the day. If the nature of the pain is different - sharp, pulsating, and there is scarlet blood from the wound, you should urgently see a dentist.
At first, the hole may smell foul. There is no need to be afraid of this: blood accumulates there, and since it cannot be rinsed out, bacteria settle in the wound. If you feel normal, there is no fever, there is no reason to worry.
The rehabilitation process is normal if:
- What medicine is put into the hole after tooth extraction?
- when touching the wound, the ichor does not appear;
- the aching pain gradually disappears;
- feeling normal (temperature up to 38° is possible only in the first two hours);
- swelling on the cheek decreases (if it was not there before extraction, it should not appear at all);
- after 3 days the wound no longer bleeds.
2 weeks after removal
To reduce bleeding, you can make a tampon yourself. Positioning it so that the edges do not injure the blood clot, hold the napkin for half an hour. In the pharmacy chain you can buy a hemostatic sponge, which can be used in cases of heavy bleeding, for example, in liver failure.
Hemostatic sponge
The hole is closed with a hemostatic sponge.
You can take one or two tablets of Dicinone or Etamzilate (no more than 8 pieces per day).
Dicynone tablets
You cannot experiment with hydrogen peroxide: it reacts with blood components, destroying the blood clot and increasing blood flow.
Types of violation
Dentists distinguish several types of postoperative bleeding:
- Early or primary. The blood does not stop flowing for a long time immediately after the unit is pulled out. The dentist has to take various measures to stop it.
- Later or secondary. The bleeding quickly stopped at the clinic, but reappeared at home. In such a situation, many people are lost and do not know what to do. There is only one rule - if a negative symptom persists for more than an hour, you should immediately visit a dental surgeon.
Generally speaking, the appearance of blood at the site of the hole should be taken calmly. During extraction, soft tissues and blood vessels are damaged. Therefore, there is nothing strange about bleeding. You need to look at its dynamics. Every day a person’s condition should improve, as should the appearance of the hole in the oral cavity. If this does not happen, then there is some problem. It needs to be identified and eliminated.
How does the healing process work?
Even if there are no complications, the wound heals completely within four to six months.
- On the 2nd day, a blood clot appears in the socket - a protective gate against mechanical damage and infections.
- If healing proceeds normally, on the third day you can already see granulation tissue at the operation site.
- In the second week, the epithelium actively grows, and granulation tissue appears instead of a clot. Primary restoration of bone structures occurs.
- In 2-3 weeks, it displaces the blood clot and bone tissue is visible around the perimeter.
- Recreation of new tissues takes 30-45 days.
- In about 60 days, the hole is closed by osteoid tissue impregnated with calcium.
- After 4 months, the bone becomes an “adult”, with a porous structure.
- When the bone is fully formed, the wound should resolve to a third of the length of the root.
- After extraction, the gums atrophy and the process of subsidence continues for 6-12 months.
Stages of tissue healing after tooth extraction
What determines the rate of tissue regeneration?
The indicated time frames are indicative information, since the restoration process is influenced by many factors:
- doctor's qualifications,
- condition of the roots,
- hygiene procedures,
- gum health
If a tooth is removed during an exacerbation of the disease, healing slows down. A lacerated wound also tightens it, especially during operations on figure eights. Particular attention is paid to high-quality treatment after the procedure. If tooth fragments remain in the hole, they will interfere with the formation of a protective blood clot, and in the end everything will end in an inflammatory process, lengthening the recovery period.
Healing socket in place of a wisdom tooth
After removal, the surgeon will definitely give advice on proper care of the wound. If you ignore advice or follow it irregularly, complications are inevitable.
Since the blood clot covers the vulnerable hole, it is important not to disturb it. If you rinse immediately after visiting the dentist, you can wash it. An unprotected wound easily becomes infected.
Rinsing after tooth extraction is prohibited
If there are problems with changes in blood pressure, sometimes the wound bleeds for a long time. Once the blood pressure normalizes, bleeding usually stops.
Signs of inflammation
The inflammatory process in the socket occurs when a blood clot is damaged and the wound becomes infected. The following signs indicate its development:
- pain of varying intensity - aching, throbbing,
- fatigue and severe weakness,
- rise in temperature to subfebrile levels,
- unpleasant odor and taste in the mouth,
- pain when touched, contact with hot and cold,
- discharge of pus,
- difficulty chewing, swallowing, opening the mouth.
With alveolitis, the socket may become dry and a greenish or yellowish coating may form. If a blood clot falls out and pain occurs, do not put off visiting the dentist. It is easier to stop the inflammatory process at its beginning. The doctor will curettage the hole, treat the wound with an antiseptic solution, and prescribe antibacterial drugs.
Complications during extraction
All unfavorable conditions lead to alveolitis - inflammation that develops after infection of the wound. Most often, problems begin after a blood clot falls out. Sometimes a clot does not form at all.
- Ear hurts after wisdom tooth removal
Alveolitis of the tooth socket
If you rinse your mouth, alveolitis is diagnosed after 1-3 days. The water pressure washes away the protection and inflammation is guaranteed. Its signs:
- increasing pain, gradually affecting neighboring areas;
- as inflammation spreads, general signs of intoxication intensify: fever, aching joints, loss of strength;
- swelling spreads to nearby areas;
- the mucous membrane turns red-blue due to impaired blood supply;
- bad odor from the problem area in which food debris accumulates.
All other complications also develop after the wound becomes infected. It is convenient to present their features in a table.
| Type of complication | Description |
| Dry socket | The blood clot has not formed, recovery time is delayed, and there is a risk of alveolitis. Most often it happens during active rinsing. A dry socket should be shown to the dentist. |
| Osteomyelitis | A serious consequence when alveolitis spreads to the jaw bone. Inpatient treatment is required. |
| Nerve damage | If the tooth has massive roots, there is a possibility of nerve damage. All tissues near the tooth lose sensitivity. For treatment, a vitamin complex and medications are used that accelerate the transmission of nerve impulses to muscle tissue. |
| Cyst | A serious complication requires surgical methods of elimination. |
After recovery, there is no need to delay prosthetics, since the absence of any unit of the dentition has a bad effect on the condition of the entire oral cavity.
Prosthetics
Dry socket after tooth extraction: causes
There are many reasons why alveolitis develops. It can arise due to the fault of the doctor, the fault of the patient, and for reasons beyond anyone’s control. If we talk about the patient’s responsibility, then alveolitis can occur when -
- poor oral hygiene,
- the presence of untreated carious teeth,
- due to smoking after removal,
- when ignoring doctor's recommendations,
- if you rinse your mouth vigorously and simply rinse the blood clot out of the hole.
Alveolitis can also occur in women due to increased levels of estrogen in the blood during the menstrual cycle or as a result of taking oral contraceptives (birth control pills). A high concentration of estrogen leads to fibrinolysis of the blood clot in the socket, i.e. to degradation and destruction of the clot.
It is because of fibrinolysis that a blood clot is destroyed both with poor oral hygiene and with carious teeth. The fact is that pathogenic bacteria, which live in large numbers in dental plaque and in carious defects, secrete toxins, which, like estrogens, lead to fibrinolysis of the blood clot in the socket.
When alveolitis occurs due to the fault of the doctor –
- If the doctor left a tooth fragment, bone fragments, or inactive fragments of bone tissue in the socket, which lead to injury to the blood clot and its destruction.
- A large dose of a vasoconstrictor in an anesthetic - alveolitis can occur if, during anesthesia, the doctor injected a large volume of an anesthetic with a high content of a vasoconstrictor (for example, adrenaline). Too much of the latter will result in the hole simply not filling with blood after the tooth is extracted. If this happens, the surgeon must scrape the bone walls with an instrument and cause socket bleeding.
If the doctor left a cyst/granulation in the socket, when removing a tooth with a diagnosis of periodontitis, the doctor must necessarily scrape out the cyst or granulations (Fig. 10), which might not come out with the tooth, but remain in the depths of the socket. If the doctor did not inspect the socket after extracting the tooth root and left a cyst in the socket, the blood clot will fester.
- Due to the large trauma to the bone during removal, this usually happens in two cases: firstly, when the doctor cuts out the bone with a drill without using water cooling of the bone at all (or when it is not cooled sufficiently).
Overheating of the bone leads to its necrosis and the start of the process of destruction of the clot. Secondly, many doctors try to remove a tooth for 1-2 hours (using only forceps and elevators), which causes such trauma to the bone with these instruments that alveolitis is simply bound to develop. An experienced doctor, seeing a complex tooth, will sometimes immediately cut the crown into several parts and remove the tooth fragment by fragment (spending only 15-25 minutes), and thereby reduce the trauma caused to the bone.
- If, after a complex removal or removal against the background of purulent inflammation, the doctor did not prescribe antibiotics, which in these cases are considered mandatory.
Conclusions: thus, the main causes of destruction (fibrinolysis) of a blood clot are pathogenic bacteria, excessive mechanical trauma to the bone, and estrogens. Reasons of a different nature: smoking, loss of a clot while rinsing the mouth, and the fact that the hole did not fill with blood after the tooth was extracted. There are also reasons that do not depend on either the patient or the doctor, for example, if a tooth is removed due to acute purulent inflammation - in this case it is stupid to blame the doctor for the development of alveolitis.
