When a tooth cannot be saved due to severe trauma, infection, or decay, a dental professional performs an extraction, commonly called “pulling” the tooth. This procedure creates a surgical site that the body must heal. Proper aftercare is extremely important for ensuring a smooth, rapid recovery and minimizing the risk of painful complications, such as a dry socket. Following specific instructions allows the body’s natural healing mechanisms to begin their work effectively.
Immediate Post-Extraction Care
The immediate concern following an extraction is establishing a stable blood clot within the empty socket. Dentists typically place a sterile gauze pad over the site, and the patient must apply firm, continuous biting pressure for 30 to 45 minutes. This pressure helps compress the blood vessels and encourages the initial formation of the clot that seals the wound.
If bleeding or oozing persists after the initial period, the patient should replace the gauze with a fresh, sterile pad and maintain firm pressure for another 30 minutes. Minor oozing may continue for up to 24 hours, but heavy, uncontrolled bleeding that soaks through multiple pads should be reported to the dental office. When lying down, elevating the head slightly with pillows can help control any bleeding.
During the first 24 hours, activities that create negative pressure inside the mouth must be avoided to prevent dislodging the newly formed clot. This means refraining from using straws, forcefully spitting, or aggressively rinsing the mouth. Smoking or using any tobacco products is also prohibited, as the sucking motion and the chemicals interfere with healing and increase the risk of complications. Rest and minimal physical activity are recommended for the first day to keep blood pressure low and minimize the chance of bleeding.
Managing Pain and Swelling
Controlling discomfort is managed through a combination of medication and external cold therapy. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are often recommended, as they address both pain and inflammation. Acetaminophen may also be used, sometimes in combination with ibuprofen, following the specific dosing instructions provided by the dental office.
Patients may be prescribed stronger pain medications, which should be taken as directed, and often only for a short duration. It is helpful to begin taking the medication before the local anesthesia fully wears off to maintain consistent pain control. Never exceed the recommended dosage of any medication, and ensure any antibiotics are taken for the entire prescribed length of time.
Swelling is a normal response to the extraction and can be minimized by applying a cold compress or ice pack to the cheek near the surgical area. This cold therapy should be used intermittently, typically 15 to 20 minutes on and 15 to 20 minutes off, for the first 24 to 48 hours. Swelling generally increases over the first couple of days before gradually starting to subside.
Protecting the Healing Site
The focus shifts to protecting the established clot and promoting healing. Maintaining a modified diet is necessary for several days to avoid damaging the healing tissue. Patients should eat only soft foods, such as yogurt, soups, and scrambled eggs, while avoiding anything crunchy, sharp, or hot that could irritate the socket.
When chewing, use the side of the mouth opposite the extraction site to prevent food particles from entering the wound. Avoid carbonated beverages, which can introduce pressure and chemicals. Gradually reintroducing solid foods should occur as comfort allows, typically after the first week.
Oral hygiene must be resumed to keep the mouth clean without disturbing the clot. Gentle brushing of the teeth can begin the day after surgery, but the brush should be kept away from the immediate extraction site for several days. Mouthwashes should be avoided entirely during the recovery phase unless specifically instructed by the dentist.
Beginning 24 hours after the procedure, rinsing with a warm saline solution is recommended to cleanse the area and promote healing. This solution is made by dissolving half a teaspoon of salt in eight ounces of warm water. The solution should be allowed to pool over the socket before being tilted out of the mouth, rather than forcefully spat out, to avoid dislodging the clot.
Physical activity should also be limited for the first three to four days, especially any strenuous exercise that elevates the heart rate. Increased blood pressure from exertion can restart bleeding or interfere with the stability of the clot. Resuming normal physical routines too quickly can delay the healing timeline.
Recognizing Complications
While most extractions heal without issue, patients should be aware of signs that indicate a complication requiring professional intervention. The most common complication is dry socket, which occurs when the blood clot is prematurely lost from the socket. Dry socket typically develops two to four days after the procedure and presents as severe, throbbing pain that radiates up toward the ear or eye.
This condition may also be accompanied by a visibly empty socket, where exposed bone may be seen, along with a foul odor or bad taste emanating from the mouth. Dry socket is managed by a dentist who cleans the socket and applies a medicated dressing to soothe the exposed bone. It is important to contact the dental office immediately if these specific symptoms arise.
Other signs of a problem include:
- Symptoms of infection, such as a fever or the presence of pus draining from the site.
- Persistent and increasing swelling after the third day.
- Heavy bleeding that does not slow down after several hours of consistent pressure.
- Pain that gets worse instead of better after the third day.