Tooth extraction aftercare: Instructions for the first 24 hours after having your tooth pulled.
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 this page outlines the changes that will occur as your extractions site heals. Extraction healing timeline.)
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.
Extraction Aftercare Checklist – The 1st 24 hours post-op.
Customize this list so you’ll know what you’ll do for these issues.
- Controlling bleeding.
- Blood clot protection.
- Sinus precautions.
- Managing numbness.
- Minimizing swelling.
- Managing pain.
- Eating, drinking, teeth cleaning.
- Smoking. | Alcohol.
- Dentist contact info.
Print out. Add notes while reading this page.
What issues are included?
We also explain the underlying principles associated with post-extraction directions.
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 we’ve listed as reference sources below.
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.
Postoperative instructions for the first 24 hours following a tooth extraction –
► Controlling bleeding from your extraction site. (First 24 hours post-op)
Gauze placed by your dentist.
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.
A minor amount of continued bloody ooze coming from your surgical site that tinges your saliva can be expected during the first 24 hours.
► 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.
► 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.
► Minimizing swelling. (First 24 hours post-op)
- 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.
► 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.
► 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 effects from taking any medication, including skin rash or itching, discontinue its use and contact your dentist immediately.
► Postoperative numbness. (First 24 hours post-op)
It’s expected that the local anesthetic administered during your procedure will slowly wear off during the next 2 to 4 hours. While numb, you’ll need to take precautions. For example:
- Be careful not to bite your lips or tongue. (Children will need to be coached and monitored on this point.)
- Avoid exposing soft tissues (lips, tongue, face, etc…) to harmful hot or cold temperature extremes.
► 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.)
► Smoking. (First 24 hours post-op)
Do not smoke. Smoking increases the risk of dry socket formation and other postoperative complications.
► Eating and drinking. (First 24 hours post-op)
Avoid eating or drinking for the first hour after your surgery (with the exception of liquids needed as an aid with taking medication).
Over the following 24 hours, drink plenty of fluids so you stay properly hydrated. Choosing soft or liquid foods makes it less likely that you’ll traumatize your extraction site when eating. The temperature of foods and beverages should be cool, not hot.
► 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.
► 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.
► Emergency contact information. (First 24 hours post-op)
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.
[FYI: Use this link for information about post-extraction bleeding that continues beyond the initial 24 hour period. What to do.]
a) Controlling bleeding with gauze.
In most cases, post-extraction bleeding can be readily controlled, and ultimately stopped, by performing the following routine:
Closing down on gauze is a good way to control extraction site bleeding.
Place firm pressure on the gauze for 45 minutes or longer.
Steps to bring post-extraction bleeding under control.
- Place a clean piece of dampened gauze over the empty tooth socket.
Before putting it in place, roll the gauze up, or better yet, fold it into a small square. (It’s only the portion that rests directly over your wound that plays a role.) If you don’t have any gauze, a piece of clean cloth can be used instead.
- 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.)
- Repeat cycles of the above, a few may be needed, to finally bring the bleeding fully under control.
Note: Applying pressure over an extended period is the key.
It’s both creating firm pressure and maintaining it continuously over a prolonged period (30 to 60 minutes of application time) 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.
Using a damp tea bag can be more effective in bringing bleeding under control 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.
More to know about post-extraction bleeding …
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.
From a standpoint of appearance, these products initially look like pieces of foam, sponge or gauze. Then once moistened with blood and oral fluids, they soften considerably and are easily adapted into the opening of the tooth’s socket. Once placed, they are typically quite visible lying across the socket’s opening.
(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?
B) Ensuring 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 Signs | Symptoms is related to the loss of the original blood clot.
Blood clot care and precautions.
As a way of protecting the clot that has formed in your tooth’s socket, during the first 24 hours following your extraction procedure, you should …
Extraction-site blood clot don’ts.
- 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.)
- Moderate physical activities. – As discussed in our next section.
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.
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.
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 this complication: Post-tooth extraction swelling. What to expect. | Management.
Don’t smoke for as many days as you can.
E) Avoid smoking.
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. The relationship.
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 the creation of what’s termed an “oroantral communication” (a direct connection between your mouth and sinus). And the development of one may complicate the healing process. Here’s how.
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.
(FYI: This page discusses pain that extends beyond the initial 24 hours following your procedure. What to expect. | Management.)
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.
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.
A narcotic pain reliever may be needed after some extractions.
Precautions with narcotic medications.
- These products tend to cause nausea (upset stomach). This effect can be minimized by taking the medication with milk or food (milkshake, 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.
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. Historically this has meant “to completion” (the endpoint where all of the medication has finally been taken according to schedule). Doing so may include continuing on even after your tooth has been removed. (Being prescribed a 7-day supply is common.)
Depending on the reason why taking the medication was indicated, under modern prescribing guidelines a common regimen for dental antibiotic usage nowadays involves a variable treatment course of 3 to 7 days, with the medication discontinued 24 hours after a complete resolution of symptoms has occurred.
FYI: This page explains some reasons for Antibiotic use with extraction cases.
I) Eating and drinking.
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.)
Precautions with eating the day of your extraction (first 24 hours post-op).
- Nutrition is important, so don’t skip meals.
- Avoid beverages during first hour.
- Wait for your numbness to wear off before eating.
- Avoid hot (in temperature) foods and beverages.
- Choose soft, non-spicy foods.
- Keep foods and chewing on the other side of your mouth.
- Maintain adequate fluid intake during the day.
- Avoid consuming alcohol.
How soon after your extraction procedure can you eat?
- Following simple single-tooth extractions, you may be able to return to a fairly normal diet and regular 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.
Drinking dos and don’ts.
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.
- Simply drink the beverage. Rinsing or similarly disrupting your extraction site with liquids during the first 24 hours should be avoided.
- Liquids should be room temperature. Hot liquids may tend to dissolve the blood clot that has formed in your extraction site.
J) Precautions with numbness.
The numbness from your local anesthetic will linger after your procedure.
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).
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.
Avoid rinsing your extraction site with mouthwash.
K) Cleaning your teeth.
- 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.
Page references sources:
Cohen N, et al. Healing processes following tooth extraction in orthodontic cases.
Lockhart PB, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association.
McGill University Department of Oral & Maxillofacial Surgery. Surgical Teeth Extractions Post-Operative Instructions.
University of Michigan Department of Oral & Maxillofacial Surgery. Tooth Extraction Post-Operative Instructions.
University of Rochester Eastman Institute for Oral Health. Postoperative instructions following dental extraction surgery.
University of Washington Department of Oral & Maxillofacial Surgery. After your oral surgery.
All reference sources for topic Tooth Extractions.
This section contains comments submitted in previous years. Many have been edited so to limit their scope to subjects discussed on this page.
I’ve noticed some pain.
I just got my tooth pulled 2 hours ago…I’m feeling a bit of pain, is that bad?
In all cases, a patient should always feel free to contact their dentist about any concerns that they have. Responding to your needs is a part of their obligation to you as a treatment provider.
It seems possible that what you are experiencing falls within the realm of usual. Here’s what our pages state about post-op pain during the same day of an extraction.
Worse after tooth extraction.
I had an upper molar removed 7 hours ago the dentist said at the time she was having difficulty extracting the tooth and had to ask her assistant to hold my head while she pushed and pulled eventually it came out successfully. 7 hours later I am suffering extreme pain worse than tooth ache is this normal?
Your case might be an example of where performing a surgical extraction might have resulted in creating less procedure trauma than performing it conventionally. But that is hindsight now.
With any extraction procedure, postoperative pain is common and not unexpected when it occurs. We discuss the issue of controlling postoperative pain during the first 24 hours here.
Rather than a website, seeking attention from your dentist makes the better plan. Dentists expect that emergencies will happen, especially with difficult extractions, and expect to hear from their patients if their assistance is needed. That is their obligation to you as your treatment provider.
First day question.
I left my gauze in place for 5 hours. I would change it every hour. I didn’t understand that it was only to be done for an hour or so. Did I hurt my blood clot? It still looks like it’s there.
Your post is a little bit unclear (did you or did you not change the gauze each hour). But either way it seems unlikely that you would have done any harm.
The customary instructions are, place the gauze and bite on it (30 minutes to an hour), then repeat that process as needed (to control continued bleeding). What you did would seem to have just ensured that the bleeding was controlled. The extended presence of the gauze probably provided better protection for the forming clot than if it hadn’t been there.