After a tooth extraction, you must keep using gauze until the bleeding completely stops and that may take up to 2-3 hours on average. The pressure from biting into gauze helps to slow down the bleeding. That provides sufficient time for your body to naturally form the blood clot so that it stops bleeding and the 2-3 hours is how long it takes.
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How to use gauze after a tooth extraction
Your dentist should've given you plenty of gauze to use. They should've also given you instructions on how to use it but if they didn't, this is what you should do.
Place 2-3 pieces of 2x2 gauze together.
Fold it in half.
Fold it in half again.
Place gauze on top of extraction site.
Bite down for 20-30 minutes.
Repeat steps #1-6 until it stops bleeding
This is what gauze looks like.
They do come in multiple sizes but most commonly your dentist will give you the 2x2 after a tooth extraction. The larger ones may not fit in your mouth.
Here is also a video with instructions on how to use gauze after having a tooth removed:
Biting into gauze slows down bleeding
After a tooth extraction blood will be gushing out because it is a fresh open wound. Biting down into gauze on top of the extraction site will obstruct the flow of blood and also provide an opportunity for the blood clotting factors to work.
Obstruct blood flow. The pressure from biting into gauze will physically obstruct the flow of blood. What you're doing is essentially occluding the blood vessel that is open to the oral environment. An analogy would be if you had a garden hose that had a puncture that was leaking water. You would grab and squeeze the hose where the puncture was to try to slow down the water leak. Biting into gauze achieves the same effect as squeezing a punctured garden hose.
Opportunity for blood clotting. An open wound gushes out blood and within that blood is all of the blood clotting factors. You need to slow down the bleeding so that the clot can actually have an opportunity to form and stay there. It is easier to do so when you're not actively bleeding and squirting out the clot. By providing momentary stoppage of blood flow, you permit the blood clotting factors to work more effectively without being squirted out.
It takes 2-3 hours for the blood clot to form
Even after biting into gauze, a blood clot will not form in the extraction socket immediately because it takes time for the clotting factors to travel to the site. It can take up to 2-3 hours after biting pressure before the blood clot matures and stabilizes enough for you to stop bleeding.
The clotting process
The blood clot will stop the bleeding via with three steps:
Constrict the blood vessel. Your body will first constrict the blood vessel to decrease the amount of bleeding and blood flow. This provides time for your clotting factors to travel to the site of bleeding and start working.
Form platelet plug. The platelets arrive to the open wound and stick together to form a temporary plug to prevent the blood from bleeding out.
Form blood clot. Finally, the fibrin threads will reinforce the platelet plug by acting as molecular glue to not only stabilize but hold the blood clot together. It acts as a scaffolding matrix for all of the factors to work cohesively.
What to do after the bleeding stops
Even after the bleeding stops and you no longer need to use gauze, there are 3 things you still shouldn't do for the first 24 hours after an extraction:
Spitting. Vigorous spitting creates suction and pressure in the mouth that can dislodge the immature blood clot. If the clot comes out, you will continue to bleed so do not spit for whatever reason within the first 24 hours. If you need to get rid of blood in your mouth, let it dribble out slowly without any force.
Rinsing. Vigorous rinsing will also create suction and pressure in the mouth that disturbs the blood clot. Please refrain from rinsing within the first 24 hours to not disturb the clot. After 24 hours, you should start rinsing with salt water after every meal to prevent food getting stuck in the wisdom tooth hole.
Drinking with a straw. Drinking with a straw creates a lot of suction and pressure in your mouth, which may dislodge the clot. Avoid using a straw for the first 24 hours so that the clot can stabilize. The consequence of using a straw will cause persistent bleeding but at least it won't cause a dry socket, which is a commonly held misconception. You will simply bleed but you won't get a dry socket.
The common theme among all three of these actions is that they exacerbate bleeding after tooth extraction by creating suction and pressure in the mouth. Therefore, in order to prevent the continual bleeding you should avoid all 3 of these activities that create suction or pressure in the mouth within the first 24 hours. If you don't, you'll have an extraction site that keeps bleeding.
When to stop using gauze after a wisdom tooth extraction
You use gauze the same way for a wisdom tooth extraction as a regular tooth extraction. The amount of time it takes for biting into gauze to stop the bleeding is also the same, about 2-3 hours. However, it may take a little longer if you're having more than one wisdom tooth being removed. That is simply due to an increase in the quantity of extraction sockets that need to be clotted.
After having a tooth removed, you should use gauze for the next 2-3 hours which is usually how long it takes for the bleeding to stop. The pressure from biting into gauze helps to slow down the bleeding and allows the blood clot to stabilize. Therefore it really isn't so much the gauze but rather the pressure that gets it to stop bleeding. The gauze is just a medium to apply pressure to the extraction socket.
So please bear with biting into gauze for a few hours but it will be worth it because at least you won't bleed anymore. However, if the bleeding does not stop within that time and it doesn't seem like it is slowly down, you should contact your dentist. You may have a clotting disorder or you're non-compliant with the post-extraction rules: no spitting, no rinsing, and drinking through a straw. Which is it that you are doing or have?
Author: Written by Dr David Chen, a dentist in long island city, NY.