All gauze after an extraction should be removed from your mouth before you go to sleep because sleeping with it is a choking hazard. If you're still bleeding, it would be safer to wait for it to stop before you go to bed.
Everything in this article also applies to wisdom teeth extractions.
Reasons to NOT sleep with gauze
Going to sleep with gauze in your mouth can be dangerous and potentially life threatening. Also sleeping with the gauze does not help you to stop the bleeding. Therefore we don't recommend going to sleep with it.
Sleeping with gauze is hazardous
You shouldn't sleep with gauze in your mouth after an extraction because it is an aspiration risk. There is a possibility that you may accidentally swallow the gauze in your mouth while you're sleeping.
If you're lucky nothing will happen and you'll simply sleep through the incident. You wouldn't even know that the gauze got swallowed until the next morning when you wake up. You'll realize that it is gone and no where to be found.
However if your're unlucky, you may swallow it and begin choking in your sleep. That could potentially be life threatening if you're unable to vomit it back out. It could potentially be the last time that you ever go to sleep...
As a general rule of thumb, you shouldn't be going to sleep with anything in your mouth except for retainers and night guards. Those oral appliances are big enough that you wouldn't be able to accidentally swallow them.
Gauze alone does not stop the bleeding
Simply placing gauze in your mouth does not actually stop the tooth socket from bleeding. It is actually the biting pressure onto the gauze which helps to stanch the bleeding.
If you do not bite on the gauze, it will have zero effect on stopping the extraction hole from bleeding. Essentially that piece of gauze will be completely useless.
You may think it is okay to sleep with it because you're biting onto it before you fall asleep. However you should know that as soon as you fall asleep, you're going to let go of biting on it. You'll probably just stop biting on it or even spit it out while you're sleeping. Both of which completely defeats the purpose of using gauze.
What if I'm still bleeding by bedtime?
If you're still bleeding from the extraction, you're NOT supposed to go to sleep. Only when you've stabilized or it has slowed down to a very mild ooze can you finally go to bed. Otherwise it may be dangerous to sleep while you're actively bleeding!
You need to continue biting onto gauze if you're still bleeding. The bleeding should stop after about 3 hours or so. If you're healthy, it may take less time than that. If your healing is compromised from pre-existing medical conditions it may take a little longer.
How to use gauze after an extraction:
Take two pieces of gauze.
Fold them in half twice into a small square.
Place gauze over extraction socket.
Bite down with firm pressure.
Remove after 30 minutes.
Repeat steps #1-5 until the bleeding stops.
What if it the bleeding doesn't slow down after 3 hours?
If the socket is still bleeding even after 3 hours you may have a complication... The first thing you can try is swapping out the gauze for a black tea bag. Black tea have tannic acid in it which has hemostatic properties that can help stem the bleeding.
How to use a black tea bag to stop the bleeding:
Wet the black tea bag.
Place it over extraction site.
Bite with firm pressure.
Switch out to a new one every 30 minutes.
If it resolves after 2-3 hours then that is great news for you. However if you notice no signs of improvement even after that time, you may potentially have an undiagnosed clotting disorder. Please contact your dentist if they're available. If not, you may need to go to an urgent care or emergency department.
Von Willebrand disease
Disseminated intravascular coagulation
Sticky platelet syndrom
Factor V leiden mutation
Prothrombin G20210A mutation
After you have the crisis resolved, you should make a follow up appointment with your primary care physician. You're going to want to find out what exactly is impairing your ability to clot.
That way you can be extra careful in the future in regards to any type of surgery or accident that you may find yourself into. You do bleed for extractions but imagine a motor vehicle accident, knife laceration, or some other type of accident. The bleeding can be significantly more severe in those scenarios.
Why can't I sleep while it's still bleeding?
The most obvious answer is that uncontrolled bleeding while you sleep can be life threatening. What if you bleed to death in your sleep?
You are not allowed to go to bed until you've got the bleeding under control. Please follow the instructions on how to use gauze properly. It should stop as long as you don't have a bleeding disorder.
You really should not sleep with gauze in your mouth for any reason whatsoever. It is dangerous because you can swallow it in your sleep and you may end up choking on it.
It also defeats the purpose of using gauze because you're using it to stop the bleeding. However you should know that gauze by itself does not make it stop. It is the act of applying pressure onto the socket by biting into gauze which makes the bleeding stop. You're certainly not going to be biting on gauze while you're asleep.
Last but not least, don't forget the rest of the extraction aftercare that you're supposed to do. There are many dos and don'ts after having your tooth taken out. Did you know that you're also not supposed to eat with the gauze? If you didn't know that you should really review all of the post-operative instructions!