Tooth extraction healing timeline. – Appearance changes and stages of extraction site healing. (The first 24 hours post-op to 4 weeks and beyond.)

X-ray of an empty tooth socket.

How long does it take for a tooth extraction site to heal?

Once your tooth’s extraction procedure has been completed, you’ll no doubt want to know how long it will take for its socket to heal and what it should look like each day and week as it does.

In providing answers to these questions, we’ve broken this page’s discussion into the following time frames and healing stages:

• The initial 24 hours following your surgery.
• Weeks 1 & 2 post-op.
• Weeks 3 & 4 post-op.

Independently, we also explain the timeline for bone tissue healing so you know what to expect and what things will look like as the hole in your jawbone fills in and smooths over.

Related page:   How can you tell if you’re developing complications?

Everyone’s healing timeline will be different.

a) Wound size matters.

While the type of healing events that have taken place at any point in time will be similar for all extractions, it’s important to keep in mind that more involved (larger, deeper, wider) wounds simply take longer to heal over and fill in than comparatively smaller ones.

So, for example, that means if you’ve had a major procedure performed, like having a wisdom tooth surgically removed, you’ll need to expect that the total amount of healing time it requires will be greater than that needed for less involved extractions, like having a lower incisor or a baby tooth pulled.

b) Personal factors come into play too.

Systemic factors.

It’s important to keep in mind that the healing capacity of individuals varies. This is in part due to their differing genetic characteristics but also includes factors associated with the person’s current status, such as age, medical condition, and personal habits (e.g. smoking).

Local factors.

▲ Section references – Cohen

The stages of extraction site healing –

A) The initial 24 hours following your tooth extraction.

Appearance of tooth sockets on day one (immediately following) the extraction process.

Blood clots have begun to form and fill in the sockets.

What will you notice? / What will your extraction site look like?

a) During the first 24 hours following your extraction, you should notice that …

• A blood clot has filled the tooth’s empty socket. (It’s the clot’s formation that actually triggers the healing process.)
• And the bleeding from your wound has stopped.  If not …, in cases where bleeding persists, it interferes with the formation of tissues that are needed for the healing process to progress.

b) Also during the first 24 hours …

• You’ll hopefully notice that the level of any discomfort associated with your extraction site has begun to slowly subside.
• You’ll probably find that the region immediately adjacent to the empty socket is tender when touched.
• Traumatized gum tissue immediately surrounding your socket may have a whitish appearance.
• It’s possible (especially in the case of a relatively involved or difficult extraction) that you’ll find some degree of swelling has already started to form, both in the tissues that surround your extraction site and possibly your face too.

  If so, this swelling should peak within the first 48 to 72 hours and then start to subside. What to expect. / Management.

What’s taking place with the gum tissue around your extraction site at this stage?

While you won’t really be able to notice anything, the creation of new gum tissue around the edges of your wound has already begun. This starts as early as 12 hours post-extraction.

What’s going on inside your tooth’s socket?

Immediately following your tooth’s extraction its socket will fill with blood and the formation of a clot will begin. The blood clot typically fills the socket up to the level of the gum tissue surrounding it.

The clot itself is composed of platelets (sticky cell fragments that initiated the clot’s formation) and red and white blood cells, all embedded together in a fibrin gel. (It’s the fibrin gel that gives the clot its semi-solid consistency.)

▲ Section references – Farina, Politis, Cohen

How long does the blood clot last after a tooth extraction?

What happens to the blood clot that forms after a tooth is pulled? / When does it go away?

These aren’t such cut-and-dried questions to answer because during the healing process, the clot isn’t specifically lost or discarded. Instead, over time, it’s infiltrated by other types of cells and newly forming tissues.

In essence, it becomes the scaffolding for all of the participants of the healing process to follow. So that means that the blood clot that fills in the tooth’s socket after an extraction isn’t so much “lost” as it is, day by day, gradually “transformed”.

On this page, in each healing period’s “What’s going on inside your tooth’s socket?” section, we describe the transformation that’s taking place at that point.

Restrictions on activities. / Taking time off.

During this initial 24-hour period following your extraction, you may start to wonder how much total time you should take off for rest and recovery.

What’s needed.

As anyone would probably anticipate, the specific circumstances associated with your procedure will be one determining factor.

• With routine extractions (“simple” extractions) … it’s common for a patient to take the rest of the day off.

  Although, with the easiest of these types of procedures (small teeth, unchallenging removal), just a few hours of recuperation followed by a light schedule may be sufficient.

• With difficult or involved extractions (impacted wisdom teeth or other “surgical” extractions) … you may need to take off a few days, once again, depending on the specifics of your procedure.

Of course, a patient’s personal factors (like their age or general health status) will need to be considered too.

Your best resource.

It is, of course, your dentist who’s in the best position to estimate what you’ll require. And it’s their obligation to advise you accordingly. So, if they don’t, just ask (or call back and ask).

If you’d like more information about this subject, we offer this page: How much time do you need to take off after a tooth extraction? Jump to page.

Tooth Extraction Healing pictures – The stages.

Appearance of extraction site healing by days 1 and 3, weeks 2 and 4.

B) Extraction site healing – Weeks 1 and 2.

What will you notice? / What will your extraction site look like?

• As compared to the skin on the outside of your body, wounds located in the soft tissues of the mouth tend to heal more rapidly.
• As a point of reference for how much repair has taken place at this stage, it’s usually considered that enough gum tissue healing has taken place by days 7 through 10 that stitches can be removed. How that’s done.

  (Removing stitches means that the healing tissues are now strong enough and anchored to the underlying bone securely enough that the stabilizing effect that the stitches provided is no longer required.)

How much will the socket have closed?

• The sockets of smaller diameter, single-rooted teeth (such as lower incisors) may appear mostly healed over by the end of two weeks. The same goes for baby teeth.
• Wider and deeper wounds left by comparatively larger teeth (canines, premolars) or multi-rooted ones (molars), or wounds resulting from surgical extractions (like needed to remove impacted wisdom teeth), will require a greater amount of time to heal over and show signs of filling in.

  So, in these types of instances, the contours of the gum tissue in the region may still show quite an indentation or divot in the area of the tooth’s socket.

What’s going on inside your tooth’s socket during this time frame?

During the first week after your extraction, the blood clot that originally formed in your tooth’s socket will have become partially colonized (it’s in the process of being fully replaced) by granulation tissue. This is a primordial type of tissue that’s rich in collagen (an important tissue building-block protein) and developing blood vessels.

▲ Section references – Cohen, Farina

Restrictions on activities.

Since the new tissues that form during this time frame are quite vascular in nature (they contain a large number of blood vessels), if you traumatize your extraction site it’s likely to bleed easily. So be careful when eating food or brushing. You can also expect this new tissue to be tender if touched or prodded.

But other than that, and especially towards the end of this two-week period, you should find that your extraction area is of minimal concern and does not need to be a major consideration in regard to performing routine activities.

C) Extraction site healing – Weeks 3 and 4.

What will you notice? / What will your extraction site look like?

By the end of the 3rd to 4th weeks after your tooth extraction, most of the soft tissue healing will have taken place.

• You’ll probably still be able to see at least a slight indentation in your jawbone that corresponds with the tooth’s original socket (hole).
• Where a large tooth (molar) or several teeth in a row have been removed, or with cases where a significant amount of bone was removed during the extraction process (like with impacted wisdom teeth), a relatively significant indentation may still remain. It may persist, even for some months.

What’s going on inside your tooth’s socket at this point?

During this stage, mesenchymal cells will continue to proliferate into the socket’s granulation tissue and organize into a dense network. At this point, they’ll have replaced about half of the granulation tissue that originally formed.

▲ Section references – Pagni, Cohen

Restrictions on activities.

You may notice that the new gum tissue that has formed has some tenderness, like when jabbed by hard foods. But at this point, even this level of trauma probably won’t cause any significant amount of bleeding.

D) Bone healing – Filling in the socket.

How long does it take the hole to close after a tooth extraction?

After you’ve had a tooth pulled, it’s the healing of the hole in your jawbone (the tooth’s socket) that takes the greatest amount of time (as opposed to your gum tissue).

• New bone formation really doesn’t start to begin until the end of the first week post-op.
• After about 8 to 10 weeks, your tooth’s extraction socket (the hole) will have substantially filled in with newly formed bone. (Around 2/3rds of the way.)
• At around 4 months, the socket will be completely filled in with new bone.
• It then takes on the order of another 2 to 4 months (6 to 8 months post-op) of further healing for the extraction site to finally finish smoothing out evenly with the contours of the surrounding jawbone.
• During the whole process, the newly formed bone gradually matures and becomes denser. It finally reaches a density similar to that of the surrounding jawbone at around 4 months (as demonstrated by x-ray evaluation).

▲ Section references – Politis, Pagni, Cohen

What will your extraction site look like as the bone fills in?

How will it change?

Initially.

During the initial weeks following your extraction, it will be easy for you to see and feel the pronounced hole left in your jawbone.

In some cases, it may be deep enough that it traps food and debris. (Especially large or deep sockets may require “irrigation” (gentle flushing out) When. How to. to keep them clean during the early weeks of healing.)

As the healing process progresses.

The formation of new bone first starts adjacent to the bony walls of the tooth’s socket, which means that as the healing process progresses the socket will fill in from the bottom and sides first.

In terms of appearance, that means that over time the width and depth of the wound will become more narrow and shallow. What once was a hole will gradually transform into less of one, then just a divot, then a dimple, ultimately smoothing out and blending in with the contours of the surrounding bone.

A healed extraction site.

Note the sunken appearance of the bone (in both height and thickness) due to ridge resorption.

The shape of your jawbone will change.

Jawbone height.

Jawbone width.

Studies have shown that the dimensional changes associated with premolar and molar extraction healing can run as high as 50% of the bone’s width at 12 months post-op.

▲ Section references – Walker, Pagni

Ridge resorption.

The height and width changes mentioned above are collectively referred to as “resorption of the alveolar ridge” (the alveolar ridge is that portion of a jawbone that holds its teeth).

One long-term study (measurements were taken 2 to 3 years post-extraction) reported alveolar ridge shrinkage on the order of 40 to 60%. (Pagni – Linked above)

How long do these changes take?

The amount of time it ultimately takes for bone healing, and thus for the “final” shape of the ridge to form, will greatly depend on the size of the original wound. Larger wounds (i.e. multi-rooted teeth like molars, surgical sites from impacted wisdom tooth removal) will take longer to heal and will result in a greater degree of alveolar ridge changes.

• Overall, the rate of resorption (and therefore bone shape changes noticed) will be greatest during the first month post-op.
• At 3 months, two-thirds of the changes will have occurred. By 6 to 12 months out, the bulk of the transformation will have been completed.
• Beyond that, some level of continued resorption will continue throughout the patient’s lifetime, albeit at an ever-reducing rate (estimated around 0.5 to 1.0% per year).

▲ Section references – Wan der Weijden, Schropp, Pagni

Immediately after an extraction, the outline of the socket is easily seen.

FYI: Bundle Bone

Restrictions on activities.

As significant as the changes that take place are, it’s really a slow gradual process that during the 6 to 8 months that it takes, you really won’t notice anything going on at all.

Bits and fragments.

The exception might be the case where you discover a small piece of broken tooth or necrotic bone poking through the surface of your gums (your body’s attempt to eject the object).

In most cases, these fragments are only of minor concern and are easily removed. This link explains in greater detail: Managing bone and tooth fragments. What to do.

Treatment timing – Making plans to replace your missing tooth.

The fact that it takes as long as 6 to 12 months for the bulk of the jawbone’s healing process to take place doesn’t mean that you have to wait that long until your empty space can be filled in with a replacement tooth.

A healing period may be needed.

With some types of restorations (dental bridges, partial dentures, some kinds of dental implants) there is typically a healing ‘wait’ period that must be adhered to for best results. For many cases, this may be on the order of just 1 to a few months. With others, it may be 6 months or longer before the final prosthesis should be placed.

The general idea is that the dentist wants to wait for your socket’s healing process to have progressed to a point where the changes it creates in the shape of the jawbone (see discussion above) won’t substantially adversely affect the fit, function, or appearance of the replacement teeth.

But even if some sort of wait period is required, your dentist should have some type of temporary tooth or appliance that can be placed or worn until that point in time when your jawbone’s healing has advanced enough.

Our next page discusses post-extraction recovery and care the day after and beyond. ►

Video transcription.

Hello, welcome to Animated Teeth.com and our page that explains the healing timeline that follows having a tooth pulled. Using this video, we’ll point out some of the main issues covered on this page.

We’ve broken this subject into three time frames. The first 24 hours. Weeks 1 and 2. And then weeks 3 and 4, the latter being a point by which most people will probably find their extraction site of little concern.

We discuss the subject of bone-tissue healing on its own. Not because it’s a separate subject but instead because it follows a longer timeline.

It’s important to point out that when it comes to how long your extraction site’s healing process will take, the initial size of the wound matters. Wounds that are larger, wider, deeper will simply take longer for your body to fill in and heal over.

Personal factors and behaviors will have an impact too, so, as you follow along, keep in mind that specifics about your situation will cause some variation in precisely what you experience.

While you’d never know by looking, the healing process within your extraction site begins on the same day you have your tooth pulled.

Your body will start to organize the process by which new gum tissue will begin to form around the edges of your wound. And then, within the tooth’s socket, the blood clot that forms will ultimately serve as the scaffolding for the mediators and nutritional components that lead to new bone formation.

We mention the latter because on our supplemental pages that outline extraction aftercare both on the day of your procedure and then the days that follow, we point out that nothing is more important for the patient to do than provide conditions so an adequate blood clot will form. And then take precautions to protect it so it isn’t compromised or outright dislodged from the socket.

During the first week, and then on into the second, you should notice a lot of changes with your extraction site. And since a picture is worth a thousand words, be sure to notice our graphic that shows the kind of healing advancement that takes place over time (day by day, week by week).

On the day of your procedure, your extraction site will of course look like a gaping wound. And even for the next several days, as its healing process gets geared up, its tissues will still look red and inflamed, will probably bleed easily on provocation, and your tooth’s socket will still be quite visible.

Also, it’s still quite likely that the area will be tender, possibly still have swelling, and may still be a source of discomfort.

Compare that scenario to what’s occurred after a full week. At this point, the color of your gum tissue, except for right around the socket, should start to return to pink instead of red. Any swelling that’s formed will probably have resolved. You should find your level of discomfort drastically reduced. And the socket’s hole in your bone will look as though it’s started to close in.

As an idea of the level of improvement that’s occurred, after a full week, enough tissue healing and strengthening have occurred that stitches can be removed. And traumatic mishaps, like having a piece of hard food jab at your extraction site, may not cause bleeding.

By the end of two weeks, the sockets of smaller-diameter teeth will probably have substantially healed over. But, as stated previously, size does matter, so with wounds associated with larger teeth or possibly multiple adjacent ones, more time will be needed.

The next two weeks, weeks 3 and 4 following your procedure, is a period when your extraction site should become less and less of a concern for you.

By the end of this period, your wound should be substantially healed over, with its tissues rounded and pink, although there will still be signs of a divot where your tooth’s socket was.

Pain shouldn’t be a factor, except for the fact that the new soft tissue covering the space may be tender if prodded by food when eating. Your gums will toughen up over time, or better yet, let your dentist make you that replacement tooth they’ve mentioned.

As far as bone forming and filling in your tooth’s socket goes, that takes longer than soft tissue healing. The process doesn’t really start to get into gear until about a week after your procedure. By 8 to 10 weeks, the socket should be substantially filled in, but it takes along the line of 4 months before the process is fully completed.

During those months, besides the hole filling in, the section of jawbone involving your extraction site will undergo changes too. The general trend is one where some bone loss takes place in terms of ridge height and width. With the result being one where the extraction site is smoothly contoured but looks somewhat sunken in.

Of course, there’s additional information on this page that explains the healing process and its timeline in greater detail, so please take the time to read it. Goodbye.

Comments.

This section contains comments submitted in previous years. Many have been edited so to limit their scope to subjects discussed on this page.