Wisdom teeth removal is a routine surgical procedure performed to extract the third molars, often to prevent problems like impaction, pain, or infection. While millions of these extractions are performed each year, complications can arise, as with any surgery. Understanding the potential issues allows for prompt recognition and appropriate management.
Understanding Alveolar Osteitis (Dry Socket)
Alveolar osteitis, or dry socket, is the most frequent and painful complication following wisdom tooth extraction. This condition occurs when the blood clot, which naturally forms in the empty socket to protect the underlying bone and nerve endings, is lost or fails to develop. The absence of this protective layer leaves the sensitive bone exposed to the oral environment.
Pain from a dry socket is typically described as a deep, throbbing ache that begins two to five days after the surgery, often spreading to the ear, temple, or neck. Unlike the normal post-operative discomfort that subsides over time, this pain is severe and usually not relieved by common over-the-counter or prescribed pain medication. The exposed site may also present with a noticeable foul odor and taste.
Managing a dry socket requires professional dental intervention, as the condition will not resolve on its own without protection. Treatment involves gently flushing the socket with sterile solution to remove debris. A medicated dressing or paste is then placed directly into the socket to coat the exposed bone and provide immediate pain relief. This dressing may need to be changed every day or two until the pain subsides, which typically takes about five to seven days as the socket heals.
Infection and Delayed Healing Issues
Complications beyond dry socket often relate to the body’s response to the surgical wound and its healing process. A post-operative infection occurs when bacteria colonize the surgical site. Signs of an infection include the presence of pus, which may appear as thick yellow, white, or green discharge from the wound, sometimes accompanied by a persistent bad taste or odor.
Infection is also suggested by swelling that worsens or spreads days after the procedure, or swelling that feels warm to the touch. A persistent fever above 100.4°F (38°C) indicates a systemic response to a spreading bacterial issue. Addressing an infection usually involves treatment with antibiotics, and sometimes the area needs to be professionally cleaned or drained.
Other healing issues include trismus, the restriction of the mouth opening due to muscle stiffness and spasm near the surgical site. This makes eating and speaking difficult, often relating to inflammation of the jaw muscles. While some stiffness is common, severe or prolonged trismus requires attention to rule out a deeper infection. Swelling and bruising are expected, but if they do not noticeably subside within the first 72 hours, it may indicate a problem.
Potential Nerve and Structural Damage
Less common, but more serious, complications involve damage to adjacent anatomical structures. The most notable is paresthesia, an altered sensation resulting from injury to a nerve near the extraction site. The inferior alveolar nerve and the lingual nerve are the most frequently affected, potentially causing numbness or tingling in the lower lip, chin, or tongue.
This nerve injury occurs because wisdom tooth roots can lie in close proximity to nerve pathways within the jawbone, making them vulnerable during extraction. In the majority of cases, the paresthesia is temporary, with sensation gradually returning as the nerve heals over several weeks or months. However, in a small percentage of cases, the sensory changes can be persistent or permanent.
Structural damage to the adjacent second molar is also a possible complication, where the root or crown can be inadvertently damaged during removal. For upper wisdom teeth extractions, the close relationship to the maxillary sinus can lead to an oroantral communication. This is a small opening between the mouth and the sinus cavity, and it must be properly closed to prevent chronic sinus issues.
When to Seek Emergency Care
Certain symptoms after wisdom tooth extraction require prompt medical or dental attention. Uncontrolled, heavy bleeding requires urgent care, especially if the gauze dressing becomes quickly saturated and the bleeding does not slow down with direct pressure. While minor oozing is expected for the first 24 hours, persistent or increasing flow is a serious concern.
A high and sustained fever, particularly one above 101°F (38.3°C), is a red flag for a spreading infection. Severe, sudden pain that is not alleviated by prescribed medication, or pain that significantly worsens after the initial recovery period, should also be immediately evaluated.
Difficulty breathing or swallowing can indicate that swelling from an infection is spreading into the throat and airway, which is potentially life-threatening. Any signs of an allergic reaction to medication, such as a widespread rash, hives, or sudden difficulty breathing, also warrant immediate emergency medical assistance.