The removal of wisdom teeth creates an open wound in the jawbone, a socket where the tooth previously resided. Following this surgical procedure, an oral surgeon will immediately place a sterile gauze pad over the extraction site. The primary purpose of this gauze is to provide necessary compression against the wound. This simple physical act encourages the initial biological process of hemostasis, or blood clotting, which is the foundational step for healing.
Failure to Initiate Clotting
Skipping the application of gauze bypasses the mechanical pressure required to stabilize the initial wound. Hemostasis begins when blood vessels constrict and platelets aggregate to form a temporary plug, which needs external stabilization to succeed. Without this stabilizing pressure, the wound remains open, allowing continuous slow bleeding mixed with saliva. This fluid movement and lack of compression prevent the platelet plug from maturing into a stable blood clot. When the clot fails to form or is continuously washed away, the initial stage of healing is compromised, making it difficult for the body to seal the wound.
The Severe Pain of Dry Socket
The most well-known consequence of a missing or disrupted blood clot is Alveolar Osteitis, commonly known as dry socket. This condition occurs when the protective blood clot prematurely dissolves or is dislodged, leaving the underlying jawbone and nerve endings exposed to the oral environment. The pain is typically a severe, throbbing ache, significantly worse than normal post-operative discomfort. This intense, radiating pain often begins three to five days after surgery and may extend up to the ear, temple, or neck, often unresponsive to over-the-counter pain relievers. Dry socket requires professional dental intervention, typically involving the gentle cleaning of the socket and the placement of a medicated dressing to soothe the exposed tissue.
Increased Risk of Infection and Swelling
A serious complication of a compromised clot is the increased risk of localized infection. The oral cavity contains vast bacteria, and a stable blood clot acts as a physical barrier against these microorganisms. When the socket is left open, it provides a direct entry point for bacteria to colonize the surgical wound, potentially leading to symptoms like fever, pus, or a foul taste. Infection can slow down the entire healing process and may require a course of antibiotics to resolve. The absence of a stable clot can also prolong the inflammatory response and subsequent swelling, which may lead to trismus, or painful stiffness of the jaw muscles.
Immediate Steps to Mitigate Risk
If the gauze was not used immediately or if bleeding resumes, the first priority is to apply firm, sustained pressure directly to the bleeding site. Use a fresh piece of sterile gauze, folded into a thick pad, and moisten it slightly with clean water. Place the moistened gauze directly over the extraction site and bite down firmly for a minimum of 30 to 45 minutes, without checking or disturbing the pad. If bleeding persists excessively after several applications, a moistened black tea bag can be used as an alternative, as it contains tannic acid to help constrict blood vessels. Apply the tea bag directly to the site with firm biting pressure for 30 minutes, and contact your oral surgeon immediately if heavy bleeding continues unabated for four hours.