Wisdom tooth extraction is a common surgical procedure involving the removal of third molars, which often become impacted or problematic. While the procedure is routine, post-operative bleeding is a significant concern for patients. Understanding that some bleeding is a normal and necessary part of the healing process can help manage anxiety. The body initiates hemostasis, the process of stopping blood flow, immediately after the extraction.
The Expected Bleeding Timeline
Bleeding after extraction follows a predictable timeline as the body works to form a protective blood clot within the socket. The heaviest bleeding typically occurs immediately following surgery and during the first few hours.
The goal of post-operative care is to promote a stable, dense blood clot. Within the first three to four hours, the flow should slow significantly as this primary clot forms. Bleeding should transition from a steady flow to a light, manageable “oozing” within 12 to 24 hours after the procedure.
It is normal to see slight discoloration in the saliva, appearing pink or light red, for up to 48 hours. This minor tinge of blood is slow seepage mixing with the mouth’s fluid, not active bleeding. Persistent, bright red flow beyond the first day suggests the clot may be struggling to stabilize.
Distinguishing Oozing from Active Bleeding
Distinguishing between normal oozing and active bleeding is a primary concern during recovery. Oozing is a gentle, subtle seepage that causes the saliva to appear pink or lightly blood-tinged. This slight discoloration is a normal byproduct of a highly vascular surgical site.
Active bleeding, in contrast, involves a steady, bright red flow that fills the mouth rapidly. It requires frequently changing the gauze because the pads become saturated quickly. If you must change a gauze pad every 15 to 20 minutes because it is heavily soaked, the bleeding is considered active. The presence of large, dark, jelly-like clots, sometimes called “liver clots,” can also signal uncontrolled bleeding.
Immediate Steps for Controlling Bleeding
To manage post-operative bleeding, the application of firm, consistent pressure is the most important step. Bite down on a piece of sterile gauze placed directly over the extraction site. The gauze should be folded into a thick pad to ensure direct pressure is applied to the socket.
Maintain this pressure continuously for 30 to 60 minutes before checking the site. Removing the gauze too frequently disrupts the delicate process of clot formation. If bleeding continues, replace the old pad with a fresh, slightly moistened piece of gauze and repeat the pressure application for another hour.
Avoiding activities that create negative pressure in the mouth is equally important, as this can dislodge the newly formed blood clot. Refrain from spitting, vigorous rinsing, smoking, or drinking through a straw for the first 24 to 48 hours. When resting or sleeping, keep your head elevated with pillows to help reduce blood flow and pressure to the surgical area. A black tea bag, moistened with cold water and wrapped in gauze, can also be used, as the tannic acid promotes vasoconstriction.
Warning Signs and When to Contact the Dentist
While light oozing is normal, certain signs indicate excessive bleeding or a developing complication. Contact your oral surgeon or dentist immediately if you experience heavy, bright red bleeding that does not slow down after four hours of continuous, firm pressure with gauze.
Bleeding that persists heavily and uncontrollably beyond 24 hours is a significant red flag. Other warning signs include the development of large, mobile blood clots (like pieces of liver), or if bleeding stops and then restarts with a heavy flow. Severe pain that worsens significantly after the first two to three days, or a high fever, also suggests a complication, such as infection or a dislodged clot, requiring immediate advice.