Bleeding after a tooth extraction will not stop: how much is normal, and when is it an emergency?

When a tooth is extracted, blood vessels are cut and the socket fills with blood within a few minutes; this blood clots and forms a plug that stops the bleeding. As the American Dental Association points out, a small amount of bleeding after an extraction is normal; the mouth fills the space left by the lost tooth root with this clot. This process of filling and clotting is complete within hours; over the following days, the main work is the soft tissue closing over the socket.

Clotting happens in several stages: first, small blood cells (platelets) plug the opening of the cut blood vessel, then a protein dissolved in the blood weaves a mesh of threads (fibrin) that strengthens the plug. This is why applying pressure works: the 20 minutes you press for give this mesh the time it needs to form and firm up. Pressure that is released too early, or checked again and again, breaks up the mesh before it has firmed up and restarts the bleeding.

The first half hour is when bleeding is heaviest; that is why the gauze your dentist places in your mouth matters. Once the gauze is out, it is normal to see pink in your saliva: a small amount of blood mixed with a large amount of saliva looks like more than it really is.

According to the Oral Health Foundation, a small amount of oozing after an extraction is normal and usually eases within hours. Keeping your head raised when you lie down helps reduce bleeding; do not be alarmed by a faint pink mark on your pillow.

The most common reason bleeding starts again is the clot being disturbed: spitting forcefully, rinsing, drinking through a straw, hot drinks and strenuous exertion change the blood flow or pressure in the area and can dislodge the fresh clot. We cover this in detail on our page about what to do after a tooth extraction; here we focus on the bleeding itself.

Cochrane's review of bleeding after extraction states that there are not enough good-quality studies comparing treatments for it. This does not mean that stopping bleeding does not work; the methods dentists recommend based on clinical experience, namely pressure, position and staying calm, are widely used and generally work.

When a teaspoon of blood is mixed with a glass of water, the whole glass looks red; saliva in the mouth does the same. That is why the amount you see when you spit into the sink is not the same as the blood you are actually losing. What you should look at is not what you see in the sink but the amount of fresh blood on the gauze, and whether that amount goes down with pressure.

Judging how much you are bleeding can be difficult, because blood mixed with saliva looks like more than it really is. What you should look at is whether it is fresh blood genuinely filling your mouth or a faint pink tinge mixed into your saliva, and whether the bleeding eases after 20 minutes of pressure.

The factors below genuinely change how long bleeding lasts. Seeing yourself in the second list does not necessarily mean you will have prolonged bleeding; it means you should tell your dentist before the extraction and keep up the pressure for a little longer.

Try the steps below in order. Most bleeding stops within the first two steps.

1. 1

   Dampen a clean piece of gauze and fold it

   Dry gauze can stick to the socket and disturb the newly formed clot; use a damp, tightly folded piece. If you do not have gauze, you can also use a clean, damp handkerchief or a tea bag.

2. 2

   Place it directly over the socket and bite down

   Place the gauze right over the bleeding area and apply pressure by closing your teeth firmly on it; bite with your jaw muscles, not just your lips.

3. 3

   Wait 20 minutes without a break

   Do not look before the time is up; every check disturbs the clot that is starting to form. During this time, do not talk, sit down and stay calm; anxiety and exertion raise your pulse and can increase the bleeding.

4. 4

   Raise your head

   Whether you are sitting or lying down, keep your head above the level of your heart; this reduces the blood pressure reaching the area.

5. 5

   Repeat if it has not stopped, and call your dentist if it goes on

   Repeat the 20 minutes of pressure once more with a clean piece of gauze. If it continues after the second attempt, or fills your mouth, call your dentist; if you cannot reach them, go to A&E.

6. 6

   An alternative: the tea bag method

   Instead of gauze, you can also use a black tea bag that has been soaked and had the excess water squeezed out. The tannin in tea is thought to help clotting; the method is the same: place the tea bag over the socket and bite on it for 20 minutes without a break.

The two pictures below help you see which side the bleeding you are seeing is closer to.

The following are common mistakes that prolong bleeding rather than stopping it.

The sequence below describes the expected course after a simple extraction.

1. The first half hour

   This is when bleeding is heaviest. Bite on the gauze and wait, and do not talk.

2. The first few hours

   The bleeding eases noticeably, though pink saliva may continue. Rest with your head raised and avoid hot drinks.

3. Overnight

   Sleep with an extra pillow. Do not be alarmed if you see a faint pink mark on your pillow in the morning.

4. The next day

   The oozing should have largely stopped. Bleeding that continues or starts again at this point is outside the normal course, and you need to let your dentist know.

This page is not selling a treatment; it explains bleeding. Even so, it helps to know the factors that decide how long the process will take:

The medicines you take

Blood thinners and some painkillers can prolong bleeding; give your dentist the full list before the extraction.

How difficult the extraction is

In extractions done through an incision or in sections, more tissue is affected, so oozing may last a little longer.

Following the instructions

Keeping up pressure for the full time, resting, and avoiding hot drinks and strenuous exertion are the most decisive factors in the bleeding stopping quickly.

Your general health

Blood pressure, liver disease and clotting disorders affect how long it lasts; mentioning these before the extraction makes what follows simpler. Listing them lets your dentist take precautions in advance.