Extraction aftercare and recovery: What to expect (and do) the day after having your tooth pulled and beyond.

- Routine care - Salt water rinses, stitches removal. / How to manage complications - Swelling, dry sockets, bone chips.

You'll need two sets of post-op instructions.

Separate from the aftercare instructions you're given for the first 24 hours after your extraction, your dentist will also provide you with a second set of directions that outline steps you should follow the next day and beyond. (That's the topic of this page.)

It's important to comply with both sets of directions. Doing so will go a long way toward minimizing your potential for developing postoperative complications.


Aftercare - 24 hours after your surgery and beyond.

The same basic instructions set is followed for all types of extractions.

We've noted below where additional steps might be indicated for larger, more involved wounds, such as those resulting from the removal of impacted wisdom teeth.

A) Basic aftercare.

In most cases, the only care that's needed during this time frame is just maintaining the extraction site in a manner that helps to promote its healing. (Extraction healing time line.)

This includes:

  1. Favoring the wound so it isn't traumatized.
  2. Keeping the extraction site clean.
  3. If needed, irrigating the socket (per your dentist's instructions).
  4. If needed, having stitches removed at the proper time.

B) Managing post-extraction complications.

The other postoperative care that may be needed is managing any complications that develop. This would include conditions such as:

1) Prolonged bleeding.    2) Swelling.    3) Bruising.    4) Continued pain.    5) Dry sockets.    6) Tooth chips. / Bone fragments.    6) Muscle / Joint pain.

Get your dentist's input.

The instructions found on this page are common guidelines typically used as a part of post-extraction care and recovery.

Your specific situation may involve special circumstances. And for that reason you should discuss these directions with your dentist so they may amend them as is needed.

Additionally, at any point during your healing process, if you have a concern or feel you have developed a complication, you should not hesitate to contact your dentist.


A) Basic aftercare.

1) Favor your extraction site.

You'll need to avoid activities that might traumatize your extraction area. That's because ...

  • They might disrupt or interfere with its healing process.

    This would include events that might dislodge or damage any stitches, dressings or tissue flaps that have been placed or positioned.

  • The new tissues that form are quite vascular (they contain many fragile blood vessels) and they will bleed easily if provoked.

Eating.

It makes good sense to shift your eating activities over to the other side of your mouth for a few days. You may find that you do this subconsciously anyway because your extraction site is a little tender.

It's also not a bad idea to choose relatively softer foods, as opposed to hard or crunchy ones that might inadvertently slip over to the wrong side and jab, poke or otherwise irritate your wound.

Overall, it's important to maintain proper nutrition and stay well hydrated. Doing so will help you regain your strength, as well as promote more rapid healing. So, if possible, try not to miss any meals. And make sure to drink 6 to 8 glasses of water (roughly two quarts) each day.

Cleaning your teeth.

During the days following your extraction you will need to clean your teeth. Just don't be too aggressive with your toothbrush or floss.

  • With routine extractions, during the first few days following your procedure just do the best that you can. You don't want to be so vigorous that you risk scraping your wound.
  • In the case of surgical extractions it's best to avoid brushing or flossing in the area of the site altogether for the first 3 days, so not to dislodge any tissue flaps, stitches or dressings that have been positioned or placed.

Over the first several days following your extraction you'll probably find that if you're too aggressive with your toothbrush the newly forming tissues in your wound will bleed easily (a small amount of blood, short duration).

That's because these forming tissues are highly vascular (have a lot of blood vessels in them) and are fragile, so back off. As they mature, your brushing and flossing habits can return to normal.

2) Keep your extraction area clean by rinsing it.

In general, the cleaner you keep your extraction site the quicker it will heal.

  • Beginning 24 hours after having your tooth pulled, you can gently rinse the area after meals, snacks and before bed (on average, 4 to 5 times daily).
  • Don't be too vigorous. Doing so may disrupt the blood clot or new tissue that has formed.

What should you rinse with?

Saline solution, which is another term for salt water, makes the best choice for rinsing your extraction site. To make it put 1/2 teaspoon of table salt in one cup of warm water.

When using saline isn't possible, lukewarm tap water will do. But don't use commercial mouth rinses because they may cause tissue irritation.

The benefit of using saline solution over plain water is that it's isotonic. That means it contains salt at the same concentration as body fluids (such as blood plasma), and therefore is as minimally irritating to the wound and its developing tissues as possible.

What does rinsing accomplish?

It's a way of gently cleansing the wound. This includes the removal of necrotic tissues being sloughed off as part of the healing process, microorganisms, and food and other debris that has accumulated in the area of the wound.

For how many days should you rinse?

As the healing of your wound progresses, the need to rinse it gradually diminishes. Performing your duties for just several days is usually sufficient. However, if your extraction site tends to trap debris, you should extend your routine accordingly so to keep it clean. (Also, see our next section about socket "irrigation.")

3) Extraction site irrigation.

In cases where a patient's post-surgical wound is large and/or deep (such as after an impacted wisdom tooth has been removed), food, microorganisms and other debris may tend to accumulate and be difficult to remove just by rinsing. If so, the extraction site may require daily "irrigation."

This process is used to gently flush away debris that may:

  • Interfere with healing.
  • Be the source of a foul taste or smell.
  • Create an environment that promotes the formation of a secondary bacterial infection.

When should you start irrigating?

You'll simply need to follow your dentist's instructions.

  • Irrigation isn't started immediately following your surgery but instead is delayed until at least several days of healing have taken place.
  • Once started (per your dentist's instructions) it's typically continued for 1 to 2 weeks as the bone healing process starts to fill in and smooth out the divot that was your tooth's socket.

Irrigation technique.

Socket irrigation involves the use of a syringe that has a curved or bent, blunt-ended tip instead of a sharp needle. It's filled with saline solution (salt water, 1/2 teaspoon of table salt in one cup of warm water), or even just lukewarm tap water.

The tip is placed at the opening of the tooth socket and the syringe is slowly expressed so its fluid floats accumulated debris to the surface and away. It's not a forceful activity but instead one that creates a gentle flushing.

A needle and suture material for placing stitches.

If stitches are placed, ask if and when they should be removed.

4) Stitches.

After removing your tooth, your dentist may find it necessary to place one or more stitches. Some types are resorbable (absorbable), meaning that they will dissolve away on their own. Others are not, and will need to be removed.

Removing stitches is easy and painless.

Non-resorbable stitches are usually removed 7 to 10 days after they were placed. The process of removing them is usually very easy and quite painless.


B) Managing post-tooth extraction complications.

1) Prolonged bleeding.

Immediately after your tooth has been pulled, there will be bleeding from your extraction site and it may continue, possibly even for several hours. But the amount that you notice should be ever diminishing. (Related content: Extraction-site bleeding - The first 24 hours.)

At that point 24 hours and beyond from when you had your surgery performed, any bleeding still taking place should only be minor. You might find some slight bloody oozing or seepage coming from the area. But if you notice more than that, you should contact your dentist so they can evaluate your status.

You'll need to make an accurate report to your dentist.

When evaluating your situation, your dentist will be interested in a description of the type and quantity of bleeding that has occurred.

They know that a small amount of blood mixed in with a larger amount of saliva will still appear red. But this type of "blood" is quite different, and represents far less quantity, than if the color of the bleeding you've noticed is dark red. Be as accurate as you can when describing your findings to your dentist so they'll know what type of attention you require.

2) Swelling.

Trauma created during the tooth extraction process can cause postoperative swelling. Any swelling that does occurs usually reaches its peak between 24 to 48 hours after your surgery.

For detailed information, use this link: Preventing and treating post-tooth extraction swelling.

3) Bruising.

Some patients may develop mouth and face bruising in the area adjacent to their extraction site. It can be black, blue, yellow or even green in coloration.

It's caused by blood oozing from the wound area and diffusing into the surrounding tissues. It's formation is common and usually manifests itself 2 to 3 days after the patient's procedure. It typically takes 2 to 3 weeks to gradually fade away.

4) Pain.

It's not uncommon to experience some level of pain for the first few days after having a tooth removed. But by at least 72 hours postoperatively (the completion of day 3 after your surgery) you should notice that its intensity has begun to subside. In those cases where it hasn't, you should be in contact with your dentist so they can evaluate your situation.

Pain that persists may be a sign of an underlying problem. One common one is the formation of a dry socket (see next section). Other causes can be: 1) Postoperative infection. 2) Retention of root, bone, or foreign body in the extraction site. 3) Jawbone fracture. 4) Sinus problems. 5) Pain from adjacent teeth. 6) Muscle spasms (see below).

If an extraction site's blood clot is lost, a dry socket will form.

5) Dry sockets.

One possible complication associated with having a tooth pulled is developing a "dry socket." (They're especially commonplace after having a lower wisdom tooth removed.)

This condition typically begins as a dull, throbbing pain that doesn't appear until three or four days after the extraction. A foul odor or taste may be noticed too.

We've dedicated an entire topic to this subject. You can access it here: Dry sockets - Causes, symptoms and treatments.

6) Bone sequestra and tooth fragments.

Initially after your extraction your tongue may discover hard projections in the area where your tooth was removed. At this point in time they are unlikely to be missed tooth roots but instead the exposed bony walls of your tooth's socket.

These types of rough projections will typically take care of themselves (smooth out or round over, become covered with new gum tissue) in the days that follow. If not, let your dentist know and they can smooth them for you.

Tooth or bone fragments.

Some patients may discover small bone chips or tooth fragments rise to the surface of their extraction site as it heals. We address this subject in detail here: Post-extraction bone chips / tooth fragments - Causes, treatment.

7) Jaw soreness / Muscle spasms.

After your extraction you may experience pain or spasm with the muscles that operate your jaw, or jaw joint soreness. If you do, a number of factors during your extraction process may have helped to cause this:

  • Fatigue and irritation associated with prolonged mouth opening.
  • Aggravation of a previously existing jaw joint (TMJ) problem.
  • Irritation associated with receiving local anesthetic injections (dental "shots").
Treatment.

You'll need to seek advice from your dentist for a specific recommendation about what type of treatment is needed. In most cases, it's directed toward:

  • Obtaining muscle relaxation.
  • Reducing inflammation of the involved joint or muscles.

This is typically accomplished by:

  • Applying warm, moist heat packs (compresses) to the area.

    For example, fill a water bottle with warm (not hot) water and then wrap it in a moist dish towel. Apply to the affected area for 20 minutes. Repeat several times throughout your day.

  • Using nonsteroidal anti-inflammatory drugs to minimize pain and reduce inflammation.

    Dentists frequently recommend taking ibuprofen (Motrin®, Advil®) continually over the course of a few days (for example, dividing the maximum daily recommended dose of the product [or less] into 4 equal doses, one of which is taken every 6 hours). You'll need to read and follow all directions, guidelines and warnings that accompany whatever product is utilized.

  • Performing stretching exercises to regain jaw function.

    Create slow, gentle motions that simply help to regain function as opposed to pushing and stretching limits. For example, perform opening-and-closing and side-to-side motions for 5 minutes, 3 or 4 times a day. Moderate, gentle gum chewing can also be a helpful exercise.

    Extreme stretching and excessive or forced testing will tend to trigger continued muscle and joint irritation.

In most cases, a patient's condition will subside in 5 to 10 days.

Our next page explains the normal time line of extraction site healing. ▶

 
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