Can You Bleed to Death From a Pulled Tooth?
Can you die from blood loss from an extraction?
As if sitting in the dental chair wasn't enough, those who fear dental procedures often have many irrational fears clouding their minds and dying from blood loss from an extraction may be one of them. So if you feel you were brave enough to endure the dental procedure, now you are left with the aftermath of dealing with the pain and blood loss associated with the extraction, not much fun! So can you really die from blood loss from an extraction? Technically yes, but it's very rare. You would have to be a victim of several, rare coincidences that would make it more likely to happen. I have been looking at literature and this is what I found. I only found a couple of cases, and this attests to how rare and unlikely this is to happen. Warning: If you are squeamish, or suffer from anxiety at the dentist, you may want to skip the next paragraphs below.
The first case talks about Pauline Coles, age 38 who died in the evening of 2009 in her bed spitting blood after having 3 teeth removed. First off, let's consider that it's wrong to spit out blood as this often removes the blood clot and prevents another from forming. For more on this, read below on what not to do after an extraction. And second, this woman was suffering from severe cirrhosis of the liver. She was an alcoholic who neglected her health problems. On top of that, she was found to have twice the legal limit of alcohol in her blood the night she died. And worth mentioning is that in 2007, she had other 4 extractions done and back then she had to be rushed to the emergency center due to her chronic bleeding. The dentist who extracted Pauline's teeth the day of her death claimed that she wasn't aware of her liver and clotting problems and that she was bleeding normally after the procedure and given post-op instructions including to seek medical help if the bleeding persisted. Her daughter claimed that her mother had used two rolls of paper towels to try to stop the bleeding and was vomiting. Apparently, due to her medical conditions, the extractions were supposed to occur in a hospital setting. Haven done that, her life could have been potentially saved.
The second case happened in 2004. The victim in this case was Robert Braber age 59, a man in a wheelchair who bled to death in the night after having his infected wisdom tooth removed. When he was found dead in the morning, his mattress was covered in blood. He had followed instructions and applied a bag of frozen peas to his cheek and then went to bed thinking that the bleeding had stopped. The pathologist that inspected his body claimed that Braber had a neurological condition known as multi-system atrophy, responsible for causing loss of balance and the inability to walk. He also added that he may have had a blood clotting disorder. Braber was found to have had swallowed more than three liters of blood during the night. Coroner Richard Hulett claimed that this was "an unusual and rare cause of death."
As seen, in both cases there were likely underlying medical conditions. In the first cases, it's pretty clear, in the second not so much, as not much details were given. Questions to ask are: was Mr. Braber taking any medications that interfered with proper blood clotting? The night of his death, could he have taken narcotics that caused him to not realize how much blood he was swallowing? Did he have some blood clotting disorder? These questions may go un-answered, but one thing is for sure, these instances are quite rare, and they're likely not going to happen to you after your extraction, and we'll see why.
Who's at risk for increased bleeding after an extraction?
The following circumstances could interfere with the proper healing of the tooth and may lead to more bleeding. Death, as discussed may be quite rare, unless you have some underlying medical disorder and are victim of a combination of some unfortunate circumstances.
People with Bleeding Disorders
At the top of the list of people prone to serious bleeding from an extraction or other surgical procedure are those suffering from some form of bleeding disorder. The bleeding disorder may be acquired, inherited or drug-induced (see below). Common inherited bleeding disorders include Von Willebrand’s disease, known for affecting proper platelet function and Hemophilia A and Hemophilia B Thrombocytopathy and Von Willebrand which can be inherited or acquired (more rarely). Other acquired disorders that can lead to problematic bleeding issues include Vitamin K deficiency, severe liver disease and some rare disorders such as mandibular arteriovenous malformation.
People on anticoagulant drugs
Always make sure your dentist or oral surgeon is aware of you taking anticoagulant drugs.Commonly known as "blood thinners" these drugs are often taken by people who have cardiovascular problems. Examples of people using anticoagulants are those who have mechanical heart valves or suffer from secondary myocardial infarction, cerebral vascular accidents, or thrombophlebitis. Commonly prescribed anticoagulants include Coumadin, Plavix or Heparin. Another category of people at risk are those on anti-platelet therapy for cardiovascular disorders or inflammatory joint disorders.
People on Aspirin and other NSAID's
It is a well-known fact that aspirin thins the blood and can cause excessive bleeding during and after a surgical procedure. If you are taking aspirin or other NSAID's, let your dentist know. These medications take a while to get out of the bloodstream so stopping them just the night before will not suffix. According to Ear, Nose and Throat Alliance Hearing & Balance Center, these drugs may have effect for even 1 to 2 weeks! Please see the list on the above website for a list of medications you should avoid taking 10 days prior to surgery. There are several medications such as Pepto-bismol and sinus or migraine meds that contain aspirin. Always inform your dentist or oral surgeon about any medications you are taking before the procedure.
People on Supplements
Supplements may seem innocuous because over the counter, but several may cause increased bleeding. According to Ear, Nose and Throat Alliance Hearing & Balance Center you should avoid taking any of these supplements at least one week prior the procedure: chondroitin, echinacea, ephedra, garlic, ginger, ginkgo biloba, ginseng, glucosamine, goldenseal, kava, milk thistle, niacin, saw palmetto, St. John’s Wort and high doses of vitamin E. Also, turmeric may interfere with proper blood clotting and should be stopped several days prior to any surgical procedure, consult with your dentist.
People who do not Follow Directions
There is a reason why the dentist office gives you post-op directions after your instructions. Following the directions will help prevent problems. It's very important to follow these directions which aren't that difficult to follow. Those who follow them are gifted with shorter recovery times and less complications. One of most important directions to follow is to consult with your dentist if the bleeding seems to persist and is in copious amounts despite your attempts to minimize it. A piece of advice: It's best to have extractions done early in the morning so you have all the rest of the day to contact your doctor if you are concerned. Also, best to avoid Friday's as you're then left with the week-end when most offices are closed. Always keep an emergency dentist number handy for after hours.
Reducing bleeding after a tooth extraction
Everybody will bleed after an extraction, this is inevitable. However, some may bleed more and some may bleed less. There are people who stop bleeding just a few minutes after leaving the dentist's office after putting pressure on the gauze for a few minutes, there are people who despite the pressure will continue to bleed for hours and the area will still weep days later. In some cases, the bleeding may stop and then resume later. According to Studio Dentaire, it's not unusual to wake up the next morning with a little blood in your mouth. Generally, bleeding should stop after 6 hours, and seeing small amounts of blood in the first 48 hours is normal. If the bleeding is consistent though or comes out like a water valve, it should be checked out immediately.
Luckily, there are many things to do to reduce bleeding once you are sent home after the extraction. These post-extraction instructions are likely given to you when you leave the dental office, but it never hurts to read more about them so to be prepared. It's stunning the amount of people who are given instructions who go home and then start spitting the blood in the sink or start using a straw to drink. These are big no-nos that may lead to increased bleeding and slower healing times! One important consideration: when you experience bleeding after a tooth extraction, it may look like a whole lot of blood is being lost. Doctor of Dental Surgery Ramsey A. Amin claims "It doesn't take but a few drops of blood to mix in with your saliva to make it look like the area is bleeding a lot."
- Bite that gauze! Your dentist will often provide you with loads of gauze to get you through the evening and next day. Bite firmly with steady pressure, at least for 30 to 60 minutes. Don't feel tempted to remove it every few minutes to take a look! That may cause the bleeding that may have slowed down to re-occur! Do the 30 to 60 minutes biting for at least the first 3 to 5 hours, until the bleeding stops. Be consistent and patient. Watch a movie to let this time go by. -
- Get some tea. If you are still bleeding after the gauze trick, you may find relief by using a regular black tea bag. Wet it up and then bite on it for at least 30 minutes. The tannin in the bag should help slow down the bleeding.
- Avoid spitting! This one of the biggest mistakes people make when they are bleeding. They will often spit the blood out. What this may do is dislodge the blood clot that has formed that ultimately is what causes healing. Dislodging the blood clot will cause bleeding again, until the next clot forms. Worse of all, dislodging the blood clot may cause a dry socket.
- Don't use straws. I often see people on forums suggesting to use a straw to eat liquid foods. This may sound logic to prevent warm liquids from going to the extraction area, but sucking through a straw, just like spitting, may dislodge the blood clot.
- Refrain from activity. Try to avoid bending down or lifting and other activity that may interfere with the blood clotting process. Calm activities during the first 24-48 hours will help keep the blood pressure low which reduces bleeding. Watching a movie, reading a book or listening to music are calm options.
- Don't smoke or drink alcohol. Smoking promotes bleeding, slows down healing and can predispose to a dry socket. Drinking alcohol may also interfere with healing, not to mention that alcohol should not be taken with pain medication.The video below also recommends not drinking carbonated drinks as the fuzz interferes with the healing process.
- Don't bother the area. It's tempting to want to touch the area with your tongue, but don't. After the extraction, blood must flush to the area to expedite healing, try your best to not interfere with the process by repeatedly touching the area with your tongue or fingers. Only gauze should be allowed in that area. This also means not brushing over the area or rinsing the mouth with mouthwash.
- Use several pillows for sleeping. The elevated position of your head will reduce bleeding. It's wise to keep a towel on the pillow to capture any blood that may seep through your mouth during the night.
- Avoid hot drinks. You need to be careful not to drink hot beverages or hot soups. The heat may dislodge the delicate blood clot.
- Don't blow balloons or play musical instruments for obvious reasons.
- According to Glendale Center for Dentistry, you should drink a minimum of 6 glasses of liquid in the first 24 hours to replenish blood loss.
The information provided on this Hub is NOT intended to replace a one-on-one relationship with a health care professional and thus is not intended as medical advice.