What to do following tooth removal
After one or more teeth have been removed, you will want to do all the right things to heal quickly. Your dentist or oral surgeon will give you personalised post-op care instructions, but below you can find some general advice.
- It is normal for the area to be tender for the first few days, and simple over-the-counter pain relief is usually enough to ease any discomfort. Start taking painkillers before the numbing has worn off – don’t wait until pain sets in. It’s far easier to prevent pain than to make it go away.
- The usual painkillers of choice are ibuprofen (some products have codeine added for extra pain relief) and paracetamol. When taken together, these two drugs enhance the effect of each other because they work in different ways. Check with your dentist or another health care provider that you can take these (for example, people who have asthma shouldn’t take ibuprofen), and follow their directions. Ibuprofen is best taken with food or on a full stomach. If you can’t take ibuprofen, your dentist or pharmacist will be able to recommend an alternative. Avoid disprin as this thins the blood and can make bleeding worse. Talk to your dentist or pharmacist if you feel you need something stronger.
- Go home, take it easy for the rest of the day, and don’t exercise for at least 12 to 24 hours. If you want to lie down, and for the first night following surgery, you may want to keep your head up with pillows. Do not bend over or do heavy lifting for 2-3 days.
- Usually, a gauze pad will be placed on the area, and you should try and keep firm pressure on it to control any bleeding. You should change this dressing about every 30 to 45 minutes, depending on the amount of bleeding, until the bleeding has stopped. The amount of bleeding can look a bit scary. Relax – a small amount of blood is mixed with a larger amount of saliva, which can make it look a lot more dramatic than it really is!
- If this doesn’t stop the bleeding, dampen a tea bag (ordinary black tea, not fruit or Earl Grey!) with cold water and fold it in half and gently bite down on it for 10 minutes or so. The tannin in black tea helps stop bleeding.
- Some slight bleeding is normal. But if you still bleed heavily after an hour or two, go back to your dentist.
- While you shouldn’t vigorously rinse for the first 24 hours, after this initial period you should gently rinse about 4 times a day (after meals and before bedtime), using warm salt water. Use 1 teaspoon of salt in a glass of warm water, or boil a kettle and once cool, pour into a water bottle and add 4-6 teaspoons of salt for use on the go. If you find that salt water stings, you could try using less salt or rinsing with warm camomile tea instead. Spit out gently. Rinse after every meal and snack, making sure that the water removes any bits of food around the area where the tooth is missing.
- Stick to a liquid or soft food diet for the first day or two. Examples include soups, yoghurts, fruit milkshakes, smoothies, mashed potatoes, etc. Avoid spicy foods, hot drinks and sodas for 3-4 days, to prevent irritation and burns.
- Your dentist may also advise you to use chlorhexidine mouth rinse (Corsodyl in the UK, available in pharmacies, Peridex in the US, prescription-only) for 10 days or so following surgery. This kills bacteria.
- Be careful when brushing near the extraction site for 3-4 days. You can carefully wipe the area with a clean, wet gauze pad. If you can’t get a toothbrush into your mouth due to swelling or discomfort, chlorhexidine mouthwash (see above) is a handy adjunct.
- After wisdom teeth removal, try to gently keep stretching your mouth open to get it moving again. It can be tempting just to not open it wide at all, but that can lead to more permanent limited opening (“trismus”). Don’t overdo it, though!
- Don’t rinse the area for 24 hours after tooth removal.
- Avoid hot food or drinks until the numbing wears off. You cannot feel pain while you’re numb and may burn your mouth. Also take care not to accidentally bite your cheek!
- Don’t poke at the extraction site – keep your fingers and tongue away from this area.
- If you can, avoid sucking, spitting, and blowing your nose more than necessary, to avoid dislodging the blood clot. If you have a cold or allergies which will want you blow your nose or sneeze, you may want to take medications to treat these.
- Avoid smoking for as long as possible afterwards, but at the very least for the rest of the day. Although the extraction may have been stressful, smoking interferes with the healing process and can create pain and problems.
- Avoid alcohol for 24 hours, as it could delay the healing process.
How long does it take to recover from a tooth extraction?
Pain tends to lessen by the second day, but this varies from person to person, and also depends on how easy or difficult the tooth removal was. For some people, pain is worst on day 4, especially after more difficult wizzie extractions.
It usually takes gum tissue about 3-4 weeks to heal. The hole in the gum can last for up to 3 months, and the bone can take up to 6 months to heal completely.
You can expect some weird sensations (e.g. occasional stabbing pains or similar) while you’re healing.
Problems after Tooth Removal
If you still feel numb more than 6 hours later (especially after lower wisdom teeth extractions), call your dentist or oral surgeon. If you get back in within 24 hours, some steroids can be injected into the nerve area, which can help reduce swelling and may help speed recovery. Prolongued numbness can also be due to a longer-lasting local anaesthetic – in this case, the effect is intentional, so check with your dentist or oral surgeon. Also, some people metabolise local anaesthetic more slowly and stay numb for longer.
“There’s a piece of bone coming out where the tooth has been pulled!”
You may feel the sharp edge of the socket with your tongue and sometimes, little bits of bone may make their way to the surface and work their way out. This is perfectly normal and harmless. If a small bit of bone is annoying you and you don’t want to wait until it comes out by itself, you can ask your dentist to remove it for you.
Sensitivity in teeth next to an extracted tooth
It’s not uncommon for the teeth next to an extraction site to be sensitive. The reason is that a little bit of bone can get lost on the side of the tooth where the extraction was carried out. This causes a small area of the root to be exposed (not covered by gum) and feel sensitive. It will get better in time, but if you want to hurry things along, rubbing sensitive tooth toothpaste onto the affected area will help.
Pain that lasts for up to a week or so but is gradually getting better is normal. You could ask your dentist or pharmacist for stronger painkillers.
Pain that starts to get worse after two days is considered abnormal and you may want to see your dentist, as this could be a sign of “dry socket”. However, after wisdom tooth extraction, it is quite common for pain to peak around day 3 to 6, and this doesn’t mean you have dry socket.
A dry socket occurs when the blood clot for healing becomes dislodged or doesn’t form. In that case, the bone and fine nerve endings are not protected and exposed to air, food, and liquids. Dry socket delays the healing process and can be very painful.
If you suspect dry socket, see your dentist. They will place a medicated dressing in the socket which will rapidly help reduce the pain. The medicated dressing should be changed every day or two at the start, and then at longer intervals. Some dressings are designed to stay in and dissolve by themselves, so ask your dentist what they are using.
Swelling and/or bruising
Swelling and sometimes bruising can occur after surgery, especially with wisdom teeth. The worst swelling, pain and jaw stiffness normally happens 2 or 3 days after surgery (although after some difficult wizzie extractions, the pain is often reported to be worst on day 4). On the day of the surgery, apply ice packs for 15 minutes on then 15 minutes off until bedtime. This will keep swelling to a minimum. Also keep your head elevated until bedtime. Moist heat after 36 hours may help jaw soreness. Arnica (a homeopathic treatment available from pharmacies and health stores) can be taken orally and/or as a cream to help with the swelling.
“My dissolvable stitches aren’t dissolving!”
This is a common problem with dissolving stitches. It is important that 3-4 days after the extraction you start brushing the stitches away to prevent food being trapped.
You can get your dentist to remove them if they don’t come out by themselves. Many people are worried about the removal of the stitches (whether dissolvable or not) but it is an entirely painless process and you don’t need any numbing for it:
“I had them removed after 10 days so needed to cut them to take them out – cut is the wrong word it was more of a ‘snip’, I had about 6 to 8 ‘snips’ altogether for 13 extraction sites – then gently using a pair of tiny tweezers pulled them out with barely any feeling at all, kind of a little tug – please note there was NO PAIN what so ever and it took seconds.”
“I just felt a tiny bit of tugging”
“everyone was right, it wasn’t painful, just felt like a tug”
Get Well Soon – Helping you to make a speedy recovery after removal of wisdom teeth (Royal College of Surgeons) – An excellent 13-page instruction booklet which includes a traffic light recovery tracker.
Advice after Tooth Removal – Patient Leaflet – A single-page PDF advice sheet for your patients (source: “Are you positive?” by Mike Gow, Dentistry Scotland Magazine, October 2008, p. 25)