Post‑Extraction Bleeding and Dry Socket
Post‑extraction bleeding and alveolar osteitis (dry socket) are common reasons for emergency department and urgent dental attendance. This section summarises pathophysiology, presentation, practical ED assessment and management, with UK‑focused safety points (NICE, MHRA/GOV.UK) and clear escalation triggers.
Introduction
- Immediate haemostasis during extraction is normally achieved with direct pressure, vasoconstrictor‑containing local anaesthetic and, where needed, sutures or topical haemostatics.
- Secondary (post‑operative) bleeding most commonly occurs when the effect of the vasoconstrictor declines.
- Dry socket (alveolar osteitis) is an inflammatory loss or failure of the post‑extraction blood clot causing severe local pain, typically 3-5 days after extraction; it is not primarily an infection and does not routinely require antibiotics (NICE HTA).
Assessment: priorities and initial actions
- Follow airway, breathing and circulation (ABCs) first; significant oropharyngeal bleeding can threaten the airway and may require airway management.
- Prepare for airway management if there is ongoing profuse bleeding, blood pooling, vomiting with aspiration risk or deteriorating consciousness.
- Triage the bleed as minor, moderate or major:
- Minor: intermittent oozing that is controlled with direct pressure and the patient is haemodynamically stable.
- Moderate: persistent bleeding despite an initial attempt at pressure.
- Major: haemodynamic instability, large‑volume ongoing bleeding, falling haemoglobin, or failure of local measures.
- Focused history should include time since extraction, which tooth(s) were removed and extraction difficulty, presence of sutures, local...