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Post-Extraction Haemorrhage — ORE Part 1 MCQ

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ModerateOral SurgeryPost-Extraction HaemorrhageORE Part 1

A 38-year-old woman attends 24 hours after extraction of the lower left first premolar because bleeding has continued from the socket. She takes no anticoagulant or antiplatelet medication and has no relevant medical history. She has already applied firm pressure with a gauze pack for 20 minutes on two occasions. Examination shows persistent oozing from the socket walls. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Identify the bleeding source, place oxidised cellulose in the socket, and suture the wound

**A is correct.** SDCEP advises that when pressure fails, the socket should be assessed to identify the bleeding source, with a haemostatic dressing (for example, oxidised cellulose) and suturing considered to stabilise the socket edges and achieve haemostasis. This patient has persistent bleeding despite two proper periods of pressure and has no anticoagulant-related reason for a different pathway. **B** repeats a measure that has already failed. **C** is inappropriate because oral tranexamic acid does not replace definitive local haemostasis; SDCEP describes tranexamic acid, where relevant, as an adjunct to local measures. **D** is excessive without uncontrolled brisk bleeding, haemodynamic compromise, or a medical emergency. **E** is not the recommended routine treatment for post-extraction socket haemorrhage and may damage local tissues.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP), *Management of Acute Dental Problems*, 2nd edition, March 2026: “Post-extraction haemorrhage.” https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/post-extraction-haemorrhage/