Tooth extraction healing. - How long does it take? | What can you expect? | What takes place? | Precautions and restrictions. | Pictures.

- An overview of the timeline and stages of post-extraction healing.

An x-ray of a tooth socket after having its tooth pulled.

X-ray of empty tooth socket.

Once your tooth's extraction process has been completed, you'll no doubt want to know how long it will take for its socket to heal.

We've broken our discussion of this subject into the following time frames following your extraction:

 

Answers to the following questions are also based on issues related to how long it takes an extraction site to heal, so we cover them on this page too.

  How much time will you need to take off after your extraction?

It only makes sense that you'll need to know how long you may need to take time off from work or school or limit your activities after having your tooth pulled.

And while your dentist is really the one in the best position to know, this page explains how different factors can affect what you'll end up needing to do.

  When can future dental work be started?

In the case where a tooth that's been pulled will need to be replaced, we explain how extraction site healing will affect the timing of this future dental work.

Things you'll need to keep in mind while reading this page.

Wound size matters.

The type of healing progress that's taken place at any point in time will generally be the same for any extraction. But you'll need to keep in mind that more involved wounds (larger, deeper, wider) simply take longer to fully heal than comparative smaller ones.

So if you've just had a wisdom tooth surgically removed, your healing time frame will extend out longer than someone who just had a lower incisor or baby tooth pulled.

Factors about you matter.

Each person has their own varying capacity to heal. For example, factors directly stemming from their genetic makeup will play a role. So will issues associated with their current status, such as age, medical condition or personal habits (e.g. smoking).

Also adding into this mix is the status of the tooth that's been extracted. For example, a socket's healing timeline can be affected by pathology that was originally connected with the tooth, like infections associated with gum disease or pericoronitis (infection around an impacted tooth).


The chronology of extraction site healing -

A) The initial 24 hours following your tooth extraction.

What will you notice?

What you'll see in terms of actual healing progress during the first 24 hours after your surgery won't seem like much. But what has taken place is vitally important.

Tooth sockets immediately after the extraction process.

Picture of sockets immediately after tooth extraction.

Blood clots have begun to form.

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. (Persistent bleeding disturbs the formation of the tissues needed for the healing process to progress.)

Additionally ...

  • You'll hopefully notice that the level of 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's taking place with the gum tissue around your extraction site at this point?

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.)

Starting at this point, and continuing on during the days that follow, the platelets in the clot, along with other types of cells that have been attracted to it, begin to produce chemical compounds that initiate and advance the healing process.

 Reference: 

Farina RT, et al. Wound healing of extraction sockets.

Politis C, et al. Wound Healing Problems in the Mouth.

Cohen N, et al. - Linked above.

Restrictions on activities. / How much time will you need to take off?

The amount of postoperative rest and recuperation you require following your extraction will vary according to the circumstances of your procedure.

a) With routine extractions.

Most patients are probably best served by just going on home after their tooth extraction and taking it easy.

  • Doing so will give you some privacy and adjustment time during that awkward period while your anesthetic is wearing off and your site's bleeding is coming to an end.
  • It will also give you an opportunity to familiarize yourself and get in sync with your dentist's all-important postoperative instructions.

Possible guidelines.

Returning to routine non-strenuous activities (going to an office job, attending class, shopping) the next day should present no problem. If you have more aggressive or involved activities in mind (including during the next several days) you should clear them with your dentist.

Generally speaking, for people who are healthy who have had the easiest, most routine kind of extraction:

  • After a short period of recuperation, you may be able to return to non-strenuous activities even the same day of your surgery.
  • With extractions involving small-sized wounds whose bleeding has been easily controlled (think small single-rooted tooth vs. large multi-rooted molar), returning to moderate physical activity the day following your extraction may be permissible too.

Ask your dentist for instructions. And of course, it always makes sense to error on the side of caution.

b) With difficult or involved extractions.

In the case of relatively involved or difficult extractions, or cases where some method of patient sedation has been used, your dentist may feel strongly that you must limit your activities during the initial 24 hour period following your surgery.

  • In regard to strenuous physical activities, their concern may extend for some days after your surgery too, you'll need to ask.
  • As far as participating in routine non-strenuous activities (school, desk work, running errands) the following day, even with your dentist's OK the way you feel (or look, if pronounced swelling has occurred) may factor into your decision about how active to become.

It's important to follow their recommendation, your safety may be involved. And remember, the way you take care (or don't take care) of your extraction site during this initial period will set the stage for the healing process that follows.

c) Taking time off / Sick leave - What research studies have found.

Here are some examples of what researchers have reported about the amount of time off patients typically require after having wisdom teeth taken out (a level of surgery that is frequently more involved than just a routine tooth extraction).

Lopes (1995)

This paper followed the healing outcomes of 522 patients that had 3rd molars removed (from the simplest to very involved surgeries). 81% of the patients took time off from work, for an average of 3 days (with a range of 0 to 10 days). 19% of the patients took no time off.

Hu (2001)

This study also evaluated patient healing outcomes associated with 3rd molar extractions (about 2000 of them). It found that on average patients missed 1.2 days of work, or were unable to perform normal daily activities.

40% of the teeth removed were erupted (had come through the gums into relatively normal position). Removing erupted teeth typically creates less surgical insult than impacted ones, thus possibly explaining the lower amount of recuperation time reported by this study.

Extraction site healing timeline.

Pictures showing progress of tooth extraction site healing over time.

B) Extraction site healing - Weeks 1 and 2.

What will you notice?

During the first two weeks following your surgery you should notice that the gum tissue that surrounds your extraction site has completed a significant amount of repair.

  • In comparison to skin on the outside of your body, oral soft tissue wounds generally heal more rapidly.
  • As a point of reference, it's usually considered that enough gum tissue healing has taken place by days 7 through 10 that stitches can be removed.

Especially towards the end of this time frame, your extraction area should look much improved, and shouldn't pose any significant inconveniences or concerns.

How much will your socket have closed up?

The total amount of healing that's been able to take place by this point in time (weeks 1 & 2) will be influenced by the initial size of your wound.

  • 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 (a important tissue building-block protein) and developing blood vessels.

Toward the end of this time period, and as a next stage, mesenchymal cells ("adult" stem cells) will begin to form a dense network within this granulation tissue (and later on fully replace it). These cells will ultimately differentiate into more specialized types of cells, such as bone tissue.

References: Cohen N, et al., Farina RT, et al. - Both linked above.

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 foods 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?

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 large 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 phase, 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.

Many of these mesenchymal cells will transform into bone cells, and they will begin to create the socket's first new bone tissue. This new bone growth takes place adjacent to the existing walls of the socket, which means that it will fill in from the bottom and sides (as opposed to across the top). This explains why tooth sockets become narrower and more shallow as they heal.

 Reference: 

Pagni G, et al. Postextraction Alveolar Ridge Preservation: Biological Basis and Treatments.

Cohen N, et al., Farina RT, et al. - Both linked above.

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.

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D) Bone healing - Filling in the socket.

When you have a tooth pulled, it's the healing of your jaw's bone tissue (as opposed to your gums) that takes the greatest amount of time.

  • New bone formation begins toward the end of the first week post-op.
  • After about 8 to 10 weeks, your tooth's extraction socket 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 takes on the order of 6 to 8 months of further healing for the extraction site to fully smooth out evenly with the contours of the surrounding jawbone.
  • During the whole process, the newly formed bone gradually matures and becomes more dense. It finally reaches a density similar to that of the surrounding jawbone at around 4 months (as demonstrated by x-ray evaluation).

References: Politis C, et al., Pagni G, et al., Cohen N, et al. - All linked above.

What will you notice?

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" 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.

Picture of healed extraction site showing alveolar ridge resorption.

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

The shape of your jawbone will change.

While the contours of your tooth's extraction site will ultimately fill in and smooth out, the shape of your jawbone in the immediate area will undergo permanent changes.

Jawbone height.

Some of the bone's original height will be lost during the healing process. Resulting in a saddle shape where its lowest point is definitely lower than where it originally lay on the extracted tooth.

Jawbone width.

There will also be a reduction in the width of the jawbone in the area of the healed socket. Usually this loss is greater on the cheek or lip side, as opposed to the palate or tongue side.

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.

Together, these changes in bone dimensions give a healed extraction site a sunken-in look (see picture).

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 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).
X-ray showing tooth socket bundle bone.

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

FYI: Bundle Bone

If your dentist would take an x-ray immediately after pulling your tooth, it would show a white line outlining the shape of your tooth's socket (see our graphic).

This is termed "bundle bone" and it's the layer of bone in which the fibers that anchored your tooth in place (its periodontal ligament) were embedded.

Since the tooth is now gone and this outline of bone no longer has a function, as the healing process progresses and new bone is formed, this layer will be gradually resorbed (be broken down and dispersed by your body).

After about 18 months or so, it will have totally disappeared and the outline of the socket will have been mostly lost.

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: Bone and tooth fragments explains this issue in greater detail.


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. ▶

 

Authorship: Written by Animated-Teeth Dental Staff

Last revision/review: 10/12/2018 - Major revision. Content added.

Content reference sources.


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Comments

I had my wisdom teeth removed

I had my wisdom teeth removed two weeks ago and everything it fine with their healing but the tooth in front of a socket on the bottom has a flap of gum on the outer side. Will it go back to normal on its own or will the dentist have to do something? It’s not infected as far as I can tell.

Anonymous

You should call you dentist and describe your situation and let them make a decision.

In routine cases, over time (several weeks) the expectation would be that your body will just take care of the excess flap of tissue on its own. The tissue will slowly shrink down and ultimately smooth out.

In cases where the dentist feels that the excess is somewhat sizable, they may trim it for the patient, so to speed things along and to insure an ideal final tissue contour (one that doesn't trap debris or interfere with brushing and flossing).

White areas in hole where tooth removed

There is white/creamy areas in the centre of the hole where both bottom molars were removed. Is this normal ? Can I rinse with anything other than salt water to remove it.?

Kerrie

It would take evaluation by you dentist to know for sure but what you notice is probably just the normal appearance of the tissues as the healing process advances (new tissues forming, clot dissintergrating).

You don't say how many days ago you had your teeth removed as there are different rinsing instructions for the first day vs. the following ones (see buttons at top of this page).

The less you do, probably the better. The use of liquids other than salt water (like mouthwash) are likely to irritate the wound and make a poor choice.

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