SOME months ago, I read in the newspapers that a young man visited a dentist, had an extraction done and died a few days after due to bleeding from the extraction site.

While I am not familiar with this particular case, there can be no doubt that haemorrhage (excessive bleeding) is frequently associated with the profession of dentistry. Also, no one can deny that bleeding after an extraction is a perennial worry of many patients.
No other profession has been so involved in the process of causing blood to flow from a person, save the time when medicine was preoccupied with employing “leaches to blood-let” as a form of treatment. Now, based on the time of occurrence, haemorrhaging can be classified as primary, intermediate, or secondary.
Primary haemorrhaging occurs during the time of surgery, and is attributable to the cutting of blood vessels. Under normal conditions, the application of pressure, along with the retraction and contraction of blood vessels, is sufficient to promote arrests.
Frequently, when infiltration anaesthesia is used, the vasoconstriction (contracting of blood vessels) agent involved also helps to promote the arrest of bleeding. It is apparent that many factors, both extrinsic and intrinsic, can prevail to promote coagulation.
Intermediate haemorrhage refers to bleeding which occurs less than 24 hours after surgery (extraction). The likelihood of this happening is as a result of many factors, for example, the removal of pressure; the dissipation of vasoconstricting agents (caused by too much spitting); and the relaxation of blood vessels.
Secondary haemorrhage occurs 24 hours after surgery, and is frequently the result of various aspects, such as intrinsic trauma (loose bone chips), infection, etc. The post-extraction wound basically, and for the sake of discussion, consists of two types of tissues: Hard and soft.
The hard tissue component (bone) constitutes the greatest part of the wound, whereas the soft tissue makes up the smallest part of the wound. Thus, haemorrhage can occur from either one of the components.
Bleeding from bone can be difficult to control because, unlike a soft tissue wound, the walls cannot be collapsed and approximated to provide the relaxation required to promote retraction and contraction of the vessels. Perhaps the most common cause of haemorrhage is due to the lack of adequate pressure on
the extraction site.