Most extractions heal without any drama. The things that go wrong afterwards are largely predictable and largely preventable, which makes the aftercare worth reading properly rather than skimming on the way out.
The first 24 hours
The clot that forms in the socket is doing the healing. Almost everything in this list is about protecting it.
- Bite firmly on the gauze for the first 30-60 minutes. Firm, steady pressure - not chewing on it.
- Do not rinse, spit or swill anything for the first 24 hours. This is the one people break, and it is the one that dislodges the clot.
- No smoking. Both the suction and the chemicals interfere with healing, and smoking is the strongest risk factor for dry socket.
- No drinking through a straw, for the same reason.
- No alcohol, and no strenuous exercise for the rest of the day.
- Keep your head elevated, including on an extra pillow overnight.
- Eat soft, cool food. Nothing hot, nothing crunchy, and chew on the other side.
What is normal
Some oozing for several hours - the small amount of blood mixes with saliva and looks like considerably more than it is. Swelling that peaks around day two or three. Soreness that peaks in the first 48 hours and then steadily improves. Some stiffness opening your mouth. A slight bad taste.
For a straightforward extraction most people are comfortable within three to five days. A surgical extraction, or an impacted wisdom tooth, takes longer.
Dry socket
This is the complication worth understanding, because it is the one people ring about.
Dry socket happens when the clot is lost or breaks down before the socket has healed, leaving bone exposed. The signature is timing: the pain is manageable for the first two days, then gets significantly worse around day three to five rather than better. It is often a deep ache radiating to the ear, with a bad taste and bad breath.
Pain that is worsening after day three, rather than easing, is the thing to ring about. It is treatable - we clean the socket and place a dressing, and the relief is usually quick - but it does need seeing.
The biggest risk factors are smoking, rinsing too early, and using a straw. Which is why the first 24 hours matter so much.
After the first day
- Start gentle warm salt-water rinses after 24 hours - a teaspoon of salt in a cup of warm water, several times a day, letting it fall out of your mouth rather than spitting forcefully
- Brush your other teeth normally; keep the brush away from the socket itself for a few days
- Take pain relief as directed, ideally before it wears off completely rather than chasing it
- Ease back into normal food as it becomes comfortable
- Avoid smoking for as long as you possibly can - 72 hours minimum
Ring us if
- Pain gets worse after day three instead of better
- Bleeding is heavy or has not settled after several hours of firm pressure
- Swelling is increasing after day three, or spreading into your neck
- You have a fever, or feel genuinely unwell
- You cannot open your mouth
- Numbness in your lip or chin has not resolved after the anaesthetic should have worn off
- Swallowing or breathing is affected - that is a 111 call
Thinking about the gap
Worth raising before the extraction rather than after. A gap lets neighbouring teeth drift and the opposing tooth over-erupt, and the bone gradually resorbs, which makes replacement harder later.
That does not mean every gap needs filling - a back molar with a healthy tooth behind it is often fine left alone. But it is a conversation to have deliberately rather than by default.
General information, not a diagnosis. Written and reviewed by Dr Adrian Paul, BDS (Otago), principal dentist at Lakeside Dental Practice, Queenstown. If something is worrying you, see a dentist.
