Bleeding After Gum Graft: What Is Normal and When to Call Your Periodontist

Bleeding from the Donor Site (Palate)

If your gum graft used tissue from the roof of your mouth (a connective tissue graft or free gingival graft), the donor site on the palate typically bleeds more than the graft site. The palate has a rich blood supply, and the wound is essentially an open tissue harvest site. Your periodontist may place a palatal stent or dressing over the site to protect it and reduce bleeding. If a stent was placed, leave it in for the recommended time, usually several days, as it helps control bleeding and protects the healing tissue.

Bleeding from the Graft Site

The graft site, where the tissue was sutured over the receded area, typically bleeds less than the palate. The graft is held in place by sutures and is usually covered by a periodontal dressing or surgical bandage. Some oozing around the sutures is normal. Avoid touching, poking, or pulling on the graft site, as this can disrupt the blood clot and the graft attachment.

Gauze Pressure Technique

Take a piece of gauze, fold it into a small square, and moisten it slightly with water. Place it directly over the bleeding area and bite down or press firmly with your finger for a full 20 minutes without checking. Repeated checking prevents a stable clot from forming. If the gauze is soaked through after 20 minutes, replace it with fresh gauze and apply pressure for another 20 minutes.

For palate bleeding, fold the gauze and press it against the roof of your mouth with your tongue or finger. Maintain steady pressure for the full 20 minutes.

Tea Bag Technique

If gauze pressure alone is not enough, a moistened black tea bag is an effective alternative. Black tea contains tannic acid, which promotes blood clotting and constricts blood vessels. Moisten the tea bag with cool water, squeeze out excess liquid, and place it over the bleeding site. Bite down or press firmly for 20 to 30 minutes. This is a well-established home remedy that periodontists commonly recommend.

Keep Your Head Elevated

Keeping your head above the level of your heart reduces blood pressure at the surgical site and slows bleeding. During the day, avoid lying flat. When sleeping, prop yourself up with 2 to 3 extra pillows or sleep in a recliner for the first 2 to 3 nights. If you bend over or lie flat, you may notice the bleeding increase.

Activities to Avoid for the First 48 to 72 Hours

• Spitting: Spitting creates suction in the mouth that can dislodge a blood clot. Let saliva drool into a tissue or sink instead.
• Using a straw: The suction from a straw has the same effect as spitting.
• Vigorous rinsing: Do not swish water or mouthwash forcefully. If your periodontist recommends a rinse, let it gently flow across the area.
• Strenuous exercise: Physical exertion raises blood pressure and heart rate, which increases bleeding. Avoid exercise, heavy lifting, and bending over for at least 48 to 72 hours.
• Hot foods and beverages: Heat dilates blood vessels and can restart bleeding. Stick to cool or lukewarm foods and drinks for the first 24 hours.
• Smoking: Smoking impairs blood clot formation and significantly increases the risk of graft failure. Avoid smoking for at least 1 to 2 weeks, or as long as your periodontist recommends.

Signs That Warrant a Call

• Bleeding that soaks through gauze in less than 15 to 20 minutes despite sustained pressure
• Bright red, steady bleeding (not oozing) that continues for more than 2 to 4 hours after surgery despite pressure and elevation
• Bleeding that has stopped but restarts heavily, especially 3 or more days after surgery
• A large, expanding blood clot (hematoma) that causes significant swelling at the surgical site
• Bleeding that continues beyond 48 hours at more than a light ooze
• Dizziness, lightheadedness, or feeling faint, which may indicate significant blood loss

Common Causes of Excessive Bleeding

Excessive bleeding after gum graft surgery is uncommon but can happen. Common causes include accidental trauma to the site (eating hard food, brushing too close to the area, or bumping the site with a toothbrush), premature dislodgment of the blood clot from spitting or using a straw, blood thinner medication that was not properly managed before surgery, and, rarely, an underlying bleeding disorder.

If bleeding does not respond to 30 to 40 minutes of firm pressure with gauze or a tea bag, call your periodontist's office. Most periodontists have an after-hours emergency line for situations like this.

First 24 Hours

This is when bleeding is most active. Light oozing and blood-tinged saliva are expected. Apply gauze pressure as needed. Swelling typically starts increasing during this time and may not peak until day 2 or 3. Keep your head elevated and avoid the activities listed above.

24 to 48 Hours After Surgery

Bleeding should be significantly reduced or stopped by this point. The surgical sites will have a dark clot or yellowish-white film over them. This appearance is normal healing tissue, not infection. Continue eating soft foods and avoiding physical exertion.

After 48 Hours

If bleeding has stopped, it should not restart under normal circumstances. Any new bleeding after 48 hours, especially if it is more than a trace amount, should be reported to your periodontist. The graft and donor sites will continue to heal over the next 2 to 4 weeks. Sutures are typically removed at 1 to 2 weeks.