Hemostasis is the body’s natural process for stopping bleeding after an injury. Routine dental procedures, especially extractions and oral surgeries, disrupt blood vessels, making some bleeding a normal part of healing. Dentists manage this bleeding using a multi-layered approach, including physical methods, surgical closure, and specialized materials. This ensures a stable clot forms and healing progresses safely.
Applying Direct Pressure and Surgical Techniques
The most fundamental method for controlling minor bleeding is the application of direct pressure. This involves placing sterile gauze firmly over the surgical site and maintaining steady pressure for several minutes. The physical pressure counteracts hydrostatic pressure within the blood vessel, allowing the body’s natural clotting factors, particularly platelets, to aggregate and form a primary plug.
Before the procedure, dentists use local anesthetics containing vasoconstrictors, such as epinephrine. These agents cause small blood vessels near the injection site to narrow, significantly reducing blood flow. This pre-emptive measure decreases blood loss, prolongs the anesthetic effect, and reduces systemic drug absorption. Following the procedure, surgical techniques like suturing are often used to mechanically pull the wound edges together. Sutures stabilize the blood clot within the socket, protecting it from dislodgement and ensuring an optimal healing environment.
Use of Specialized Hemostatic Agents
When simple pressure or surgical closure is insufficient, dentists use specialized hemostatic agents placed directly into the surgical site. These materials physically or chemically enhance the clotting cascade. A common material is the absorbable gelatin sponge (Gelfoam), derived from porcine skin gelatin. Gelfoam acts as a mechanical scaffold by absorbing blood and providing a porous meshwork that facilitates platelet aggregation and stable clot formation. This sponge is fully biodegradable, liquefying within about a week and being completely reabsorbed by the body within four to six weeks.
Another frequently used agent is oxidized cellulose, available as a sterile fabric meshwork. This material absorbs blood, swelling into a gelatinous mass that aids clotting and promotes platelet adhesion. Oxidized cellulose also has a low pH, which contributes to its hemostatic effect and provides some antimicrobial properties. For patients with known bleeding risks, topical thrombin may be used. This active hemostat directly catalyzes the conversion of fibrinogen to fibrin, the final step in creating a strong, stable blood clot. This enzyme application bypasses earlier steps of the natural coagulation cascade, making it effective for quickly achieving hemostasis.
Managing Bleeding After the Procedure
Preventing secondary bleeding relies heavily on the patient following clear post-operative instructions to maintain clot stability. Patients are instructed to continue applying gentle, steady pressure by biting on a folded gauze pack for a specified period, often 20 minutes. Maintaining this pressure allows the clot to fully mature and stabilize within the socket. Post-operative advice includes avoiding activities that could dislodge the clot for at least 24 hours, such as vigorous rinsing, spitting, or using a straw. These actions create negative pressure, which can pull the clot out and lead to renewed bleeding or a painful dry socket.
Dentists must carefully consider the patient’s medical history, especially the use of anticoagulant or antiplatelet medications (blood thinners). Before surgery, the dentist consults with the patient’s physician to determine the safest approach. This may involve advising the patient to delay a single dose of medication on the day of the procedure. For patients on these medications, dentists may also provide a tranexamic acid mouthwash, which stabilizes the forming clot by inhibiting its breakdown. Patients should contact the dental office immediately if bleeding becomes excessive or prolonged, defined as bleeding that soaks through multiple fresh gauze pads and does not stop with continued pressure.