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A 19 year old man presents 4 hours after leaving his dentist office from wisdom tooth extraction. He has been having bleeding from the socket that will not stop for the last 2 hours. His dentist office is now closed and no one is answering the phone. He has no prior history of excessive bleeding and is not taking any medications. He is hemodynamically stable, and on exam you see a clot in the socket surrounded by a steady ooze of blood, which the patient spits out onto a napkin every minute or so.
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November 21, 2018 at 2:50 am
C) Use tranexamic acid on a gauze
Oozing after wisdom tooth extraction is common, resulting in blood-tinged saliva that gradually clears over the first post-op day, but ongoing bleeding needs medical attention. Clots should be gently rinsed or removed. Extensive lab work-up is not indicated if the patient is stable and there are no concerns for a bleeding diathesis. Pressure alone on a gauze may stop mild bleeding, but if bleeding continues 10% tranexamic acid solution on the gauze or use of a 5% tranexamic solution mouthwash is the next step. Tricks of the trade: if no tranexamic acid is available, biting down on a dampened tea bag may work (the tannins in the tea have some efficacy). Patients should be advised not to rinse their mouth or probe the socket with fingers or tongue x 24 hours, to reduce the risk of bleeding.