Tooth extraction aftercare: Instructions for the first 24 hours after having your tooth pulled.

- Stopping the bleeding. | Blood clot protection. | Minimizing swelling. | Directions about: Smoking, Eating, Numbness, Pain control. | What to expect postoperatively. General post-op do's and don'ts.

This is the first of two post-extraction instruction sets that you'll need.

Once your tooth extraction procedure has been completed, your dentist will need to provide you with two sets of aftercare instructions.

  • One set will address things to do, and not to do, during the first 24 hours after having your tooth pulled. (That's the subject of this page.)
  • The second set of instructions will outline recovery instructions for the days following (the days after the first 24 hours post-op).

(If you're interested in the changes that will occur as your extraction site heals, visit our Extraction Healing Timeline page.)


Aftercare instructions - The first 24 hours after having your tooth pulled.

Where do our instructions come from?

As sources for this page, we read through the post-extraction directions published on the websites of several university-based oral surgery programs. (See links below.)

From them, we've identified the most frequently mentioned issues pertaining to the first 24 hours post-op, and created the composite instructions outline that you'll find below.

What issues are included?

The topics we found most frequently addressed include:  1) Controlling bleeding.  2) Protecting the blood clot that has formed.  3) Directions for how to minimize swelling and pain.

Our list also addresses 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 prescribed, the use of antibiotics.

We also explain the underlying principles associated with post-extraction directions.

Some people may want to know the rationale that lies behind the instructions their dentist has requested they follow. If you're one of them, we explain those issues too.

Just follow the links we've placed throughout this page for those more in-depth type of details. In some cases, we've dedicated entire pages to individual subjects.

Get your dentist's input and OK.

While we've included what we found to be the most frequently given aftercare instructions for the first 24 hours following an extraction, your specific situation may involve special circumstances or concerns.

For this reason, in all cases you should discuss the steps we outline (scroll through our list with your dentist or their staff member on your phone) so they can modify and amend them as they feel is indicated.

Additionally, and once again in all cases, if you feel you have developed complications, including any issues not mentioned on this page, you should never hesitate to contact your dentist. It's their obligation to address all of your post-op needs.

Postoperative instructions for the first 24 hours following a tooth extraction.

Here's our composite list of directions, as formulated from those published by the university-based oral surgery departments listed at their end.

Our links lead to more in-depth coverage.

Studies show that compliance is higher when patients are given short, concise directions, so we have kept ours to a minimum.

However, throughout both our instructions and the remainder of this page there are numerous links that take you to locations on our website were the linked subject is explained in greater depth. You should take advantage of this added information.

Postoperative instructions for the first 24 hours following a tooth extraction -

  Controlling bleeding from your extraction site.    (First 24 hours post-op)

Your dentist will have placed a folded piece of gauze over your tooth's socket at the completion of your procedure. You should continue to apply firm pressure to that gauze for the next 30 minutes. Doing so should stop the bleeding from your extraction site.

If bleeding persists.

After following the instructions above, if bleeding continues or at some point restarts, place a fresh piece of moistened gauze over your extraction site and apply firm, constant pressure on it for 30 to 60 minutes. You may need to repeat this process a few times. If after doing so bleeding continues, you should contact your dentist.

What's normal?

A minor amount of continued bloody ooze coming from your surgical site that tinges your saliva can be expected during the first 24 hours.

More in-depth coverage about post-extraction bleeding.

  Blood clot protection.    (First 24 hours post-op)

Do not rinse your mouth during the first 24 hours following your surgery. Avoid vigorous spitting too. These activities may prolong bleeding.

Also, avoid creating positive or negative pressure events (sucking or blowing actions). This includes the use of a straw, the act of smoking, blowing a musical instrument or activities like blowing up a balloon. Doing so may dislodge or disrupt the socket's blood clot.

More in-depth coverage about protecting the blood clot that forms.

  Sinus precautions.    (First 24 hours post-op)

If you've had an upper tooth pulled, avoid creating increased pressure situations with your sinuses. Do not blow your nose. If you need to sneeze, do it with your mouth open.

More in-depth coverage about sinus precautions.

  Minimizing swelling.    (First 24 hours post-op)

The formation of swelling is a normal response to having had surgery. The amount of swelling that ultimately forms can be kept to a minimum by applying ice packs wrapped in a moistened towel against your face in the area of your surgical site.

  • Repeated cycles (ice pack/no ice pack) during waking hours only, 15 minutes on followed by 15 minutes off.
  • Begin the applications immediately following your procedure.
  • Additionally, when lying down keep your head elevated by propping it up with 2 or 3 pillows.

More in-depth coverage about post-surgical swelling.

  Pain control.    (First 24 hours post-op)

It's normal to feel some discomfort at your extraction site. Taking pain medication promptly after your procedure and before your numbness has worn off can help to limit the amount you experience.

  • Ibuprofen (Advil, Motrin, or generic) can make a good choice for controlling mild to moderate post-extraction pain. Or if you cannot use ibuprofen, acetaminophen (Tylenol or generic) can provide an alternative. In all cases, you must stay within the guidelines stated by the product's manufacturer.
  • If your dentist anticipates that your post-op recovery may involve comparatively more severe discomfort, they will prescribe a prescription pain medication for you.
  • Avoid taking pain relievers that contain aspirin because their use may lead to more bleeding.
  • If you notice side effects from taking any medication, including skin rash or itching, discontinue its use and contact your dentist immediately.

More in-depth coverage about post-extraction pain control.

  Antibiotics.    (First 24 hours post-op)

If your dentist feels that the use of an antibiotic is indicated, they will give you a prescription for one. If antibiotics have been prescribed (either before or after your surgery), take the full course as directed.

If you notice any side effect from taking any medication, including skin rash or itching, discontinue its use and contact your dentist immediately.

More in-depth coverage about post-extraction antibiotics.

  Postoperative numbness.    (First 24 hours post-op)

It's expected that the anesthetic administered during your procedure will slowly wear off during the next 2 to 4 hours. While numb, you should take precautions. For example, be careful not to bite your lips or tongue. Pay attention in preventing the exposure of your tissues (lips, tongue, face, etc...) to harmful hot or cold temperature extremes.

More in-depth coverage about precautions with numbness.

  Physical activity.    (First 24 hours post-op)

You should limit your activities for the rest of the day following your surgery. Avoid bending over, lifting objects, or participating in sports or exercise classes. The best plan is to just relax and get plenty of rest.

When lying down, prop your head up with 2 or 3 pillows. (Doing so will help to minimize bleeding and swelling.)

More in-depth coverage about post-extraction activities.

  Smoking.    (First 24 hours post-op)

Do not smoke. Smoking increases the risk of dry socket formation and other postoperative complications.

More in-depth coverage about tooth extractions and smoking.

  Drinking alcohol.    (First 24 hours post-op)

Do not consume alcoholic beverages following your surgery. Alcohol consumption is also contraindicated as long as you are taking narcotic pain relievers, and some types of antibiotics.

  Eating.    (First 24 hours post-op)

Avoid eating or drinking for the first hour after your surgery (with the exception of taking medication).

Over the following 24 hours, drink plenty of fluids so you stay properly hydrated. Choose soft or liquid foods. The temperature of foods and beverages should be cool, not hot.

More in-depth coverage about eating and drinking following an extraction.

  Oral home care.    (First 24 hours post-op)

Do not rinse your mouth during the first 24 hours following your procedure.

You may clean your teeth on the day of your extraction but you must be careful to avoid your surgical area. For routine cases, stopping a tooth short of either end of your extraction site typically makes a good plan.

More in-depth coverage about post-extraction oral home care.

  Emergency contact information.    (First 24 hours post-op)

Your dentist should provide you with their emergency contact information. If you feel you need their assistance, you should not hesitate to contact them. That's their obligation to you as your treatment provider.

 Reference: 

Resources used for the above guidelines -

University of Washington Department of Oral & Maxillofacial Surgery. After your oral surgery.

University of Michigan Department of Oral & Maxillofacial Surgery. Tooth Extraction Post-Operative Instructions.

McGill University Department of Oral & Maxillofacial Surgery. Surgical Teeth Extractions Post-Operative Instructions.

University of Rochester Eastman Institute for Oral Health. Postoperative instructions following dental extraction surgery.

More in-depth details about the above instructions -

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 continued post-extraction bleeding beyond the initial 24 hour period, use this link.]

Closing down on gauze is a good way to control extraction site bleeding.

Animation illustrating the placement of gauze directly over the tooth's socket, then applying firm pressure.

Place firm pressure on the gauze for 45 minutes or longer.

a) Controlling bleeding with gauze.

In most cases, this bleeding can be controlled and ultimately stopped by performing the following steps:

  1. Place a piece of clean damp gauze over the empty tooth socket.

    Roll up the gauze, or better yet, fold it into a small square. (It's only the portion that rests over your wound that plays a role.) If you don't have any gauze, a piece of clean cloth can be used instead.

  2. Bite firmly on the gauze for 30 minutes to an hour.

Make sure the wad of gauze is large enough and positioned so that when you bite down on it it applies pressure directly onto your extraction site. (If your teeth come fully together when you close, the gauze may not be receiving much pressure.)

Applying pressure over an extended period is the key.

It's both creating firm pressure and maintaining continuously it over a prolonged period of time (30 minutes or so) that are important factors in getting this technique to work.

  • Don't keep changing the gauze, don't chew on it and don't get started up in a conversation. Just put the gauze in place and continuously close down on it for the full 30 minutes to an hour.
  • If at the completion of the application your bleeding has stopped, you can discard the gauze. It is no longer necessary.

b) Controlling bleeding with a tea bag.

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 the process as needed.

Continued bleeding. / Renewed bleeding.

If some bleeding still persists after the completion of a 30 to 60 minute application, then repeat the process above with a fresh piece of gauze or new tea bag. The same goes if your bleeding once stopped starts up again.

A few application cycles may be needed. However, after each one you should notice that the amount of flow coming from your extraction site is less and less.

It's rare that this technique, especially when a tea bag is used, doesn't provide a solution. However, if bleeding continues, you should contact your dentist.

What constitutes persistent bleeding?

Every extraction site is expected to have some bleeding associated with it. And this can include some bloody oozing that is normal and may persist for 24 to 48 hours after your surgery.

In all cases where you have questions about the bleeding you've noticed, you should contact your dentist. Their questions will help them differentiate between:

  • Oozing - A small amount of blood coming from the wound that tinges your saliva. (A little bit of blood in a lot of saliva will seem like a lot of blood.) Or dark red clumps of clotted blood.
  • Bleeding - Bright red blood pooling in, or dripping out of, the surgical area within 15 to 20 seconds of removing the gauze.

Clotting aids.

In some cases your dentist may anticipate that post-operative bleeding will be a concern. If so, they may 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. For specific details, you'll simply have to ask your dentist what has been placed.

(Absorb = the process where a person's body will naturally degrade and then take up the breakdown components of an object.)

You still need to follow standard protocol.

By no means does your dentist having placed a clotting aid in your tooth's socket lessen your need to follow standard post-op instructions.

Instead you should recognize that they consider you to be at elevated risk for complications, which makes faithfully following their directions all that more important.

What becomes of the clot?

As a socket's healing process progresses the space occupied by its clot is gradually replaced by granulation tissue (new tissue that's especially rich in blood vessels). During this transition the clot is broken down into components that are resorbed by your body. The whole process is usually completed within about one week following your extraction. (Cohen)


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 plays an important role in supporting the healing process that follows, 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.

Blood-clot Don'ts.

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.
  • Don't disturb your extraction site. - Don't touch or poke at it with your finger. Don't explore it with your tongue.
  • Don't consume hot liquids and foods. - Hot items, especially liquids like soup, tea and coffee, 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, or objects like a musical instrument or blowing up a balloon. 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 bleeding from your extraction site, or interfere with blood clot formation and retention.

While the risk of these complications is often minimal after very simple extractions, when multiple teeth have been removed or the patient's procedure has been difficult, they can become a substantial concern. Either way, it only makes sense to take precautions.

Activities.

It's best to 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.

(Use this link for more details about post-extraction activities.)

Resting.

When you sleep or lie down, position yourself so your head is above the level of your heart. Doing so tends to lower your head's blood pressure level, which when trying to control post-extraction bleeding is a favorable thing.

Toward this goal:

  • In bed, prop your head up using an extra pillow, or even 2.
  • Rest in a recliner with the head portion of your chair positioned higher than your feet.

Be careful when transitioning from a reclined to upright position. You may find you get lightheaded. Try just sitting up for a minute before slowly getting on up.

D) Swelling may occur.

It's common and normal for some degree of swelling to occur after having a tooth pulled. The amount that ultimately forms is typically proportional to the extent of the surgery that has taken place. That means:

  • After very simple extractions you may notice very little, possibly none.
  • With more involved cases (longer, more difficult extractions or the removal of several teeth) you may notice a pronounced enlargement, possibly involving a large portion of your face.

Generally speaking, the amount of swelling that forms can be minimized via the application of ice packs on the outside of your face over the area where your surgery was performed, starting immediately upon the completion of your procedure.

This page provides in-depth details and instructions about managing this complication: Post-tooth extraction swelling.

'No Smoking' graphic.

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.

Oroantral communications.

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.)

Other precautions.

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 a patient can expect during the first 24 hours following their extraction can be quite variable. For some people, it will be a non-event. For others, it may be quite noticeable. (This page discusses managing pain that extends beyond the initial 24 hours after your procedure.)

Timing your medication.

Quiz your dentist about what to expect. If they feel it's highly likely that you'll need to take an analgesic (pain pill), a good plan can be to do so before the local anesthetic used for your procedure has worn off. (That will be tapering down over the next hour or two.)

If discomfort does become an issue, in terms of types of analgesics there are two general classes of medications that are typically used.

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a) OTC medications.

For just minor to mild pain, your dentist will probably advise the use of an over-the-counter (non-prescription) analgesic.

Commonly used 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.

Picture of prescription pain relievers.

A narcotic pain reliever may be needed after some extractions.

Narcotic medications.

The formulation of many prescription pain relievers includes the narcotic codeine (or related compounds).

  • These products tend to cause nausea (upset stomach). This effect can be minimized by taking the medication with milk or food (milk shake, soup, fruit juice, yogurt, mashed potatoes, etc...).
  • Taking a narcotic may make you dizzy, drowsy or groggy. It may also slow down your reflexes or cause you to act strangely.

    If you're taking a narcotic medication, you should let those around you know. You should also limit your activities (driving, operating machinery, etc...).

  • Additional common side effects include nausea, vomiting and constipation.
  • You should abstain from drinking alcoholic beverages when taking a narcotic.
Other precautions.

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.

Any antibiotics prescribed by your dentist should be taken as directed, which typically means "to completion" (the endpoint where all have finally been taken according to schedule). Doing so may include continuing on with your medication even after your tooth has been removed.


I) Eating.

Is it OK to eat after having a tooth pulled?

Yes, maintaining proper nutrition is important for both keeping up your strength and providing the nutrients needed for your extraction site's healing process, so try not to skip any meals.

For the first several days, keep foods away from your surgical area by chewing on the other side. That will help to minimize any chances of disrupting its healing process or allowing debris to collect in it.

Sticking to cool, soft foods makes the right choice after simple extractions. When multiple teeth, multiple extraction sites or surgical extractions are involved, a liquid diet (supplemental nutrition drinks) may be indicated during the first 24 hours. (See our post-extraction food suggestions below.)

How soon after can you eat?

It's best to wait until the local anesthetic used for your extraction has worn off. Trying to eat while you're still numb could result in an accident (like biting your lip) or trauma to your surgical site.

  • Following simple single-tooth extractions, you may be able to return to fairly normal eating habits after just a few days.
  • After more involved ones (surgical extractions, the removal of multiple teeth) you may need to favor your extraction site for most of a week as its healing gradually progresses.
What kinds of foods are recommended?

As a general rule, stick to cool, soft foods as opposed to hard, crunchy or spicy ones after having a tooth pulled. You should also avoid consuming alcoholic or carbonated beverages, or drinking using a straw (the negative pressure might draw the blood clot out of your socket).

  • Soft foodstuffs are less likely to traumatize your extraction site (this is true for both the day of your extraction as well as during the healing process that follows).
  • Hot food items (especially soup or coffee but even semi-solid ones) have the potential to dissolve the blood clot that has formed in your tooth's socket, so they should be avoided during the first 24 hours.

Consider food items like these: pudding, yogurt, jello, mashed potatoes, oatmeal, applesauce, scrambled eggs, pancakes, noodles, (cool) soup, ice cream, milkshakes, supplemental nutrition drinks.

As the healing of your extraction site progresses, you can start to add foods that have more firmness and texture to your diet.

Drink plenty of water.

It's important to stay well hydrated. That's because you've lost some bodily fluids during your extraction procedure. You'll also want to maintain optimal body chemistry for your socket's healing process.

  • As a best practice, except for taking medication you should delay drinking fluids for 1 hour following your extraction procedure.
  • Especially following more involved extractions (difficult procedures, the removal of multiple teeth), drinking 6 to 8 glasses of water per day makes a good idea.

J) Precautions with numbness.

Picture of a dentist giving a dental injection.

The numbness from your local anesthetic will linger after your procedure.

After the completion of your procedure you'll still have some lingering numbness. Besides just your extraction site, some aspect of your lips, cheeks or tongue are likely to be affected too.

How long will the numbness last?

You can expect to notice the effects of the anesthetic used for your extraction for some hours following your appointment. The method of injection, and type and formulation of anesthetic solution used, are primary determining factors.

Studies evaluating the effect of various anesthetic solutions commonly used in dentistry for numbing up lower molars (inferior alveolar nerve block injections) have reported duration times of:

  • 2.5 hours (Elbay 2016), 2.5 hours (Managutti 2015) and 3.8 hours (Kammerer 2012). [page references]
  • Differences in the duration of numbness among individual patients generally varied from 18 to 35 minutes (plus or minus).

As time passes, the level of numbness you notice will slowly fade as your body's vascular system carries the anesthetic solution off to be metabolized and excreted.

What precautions should you take?

The sensory loss (pain, temperature and touch) that your postoperative numbness creates can result in accidents. For example ...

  • 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.

In regard to this last issue, children must always be monitored during periods of numbness.


'No Mouthwash Use' graphic.

Avoid rinsing your extraction site with 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 has been pulled, it's best to avoid brushing those teeth that directly border your extraction site. Wherever access isn't a problem, it's OK to clean your other teeth.
  • During the first day after your extraction, it's OK to let water or saline solution (1/2 teaspoon of table salt in 1 cup of warm water) roll around in your mouth but rinsing vigorously must be avoided. Doing so might dislodge the blood clot that's formed in your tooth's socket.
  • Avoid the use of commercial mouthwash or mouth rinse. These products may irritate your extraction site.

This page discusses recovery & care for the days following your first 24 hours post-surgery. ▶

 

Authorship: Written by Animated-Teeth Dental Staff

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

Content reference sources.


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