Tooth extraction aftercare: Instructions for the first 24 hours after having your tooth pulled.
Once your tooth extraction has been completed, your dentist should provide you with two sets of aftercare instructions.
- One will cover things to do (and not to do) during the first 24 hours after having your tooth pulled. (The subject of this page.)
- The other will be recovery instructions for the days that follow. (Use the link for more information about this topic.)
Related page: Extraction Healing timeline.)
Aftercare - The first 24 hours after having your tooth pulled.
They also address post-extraction do's-and-don'ts for issues such as: 1) Smoking. 2) What types of physical activities are appropriate. 3) Eating and drinking. 4) Issues with numbness. 5) Cleaning your teeth. 6) If indicated, the use of antibiotics.
Remember, the care you take (or don't take) during this first 24 hour period will set the stage for the healing process to come.
Get your dentist's input.
While this page contains common aftercare guidelines typically used during the first 24 hours after an extraction, your specific situation may involve special circumstances. For this reason, you should discuss these instructions with your dentist so they can amend them as is needed.
A) Stopping tooth extraction bleeding.
Immediately after your tooth has been pulled, some amount of bleeding will occur, possibly for some time.
[For information about post-extraction bleeding continuing beyond the initial 24 hour period, use this link.]
Place firm pressure on the gauze for 45 minutes or longer.
a) Controlling bleeding with gauze.
In most cases, this bleeding can be effectively controlled and ultimately stopped by using the following steps:
- Place a piece of clean damp gauze over the empty tooth socket.
(Roll or fold it up into a ball or square. It's the part that rests directly over your wound that's important. If you don't have gauze, a piece of clean cloth can be used instead.)
- Bite firmly on this gauze for 45 minutes to an hour.
Make sure the gauze wad is positioned, and is large enough, that when you bite down on it it's able to apply pressure directly onto the extraction site.
(If you bite down and your teeth come together fully, you may not be placing much pressure on the gauze.)
Applying pressure over an extended period is the key.
It is both firm pressure and maintaining this pressure over a prolonged period of time (45 minutes or so) that are important factors when this technique is used.
Don't keep changing the gauze, and don't chew on it. Just put it in and then clamp down on it for 45 minutes to an hour.
b) Controlling bleeding with a tea bag.
If your bleeding seems to persist, a dampened tea bag can be more effective than gauze.
One of the components of tea (black tea, the regular stuff you would use to make iced tea) is tannic acid. Tannic acid aids in the formation of blood clots, thus making this method a very effective technique. (Same instructions as above, just substitute the tea bag for the gauze.)
Repeat as needed.
If some bleeding still persists after the completion of a 45 minute application, then repeat these instructions.
After each subsequent application, the amount of bleeding that remains should be noticeably less. If heavy bleeding persists, then contact your dentist.
In some cases your dentist may anticipate that post-operative bleeding will be a concern. And if so, they may feel that it's indicated for them to place some type of clotting aid in your extraction socket. This might be an absorbable collagen or gelatin dressing (CollaPlug®, Gelfoam®), oxidized cellulose (Surgicel®), microfibrillar collagen (Avitene®), or similar-purposed product.
By no means does your dentist having placed a clotting medicament in your tooth's socket lessen your need to follow standard protocol for controlling bleeding. In fact, you should consider yourself to be at elevated risk for complications and adhere to instructions all that much more closely.
B) Insuring that an adequate blood clot forms (and stays) in the tooth socket.
The blood clot that forms in the tooth's empty socket is an important part of the healing process, so be careful not to do anything that will dislodge or disrupt it.
Remember, events that occur during this first-24-hours time frame will affect the healing process for days to come. For example, it's thought that the formation of a dry socket is related to the loss of the original blood clot.
As a way of protecting the clot that has formed, during the first 24 hours following your extraction, you should ...
- Avoid vigorous rinsing or spitting. These activities may dislodge the clot.
- Stay away from hot liquids (soup, coffee) because they tend to dissolve blood clots.
- Minimize air pressure differences. You should also avoid creating air pressure variations in your mouth, or pressure differences between your mouth and your sinuses (in the case of an upper tooth extraction) because these events may dislodge the blood clot from its socket.
This means you should avoid smoking or using a straw (these activities create suction). Also, don't blow your nose. And if you need to sneeze, sneeze with your mouth open. (See below for more details.)
C) Minimize activities that may make it harder to control bleeding.
During the first 24 hours after your tooth extraction, you'll want to avoid any activities that might make it difficult to control the bleeding from your extraction site, or interfere with blood clot formation and retention.
As examples, you should avoid strenuous work or exercise. You should also avoid bending over or lifting heavy objects. In general, it's not a bad idea to just take it easy for the rest of the day following your surgery.
When you sleep or lie down, position yourself so your head is above the level of your heart. (Prop your head up using an extra pillow.) This positioning will lower the blood pressure level at your head, which is a favorable thing for controlling bleeding.
D) Swelling may occur.
Trauma created during the extraction process can result in tissue swelling. The amount that forms might be very slight, almost unnoticeable. Or, at the other extreme, a pronounced enlargement that involves your face.
We discuss this complication, including instructions for managing it, in detail here: Post-tooth extraction swelling.
Don't smoke for as many days as you can.
E) Avoid smoking.
People who smoke tend to experience a higher level of complications with extraction site healing. That means if you can avoid smoking for the first 24 hours (and preferably 48 hours and longer) after having your tooth pulled, it will be to your benefit.
We explain the how's and why's of this effect in greater detail in our discussion of smoking as a risk factor for dry sockets (a common post-extraction complication).
F) Avoid blowing your nose.
As mentioned above, in the case where you've had an upper back tooth removed (molar, bicuspid) it's best form to refrain from blowing your nose.
That's because doing so can create a pressure difference between your mouth (via the recesses of your extracted tooth's socket) and your sinuses that might be great enough to disrupt what in some cases may be just a paper-thin layer of bone separating the two.
Failing to follow these directions can result in creating what's termed an "oroantral communication" (a direct connection between your mouth and sinus). And the development of one will complicate the healing process. (The communication itself will need to be blocked off before normal healing of the socket can occur.)
Actually, it's not just avoiding blowing your nose that's important. You should generally refrain from doing anything that might create a pressure difference, such as:
- Sneezing. If you need to sneeze, do so with your mouth open.
- Avoid sucking on items such as a straw or cigarette.
- If you play a 'wind' musical instrument, ask your dentist when it will be OK to resume playing.
G) Controlling extraction-site pain.
The level of discomfort you can expect during the first 24 hours following your extraction can be quite variable. For some people, it will be essentially a non-event. For others, it may be quite noticeable.
If discomfort becomes an issue, in terms of analgesics (pain pills) there are two classifications of products that might be used to provide relief.
a) OTC medications.
For just minor to mild pain, your dentist will probably advise the use of an over-the-counter (non-prescription) analgesic.
Common products include acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®). You'll need to read and follow the directions and warnings that accompany the one that's been recommended for you.
b) Prescription medications.
If a higher level of pain relief is needed, your dentist will likely turn to the use of prescription analgesics.
The formulation of many prescription pain relievers includes the narcotic codeine (or related compound). These products will tend to upset
your stomach, so it's usually best to take them with food or milk.
Taking a narcotic may make you dizzy, drowsy or cause you to act strangely. So if you're taking one, you should let those around you know. You should also limit your activities (driving, operating machinery, etc...).
Make sure that you read and follow all directions and precautions associated with your medication's use. If you have any questions, you should discuss them with your dentist or pharmacist.
Remember that your product has been prescribed to you for the short-term use of controlling the pain associated with your extraction. Since some products can become habit forming, their use should be discontinued at the earliest point where pain control is no longer needed.
H) Continue on with prescribed antibiotics.
- After a difficult extraction, a soft (nothing hard or crunchy) or even liquid (dietary supplements, milk shake) diet might be indicated for the first 24 hours or so after your surgery.
- For simpler extractions, just making sure that you do your chewing somewhere else should be precaution enough.
Types of foods.
It makes good sense to avoid relatively hard or crunchy foods as a general rule because they may accidently wind up in the wrong area and traumatize your extraction site or cause it to bleed.
J) Precautions with numbness.
After your tooth has been pulled, some portion of your mouth will still be numb, possibly for some hours. Besides just the area immediately surrounding your extraction site, this will likely include some aspect of your lips, cheeks or tongue too.
This sensory loss can result in accidents. As examples ...
- You might unknowingly bite your lip or tongue while chewing, possibly even repeatedly.
- You might not be able to test hot (temperature) foods and beverages adequately, which could result in burns.
- Some patients, especially children, may find their numbness a novelty and will bite on, or chew, numbed tissues (lips, cheeks or tongue). This may result in significant damage.
Avoid using mouthwash.
K) Cleaning your teeth.
It's important for you to maintain good oral hygiene over the days and weeks while your extraction site is healing.
On the day your tooth is pulled, it might be best to avoid brushing those teeth that directly neighbor your extraction site. You can resume cleaning these teeth the following day but be gentle.
During the first 24 hours after your extraction, don't rinse vigorously when you perform your oral hygiene. Doing so might dislodge the blood clot that's formed in your tooth's socket.
It's also best to avoid the use of commercial mouthwash or mouth rinse. These products may irritate your extraction site.
Our next page discusses recovery & care for the days and weeks after your surgery. ▶
Full menu for topic Tooth Extractions. ▼
- The extraction process -
- Surgical tooth extractions.
- Extraction costs. / Insurance.
- Extraction aftercare and recovery -
- Assorted FYI facts about having your tooth pulled.
- Page reference sources.
Related topics -