An impacted wisdom tooth is a third molar that is blocked from fully erupting into the mouth, often due to lack of space or an abnormal angle of growth. This impaction can lead to significant discomfort. The duration of the pain depends on whether the tooth is left untreated or is surgically removed. When the tooth remains in place, the pain is typically episodic and recurring, linked to inflammation or infection. If the tooth is surgically extracted, the pain is acute but follows a predictable healing timeline that rapidly improves within a week.
Understanding Pain from Untreated Impaction
Pain from an impacted wisdom tooth that is not removed rarely lasts continuously. Instead, it presents as recurring episodes of discomfort that can last for days or weeks. This intermittent nature is often linked to the tooth’s gradual eruption process or localized infection. As the tooth attempts to push through the jawbone or gum tissue, it exerts pressure on adjacent structures and nerves. This leads to throbbing or aching sensations that may radiate to the ear or jaw joint.
The most frequent cause of an acute, painful flare-up is pericoronitis. This is an infection of the soft gum tissue surrounding a partially erupted molar. Because the tooth is only partly visible, a flap of gum tissue often covers part of the crown, creating a trap for food particles and bacteria. This bacterial buildup causes inflammation, swelling, and localized infection, leading to intense pain.
When treated with antibiotics and thorough cleaning, an episode of pericoronitis may subside within a week. However, the underlying condition remains. If the tooth is not removed, this gum flap can become repeatedly inflamed and reinfected. Therefore, if an impacted wisdom tooth is left untreated, the pain remains a long-term risk of recurring discomfort.
Expected Healing Timeline After Removal
The pain experienced after surgical removal is acute but predictable. The first 24 hours post-surgery generally represent the peak of discomfort, with the surgical site experiencing maximum swelling and some controlled bleeding. Medications prescribed by the surgeon are most effective during this phase to manage pain before the local anesthetic fully wears off.
In the acute recovery phase (Day 2 to Day 4), swelling often peaks around the second or third day before it begins to visibly subside. Pain levels should also decrease significantly during this time, moving from a sharp intensity to a more manageable dull ache. This period requires careful adherence to post-operative instructions to encourage the formation of a stable blood clot in the socket.
By Day 5 through Day 7, most patients have transitioned off prescription pain medication. They manage any lingering soreness with over-the-counter anti-inflammatories. The swelling should be largely diminished, and many individuals feel well enough to return to work or school. While significant discomfort resolves within the first week, soft tissue healing continues for up to two weeks.
When Pain Signals a Complication
If pain begins to worsen instead of improve after the third day following surgery, it can signal a complication that requires professional attention. One of the most common issues is alveolar osteitis, more widely known as dry socket. This occurs when the protective blood clot is prematurely lost from the extraction site. The pain from a dry socket is distinct from normal post-operative soreness because it is severe, throbbing, and often radiates to the ear, temple, or neck.
Pain from a dry socket typically begins two to five days after the extraction, a time when discomfort should be noticeably decreasing. Without the protective clot, the underlying bone and nerve endings are exposed, causing intense sensitivity. With prompt dental treatment, which involves cleaning the socket and placing a medicated dressing, the pain should be relieved almost immediately. The condition typically resolves within seven to ten days.
A different complication is a post-operative infection, often indicated by pain that worsens after the fifth day. This is accompanied by symptoms like fever, pus discharge from the socket, or excessive swelling that does not subside. While a dry socket is not an infection, a persistent or worsening infection requires intervention, usually with a course of antibiotics. Any pain that is not progressively improving after the first week should be evaluated by an oral surgeon to rule out or treat these complications.
Practical Strategies for Pain Management
Managing discomfort involves a combination of medication and home care. Non-prescription pain relievers, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, are highly effective because they target both pain and inflammation. These medications can be used to manage the periodic pain from an untreated impaction and the soreness following surgery.
Prescription pain medication may be provided for the first few days after extraction to manage the most intense discomfort. These should be taken exactly as directed by the surgeon. Combining these with home remedies can further enhance comfort and healing. Applying a cold compress or ice pack to the cheek for 20-minute intervals during the first 24 to 48 hours helps minimize swelling and numb the area.
Beginning 24 hours after surgery, gentle rinsing with warm salt water several times a day is recommended to keep the extraction site clean and soothe the gums. Dietary modifications are also necessary, especially in the first week, with patients advised to eat only soft foods. Avoiding actions that could dislodge the blood clot, such as using a straw or forceful spitting, is an important strategy to prevent the intense pain of a dry socket.