If the above efforts do not control the
hemorrhage, and if the bleeding appears to be
coming directly from the alveolus, dry the
alveolus, pack it with Surgicel® or Gelfoam®, and
place a gauze pad as a pressure dressing over the
wound site. Have the patient bite down for
15 to 20 minutes. Refer the patient to a
dental treatment facility if the hemorrhage
continues. Occasionally postextraction hemor-
rhage occurs 3 to 5 days following the extrac-
tion. In general, follow the same treatment
procedures for hemorrhage within the first
This condition, also known as dry socket,
results when a normal clot fails to form in the
socket of a recently extracted tooth. Since this
condition is usually very painful, always consider
it a serious emergency.
SYMPTOMSA patient presenting with a
dry socket will usually have a history of extrac-
tion within 5 days; a complaint of excruciating,
constant pain; and the loss of a blood clot or the
failure of a clot to form.
SIGNSUpon examination, you will prob-
ably note the absence of a blood clot in the socket
of a recently extracted tooth; however, the socket
may contain food debris. Alveolar bone may
be visible in the socket, and you may smell foul
breath. The patients temperature is probably
TREATMENTGently rinse the socket with
warm saline. Moisten a small strip of surgical
gauze with eugenol, and press the gauze between
two dry gauze pads to remove excess moisture.
Place a strip of surgical gauze loosely in the
socket. Do not exert pressure on the socket when
placing the strip. Have the patient return daily.
Clean the socket and change the dressing until the
condition is corrected.
Pain in fractured teeth usually results from the
irritation of the pulp tissue. The primary goal is
to lessen the pain and, if possible, prevent
further injury while awaiting treatment by a
There are four different types of tooth
Type IThis is a slight chip fracture of
the tooth enamel as illustrated in figure 2-21. The
pulp is not exposed. The tooth may be sensitive
to heat or cold.
TREATMENTSmooth sharp edges of the
chipped area with sandpaper strips to eliminate
irritation of the tongue and lips. Apply small
amounts of cavity varnish over the chipped area.
Tell the patient not to take extremely hot or cold
foods and liquids, since this may damage the tooth
pulp and be very painful.
Type IIThis is a fracture with slight
exposure of the pulp (fig. 2-21). It is a more
Figure 2-21.Types of tooth fractures.