Facial bruising after dental work is a very rare complication which can occur as a result of prolonged bleeding due to delayed clotting.
That may sound a little complicated and convoluted but we'll break it all down for you in a way that is easier to understand.
As a general overview, you need to understand how bruising works and what triggers it from dental work. Fortunately for you, it is a self-resolving condition but we'll give you some tips on how to manage it.
How bruising works
A bruise (contusion) is a discolored mark on your skin that is a result of blood pooling underneath your skin. When the blood begins to decompose, it can start changing colors.
For the complete timeline progression of a bruise, please visit MedLinePlus for additional information. Nonetheless, most commonly it will begin as a light red color and then turn into a dark purple to blue color. At the final stage of healing it will look green to yellow in color before it returns back to normal.
Pooling blood causes
The most common cause for a bruise is when you sustain an injury and the blood vessels pop thus leaving a pool of blood under the skin.
Examples of skin injuries resulting in a contusion:
Blunt force trauma - punched, slapped, or hit.
Fall - tripping and falling.
Bang your appendages (arms & legs) against furniture.
Getting your blood drawn for blood tests or for donations.
Dental work - after a filling, after an extraction, after a root canal, or after an injection.
Alternatively, bruising can also be a result of a rare bleeding or clotting disorder.
Ehlers–Danlos syndrome. Easy bruising is present in all subtypes of this disorder. which is a vascular problem. The blood vessels are more fragile and tend to burst more easily.
Haemophilia. This condition is characterized by a clotting deficiency with insufficient Factor VIII. Surprisingly, those with at least a 25% functioning level of Factor VIII will clot normally. However, those with less than 5% function of that factor will have symptoms of abnormal bleeding and easy bruising.
Needless to say, patients who are taking blood thinning medication will also be at higher risk for bruising after any type of surgical procedure. This includes anything that would result in bleeding.
Facial bruising mechanism after dental work
Facial bruising after dental work is caused by prolonged bleeding due to delayed blood clotting. This may occur for any dental procedure which is surgical in nature or if it involves a dental injection. Both of those will draw blood which can be the cause for bleeding.
Dental procedures with potential bruising:
Wisdom teeth removal
Osseous surgery or any gum surgery
Dental anesthetic injection
Signs & Symptoms:
Initial facial swelling.
Bruising within next few days.
Light red and pink color first.
Progresses to black, purple, and blue color next.
Transitions to a greenish yellow color.
Return to normalcy after a few weeks.
The surgical dental procedures which result in a lot of bleeding in the mouth is self-explanatory.
The procedure causes a lot of bleeding.
Blood can pool, decompose, and start changing colors thus resulting in a bruise.
However, where we believe warrants an additional explanation is bruising after a dental filling or after an injection. You may be wondering where all of that blood would come from with a cavity filling but we will explain why.
Bruising after dental filling
Bruising is a rare but potential complication after a dental filling. The cause isn't a result of the tooth filling procedure itself but rather from the injection of the dental anesthetic. In other words, the cause for contusion is solely due to the needle injection.
The penetration of the needle through the oral soft tissue will cause very mild bleeding.
However, the tooth nerve is often next to a large artery or other blood vessels.
There are times where the needle will nick or deflect off of these blood vessels and cause it to bleed.
The image above shows the path of the dental injection to numb the mandibular teeth. Anatomically, the nerve happens to be right next to where the artery is. Needle contact with the nerve and blood vessel is unavoidable.
The bleeding from the dental needle contacting the blood vessel is usually not an issue. Most individuals will begin the clotting process immediately so blood will not have the opportunity to pool under the skin and form a bruise.
However, there are times where the clotting process can go awry and result in facial swelling (hematoma) and facial bruising afterwards. Your body can have a "bad day" and not function properly for whatever reason. Alternatively, you may have an undiagnosed bleeding or clotting disorder.
Most frequently seen
When we say that contusions after dental work are rare, we mean it. Most dentists will probably have a handful of incidences at most. However, there are certain patient populations where it can be more prevalent and this complication can be expected.
Typically older patients who are undergoing extractions or major implant surgeries may end up with bruising afterwards. They also tend to be on various blood thinners which contribute to it.
Where we do not expect to see this condition is in the younger patient population.
Treatment & Management
Bruising from dental work will resolve on its own without any intervention from you. Although the recovery and healing process can take a few weeks. In some situations it may be over a month before it completely resolves.
While there is no cure for it, there are things you can do to alleviate some of the discomfort.
Cold compress. During the first 48 hours, using a cold compress will help manage and reduce the facial swelling which often accompanies the bruising.
Warm compress. After 48 hours, using a warm compress can help speed up bruising recovery. The warmth and pressure will help the stale blood disperse and recirculate.
Pain medication. If you're having discomfort you should take some painkillers. Although you should avoid the medicines with potential bleeding because it can worsen the bruising. That means you should avoid ibuprofen and aspirin but acetaminophen would be a better choice.
A common alleged home remedy for bruising is using toothpaste but unfortunately that doesn't work. The combination of cold and warm compression is much more effective.
How to tell if you're healing
The best way to tell if you're recovering from the bruising after dental treatment is if you notice a decrease in symptoms and if you're progressing through the stages of bruising.
Signs of healing from a contusion:
Symptoms decrease. It will be the most painful during the first few days but as you heal, it should get less painful. The swelling should also come down slowly.
Bruising stages progression. The best indicator of progressing through the stages of a contusion is by observing the color change.
It's rare to end up with a bruise after getting dental work but it can happen. The risk increases if you're older, you're on blood thinners, or if you have a clotting disorder. It may seem scary but the condition is self-resolving and will go away on its own.