What is the treatment for dental bleeding?

Treatment of Dental Bleeding

For dental bleeding, the most effective first-line treatment is applying direct pressure with gauze, potentially soaked with tranexamic acid, which can improve hemostasis by a factor of 1.6 compared to dry gauze alone. 1, 2

Initial Management

• Clean the bleeding wound with saline solution or tap water 1
• Apply direct pressure to the bleeding site using gauze or cotton 1, 3
• For improved efficacy, use gauze soaked with tranexamic acid (TXA) 2, 4
• Maintain compression for at least 30 minutes for most minor bleeding episodes 2, 3

Pharmacological Management

• Tranexamic acid (TXA) is highly effective as a topical agent for dental bleeding:
  • Apply as a mouthwash (5-10 mL of a 5% solution) before dental procedures and 3-4 times daily for 1-2 days afterward 1
  • For active bleeding, apply TXA-soaked gauze directly to the bleeding site 2, 4
  • TXA works by preventing the breakdown of blood clots that have formed 5

Advanced Hemostatic Measures

If bleeding persists despite initial compression measures, consider escalating treatment:

• Apply local hemostatic agents (e.g., gelatin sponge, collagen fleece) 2, 4
• Place sutures at the bleeding site 3, 4
• For severe cases, consider fibrin sealants or human thrombin products (e.g., Floseal®) 4
• Electrocautery may be necessary in resistant cases 3

Special Considerations for Patients on Anticoagulants

• For patients on vitamin K antagonists (VKAs):

  • Continue VKA therapy with coadministration of tranexamic acid mouthwash rather than interrupting anticoagulation 1
  • If necessary, partial interruption (2-3 days before procedure) is preferable to complete interruption 1
  • Risk of bleeding with continued VKA therapy is low (<5%) and typically self-limiting 1

• For patients on dual antiplatelet therapy:

  • Continue antiplatelet medications during dental procedures 1, 6
  • Most bleeding complications (91.2%) are minor and controllable with local measures 6
  • Stopping antiplatelet therapy carries significant risk of thrombotic events 1

Risk Factors for Difficult-to-Control Bleeding

• Patients taking antithrombotic agents have approximately twice the risk of requiring complex hemostatic measures 3
• Presence of inflammation at the bleeding site increases risk of prolonged bleeding by a factor of 10 6
• Multiple root extractions (especially 3-root extractions) increase bleeding risk by a factor of 7.3 6
• Minor oral surgery procedures (beyond simple extractions) may require more aggressive hemostatic approaches 3

When to Seek Advanced Care

Refer for specialized management when:

• Bleeding persists despite appropriate local measures for more than 30-60 minutes 3, 6
• Patient has known bleeding disorders requiring factor replacement or other specialized interventions 7
• Significant hemodynamic instability or major bleeding with hemoglobin decrease ≥2 g/dL 1
• Bleeding occurs at a critical site or is life-threatening 1

Prevention of Recurrent Bleeding

• Instruct patients to avoid hot foods/beverages for 24 hours after dental procedures 4
• Advise against vigorous mouth rinsing or spitting for 24 hours 4
• For patients at high risk, consider prescribing tranexamic acid mouthwash for prophylactic use at home 1