What to do if bleeding does not stop after tooth extraction?

Possible reasons

Bleeding after dental surgery can be divided into two groups. In the first case, we are talking about primary bleeding, which cannot stop on its own after surgery. The second group includes situations where the problem arose only after a day or several days. Usually the reason is non-compliance with the post-operative period: heavy lifting, hot bath, non-compliance with the diet, alcohol, etc.

Let's consider the possible reasons for the first group:

• Violation of blood composition.
• Taking certain groups of medications that cause blood thinning.
• Blood pressure surges.
• Blood diseases.
• Nervous tension.

There are also reasons beyond the patient's control. For example, medical negligence. Some inexperienced dentists damage the tissue too deeply during tooth extraction. Due to deep trauma and damage to blood vessels, the wound does not heal.

Course and combination of procedures

The effect of injection and physiotherapy procedures is enhanced when they are combined due to different mechanisms of influence on the regenerative forces of the body. The rehabilitation program is compiled individually depending on the size of the swelling and the “brightness” of pain:

• For minor surgical interventions, just one injection procedure of PRP or MesoSculpt C71 on the day of surgery is sufficient. The swelling begins to gradually subside within 1-2 days, depending on the depth of the injury. For muscle tension, microcurrents are prescribed after 2-3 days. If the swelling does not go away by this time, another injection procedure is performed in the complex on the same day. If necessary, microcurrent therapy is prescribed again after 2-3 days.
• If there was global surgery , the physiological swelling and discomfort are many times greater. You will need 1-2 procedures with one of the injectable drugs (D-NUCLEO or MesoSculpt C71) and 1-3 microcurrent sessions. The course of physiotherapy depends on the degree of muscle spasm. In some patients, the feeling of tightness, muscle tension, and clicking in the joint persists for up to 2 weeks. In this case, a course of 5 sessions of microcurrent therapy will be required with an interval of 2-3 days.

Indicative rehabilitation programs:

If you have a meeting, wedding ☺️ or other important event today, the rehabilitation course will help you look presentable in 1 hour!

What can you do at home?

If the problem has not resolved itself within three hours, then the following tips will help you:

• Apply a cold compress to your cheek. You can use a cold product or ice previously wrapped in cloth.
• Roll up sterile gauze, apply to the hole and bite for 10-15 minutes.
• Make strong tea. Soak a piece of bandage in liquid and apply to the damaged mucous membrane for 3-5 minutes.
• If you experience high blood pressure, you need to normalize it with medication. The specific drug and dosage are prescribed by the doctor.

What operations may require rehabilitation?

All surgical interventions differ in technique, complexity and extent of injury. The degree of manifestation of the body’s reaction also depends on this.

Implantation

• Transgingival implantation Nobel Guide The method is minimally invasive - the implant is fixed by puncturing the gums, without incisions or sutures. The consequences are minimal, in rare cases they manifest as slight swelling even with the installation of several implants. In most cases, rehabilitation procedures are not necessary.
• Classic patch implantation involves an incision and peeling of the gum; after installation of the implant, sutures are applied. In 50% of cases, small to medium edema and hematomas are possible due to capillary fragility. With total implantation, the symptoms are more widespread, muscle tension is possible, rehabilitation is required in 90% of cases.

During the second surgical stage of implantation, the gum former is installed. After the implant has healed, it is opened, the plug is removed and the former is fixed. The procedure is minimally invasive, bone tissue is not damaged, only an incision is made in the mucous membranes. Accompanied by slight swelling of the gums, very rarely of external tissues. In most cases, rehabilitation procedures are not necessary.

Bone grafting

• Closed sinus lift A low-traumatic method, performed with the installation of no more than 1-2 implants. Manipulations to lift the lining of the maxillary sinus are carried out through the implantation bed using a microsurgical method and end with the installation of implants. In 50% of cases, moderate swelling of the zygomatic region and small hematomas are possible, requiring a course of rehabilitation.
• Open sinus lift To access the maxillary sinus, an opening is created on the anterior wall of the maxillary bone. When operating in the area of ​​1-2 implants, in 60% of cases swelling on the cheek and under the eye on the operated side is likely, often accompanied by bruising. During sinus lifting for the installation of 3 to 5 implants, the symptoms are more intense, appearing in 90% of cases, muscle microspasms are added, which requires procedures to minimize the manifestations.
• Guided bone regeneration The most gentle way to build bone tissue. After the gum is incised, the osteomaterial is fixed, a protective membrane is installed, and the gum is sutured. Consequences range from minor (for surgery in the area of ​​1 implant) to moderate (for bone augmentation in the area of ​​3-5 implants). Depending on the scale, the need and composition of restoration procedures are determined.
• Bone block transplantation The most traumatic method of bone grafting. A double operation is performed to transplant the graft from the area behind the wisdom teeth or chin to the desired area. It is rarely used when no other material other than your own is suitable. Accompanied by intense swelling and the formation of “bruises”. When taking a block in the figure eight area, it is accompanied by difficulty opening the mouth. A course of rehabilitation procedures is necessary in almost 100% of cases.

Tooth extraction

• Simple Even with simple tooth extraction, the ligaments that hold it in the bone rupture. But when using an ultrasound protocol, the consequences are minimal, swelling is localized only in the gum area, without affecting the facial tissue. Rehabilitation is usually not required.
• Difficult It is carried out when removing wisdom teeth that have branched roots. The procedure becomes more complicated if the figure eights have partially erupted or are completely in the gum. An incision in the gum and fragmentary extraction in parts will be required. The consequences of such an operation in 80% of cases are accompanied by swelling of the cheek and/or neck of varying degrees, and hematomas. Very often there are difficulties opening the mouth.

General recommendations

To avoid such problems, we strongly recommend that you follow the simplest rules of the rehabilitation period:

• Eating can be done no earlier than 3 hours after tooth extraction.
• Don't eat hot or cold foods.
• Give preference to liquid porridges and broths. Supam. Solid foods should be avoided until the hole is completely healed.
• Avoid taking hot baths and saunas.
• Avoid heavy lifting and exercise for a week.
• After tooth extraction, you should not rinse your mouth; this will significantly increase the healing time of damaged tissue.
• Limit brushing your teeth for the first 24 hours.
• You should not drink alcohol for a week after the operation.
• Never apply warm or hot compresses to your cheek.

Hematomas and swelling after surgery

Surgery is not a regular medical procedure. This is a kind of trauma, with damage to mucous and bone tissues. As a result of the physiological reaction of the body's defense systems, there is an influx of lymphatic fluid, which helps the operated area to regenerate and recover. It manifests itself as internal swelling of the oral mucosa, swelling of facial tissues. Hematomas are possible as a result of damage to blood vessels.

Long-term large-scale operations are complicated by the need to stay with your mouth open for a long time. Muscle spasms and pinching of the maxillary joint are likely. It can be difficult for the patient to adapt - muscle tension is felt, it is difficult to chew and speak. This is a normal, explainable condition; traditionally, rehabilitation lasts 7-14 days, in some cases up to a month.

For patients who want to quickly get rid of postoperative discomfort, our Center offers an accelerated rehabilitation program. A complex of injection and physical procedures reduces swelling, eliminates bruises, reduces pain, and completely eliminates micro-spasms of the muscles of the face and neck.

We
do not use outdated punitive surgical
. We have not used drills, hammers and chisels since 2012. Work with bone tissue is performed using ultrasonic piezo technology with minimal trauma. For patient comfort, all operations are performed in medicated sleep.

Levin Dmitry Valerievich Chief physician and founder of the Doctor Levin center

Despite gentle technologies, tissue injury cannot be avoided in any case. The body's reaction to intervention is an understandable natural process. The “brightness” of the manifestation is individual and depends on the volume of the operation performed and the characteristics of the body. For example, representatives of the fair sex are more prone to swelling than men.

Prosthetic options after tooth extraction: when should it be done?

How does the tooth extraction process work? Photo: Smile-at-Once

Modern and progressive dentists never rush to remove teeth unnecessarily. Today, even “wisdom teeth” are most often preserved if their treatment is appropriate and they do not interfere with closing the jaws. Nevertheless, sometimes it is still necessary to remove teeth. And after this, a completely logical question arises - what next?

A simple and quick answer - we wait for tissue restoration and deal with the issue of restoration. But in what way - “KP” figured it out together with experts.

Why do we lose teeth?

No one is immune from tooth loss, even if they are completely healthy. It’s easiest for children, because after their first breasts fall out, they will grow strong permanent ones. In adults, unfortunately, new ones do not appear, although scientists are trying to grow new ones from stem cells.

The most common cause of loss of front teeth, both in children and adults, is injury: bruises, falls, fights, biting nut shells, etc. The problem is also caused by poor oral hygiene, which causes caries, as well as gum inflammation and periodontitis.

Unbelievable but true! The most common disease is caries. If you run it, you can lose only 1-2 teeth. But inflammation of the gums, namely periodontitis, is considered the main reason that we lose a large number of teeth almost simultaneously.

An age-related slowdown in metabolism can also lead to tooth loss - tissue nutrition deteriorates, the protection of tooth enamel decreases, and the bone becomes less dense.

But the fact remains that you have lost a tooth, now you just have to decide what to do next and how to restore it.

Why can't you stay without teeth?

In addition to the fact that your smile will be unattractive and you will not be able to fully chew food, there are several other reasons for surgical dental restoration. We asked a specialist from the Smile-at-Once clinic, leading maxillofacial surgeon and implantologist Roman Bespalov, to comment on the situation:

“Your remaining teeth will shift and become loose. The bite is disrupted, which will lead to problems with the temporomandibular joint. Due to changes in nutrition, disturbances in the functioning of the gastrointestinal tract will appear. Not only the smile will change, but also the shape of the face, individual facial muscles lose tone, wrinkles and nasolabial folds appear, and the lips will become thinner. And the more teeth are missing, the more pronounced these consequences are.”

After losing teeth, changes will not take long to occur. Photo: Smile-at-Once

When can dentures be installed after tooth extraction?

Immediately after removal, the hole fills with blood - in about 2 hours it completely coagulates, after which a blood clot begins to form. This is a small ball or nodule that will remain on top of the gum for about 5–7 days: it covers the internal tissues from infection and serves as a “base” for the formation of new ones. In about 7–10 days, the wound is completely healed, and the gums become their usual pink color. But internal processes are still ongoing - bone tissue needs the most time to recover: it modulates and partially fills the hole in 4-6 months. Hence, certain restrictions arise for subsequent prosthetics.

• if you are planning to install a bridge : you will have to wait at least 3-4 weeks, since the hole must be completely filled with new tissue, because installing and adjusting the bridge is quite painful. Even for fitting, you will have to fix and remove the structure by prying it with a tool, the sharp edge of which will damage or infect the area healing after removal,

• if you are planning to install a removable denture : if we are talking about temporary replacement of just 1 tooth, then you can take impressions and prepare for dentures in 3-4 days. But if a lot has been removed, it is better to allow at least 20–30 days for the tissue to recover a little, including bone,

• if you are planning to undergo implantation : if there was time for preparation, you can place the implant immediately after removal, on the same day. And if there was no time, you will have to wait until the bone recovers - this is at least 3-4 months.

“Do not trust the removal of teeth to a dental therapist - the procedure should be carried out by a dental surgeon or even an oral and maxillofacial surgeon who can extract the tooth as sparingly as possible for all tissues. It is also recommended to immediately use special bone analogues or preparations for tissue regeneration in combination with special protective membranes, since bone tissue cannot be restored to its natural volume on its own. This is especially true if you are planning dental implantation in the future,” comments Roman Bespalov.

Which denture is suitable if several teeth are missing?

In general, there are three main methods for restoring teeth, but within each there are several dozen more subtypes, mainly based on the materials used. These are removable dentures (they rest on the gums and are held on by hooks on the remaining teeth), these are dental bridges or bridge-like dentures (neighboring supporting teeth are used to fix them), and there are also dentures supported by implants. The last type is called implantation. In the article at the link, we already talked about how you can restore all your teeth. Now we will talk about what to do for those who have single defects in the dentition.

And let's start with the most worthy option.

Prosthesis on implants

Implantation, like any other type of prosthetics, has certain disadvantages (it requires surgical intervention and is quite expensive). But still, it is many times better than removable or bridge dentures. And that's why.

Firstly, this is a physiological decision. You will have to replace not only the apex, but also the root, that is, all the tissues of the jaw system will work. Secondly, you will not have to sacrifice living teeth that are located at the edges of the defect. Thirdly, this is the most durable option. Of course, if you choose high-quality implants and a doctor who will install them in strict accordance with technology.

Watch the video

Installation of implants on chewing teeth: stages of treatment and how the patient changes

Installation of implants on chewing teeth: stages of treatment and how the patient changes

And if you look at your lifestyle, you can actually forget that you have a denture – teeth on implants are so comfortable and indistinguishable from natural ones. Once the implants take root, there will be virtually no restrictions in terms of food.

There is also good news - you can place an implant immediately after extracting the tooth root from the socket. But here it is important to take into account the fact that you need to be well prepared for implantation. That is, if you remove a tooth urgently, you cannot immediately place an implant - you need to study the condition of the bone, periodontal tissue, and assess your health. And if the operation is planned, then the two procedures can be easily combined with each other.

If one tooth is missing, then, as a rule, the most standard implantation protocol is used - it is called “classical or two-stage.” First, implants are installed, and after they have completely fused with the bone, a prosthesis is installed. This can be a crown made of metal ceramics, ceramic composite or zirconium dioxide, as well as a bridge prosthesis if several teeth are missing.

But there are some peculiarities: in a number of situations, the prosthesis can be installed much faster - immediately, after 2-4 weeks, or traditionally after 4-6 months. Let's take a closer look:

• the prosthesis is placed delayed - after 3-6 months: we are talking mainly about the lateral teeth with which we chew. This approach is relevant for most brands of implants - they are safe to load only when they have completely fused with the bone, that is, taken root. And speaking in medical terms, they become osseointegrated,

• the prosthesis is placed quickly: not immediately, but quickly - within a period of 3-4 to 6-8 weeks. This is only possible with some premium brands of implants, in particular Nobel or Straumann, which have an active surface and literally stimulate the growth of bone tissue cells. Due to this, their engraftment, as well as primary fixation, occurs faster,

• the prosthesis is placed immediately: if we talk about the absence of all teeth, then a fixed prosthesis can be installed already on the 3rd day after implantation - this can be done with modern implantation protocols with immediate loading. This is safe if the technology is followed - and the prosthesis itself fixes the position of the implants by combining them into a single system (a metal frame is created in the prosthesis for this purpose). But if 1-2 teeth are missing, then a permanent denture cannot be installed right away. Only a temporary crown, but a lighter one, can be attached to the implant. The doctor can also make it a little shorter in height so that this tooth does not participate in chewing. This way, the aesthetics will be restored immediately, and nothing will interfere with the implants taking root smoothly.

“70% of the success of implantation depends on the actions of doctors - a surgeon and an orthopedist. But it is important to make the right choice in favor of the brand of implants - I advise you not to skimp on your health, but to choose high-quality models that have been on the market for more than 20 years and have a large clinical and evidence base of success. Only original prosthetics should be installed - in particular, abutments of the same brand. They fit as accurately as possible - there are no gaps in which bacteria can accumulate, and this reduces the risk of rejection even after 10-15 years of using new teeth,” notes Roman Bespalov.

Removable denture

To restore 1-3 teeth, so-called “butterfly” dentures are used, which have “wings”, or more precisely, hooks that clasp the living teeth on both sides. Such prostheses can only be counted on as a temporary solution to the problem - they will not last long, since they have little support, and they hold up very poorly. In general, removable appliances have good fixation if they are attached on both sides of the row at once, but often patients lose their last chewing teeth and the attachment has to be done only on one side.

The removable butterfly prosthesis replaces only a couple of teeth, but holds up rather poorly.

In this prosthetic scenario, doctors strongly recommend remembering not only the inconvenience of the design, but also the fact that physiological changes occur - the teeth on which the prosthesis rests quickly fail due to overload. Bone atrophy also occurs, but here it’s the other way around – due to a lack of chewing load, because there are no tooth roots. Therefore, the bone under the prosthesis will gradually decrease along with the gum - a gap will appear, and the structure itself will hold up even worse than initially. And this, by the way, applies to any “pullers” – regardless of how many teeth they replace.

Which exit? Place removable dentures for a while, and then try to carry out implantation.

Bridge prosthesis

This prosthesis consists of at least three crowns. Those on the edges are placed on top of living roots. The central ones, as a rule, are 1–3 pieces, replace the lost ones. Such a prosthesis is non-removable and holds up very well, especially if the supporting teeth are initially healthy. The aesthetics are also high, since the crowns are located just below the gum level - artificial teeth look very natural. But all this is just at the beginning - the first 2-3 years, and if you’re lucky, then a maximum of 5-7 years.

The photo clearly demonstrates the effect that living teeth and various dentures have on the gums and bone tissue.

A dental bridge has a number of obvious disadvantages: lack of physiology - the supporting teeth are overloaded, and atrophy of all tissues occurs in the area of ​​lost elements. Such dentures often have to be removed along with the destroyed supporting teeth after 5–7 years. And the bone and gums, which shrink in size, lead to the formation of a gap under the denture - food debris gets clogged there, rotting, tissue inflammation, pain and bad breath occur. In addition, if you have lost only 1 tooth, you will have to deliberately destroy two more, even if they are completely healthy - you will have to sharpen them heavily for the crowns of the bridge, and also remove the nerve.

Which exit? It is good to think about whether it is worth resorting to this option, because it is better to place an implant and not harm other teeth. If you still decide to go for it, then regularly check the condition of your supporting teeth at the dentist, and undergo professional oral hygiene every 6 months. This will extend the life of the bridge.

As you can see, there are few effective options for replacing an extracted tooth, and restoration cannot be delayed, otherwise the problem will result in large-scale damage.

Before removing a tooth, be sure to consult a surgeon and orthopedist, listen to their words, it may still be possible to preserve the root of the tooth, stop the inflammatory process in the bone and soft tissues. By assessing all the pros and cons of your situation, you can make an informed choice.