Wisdom teeth removal is a common surgical procedure resulting in temporary, noticeable changes in the mouth’s visual appearance. Understanding the expected look of the surgical sites and surrounding tissues helps distinguish between normal healing and potential complications. The visual progression from the immediate post-operative state to the first week follows a clear biological timeline.
Immediate Appearance After Surgery
Immediately following the procedure, surgical gauze is placed firmly over the extraction sites to control bleeding and encourage clot formation. The gauze will appear soaked with dark red blood and saliva and must be replaced until heavy bleeding subsides. Internally, the empty socket should be filled with a blood clot, which looks like a dark, gelatinous mass. This clot is a natural biological dressing that protects the underlying bone and nerve endings.
Swelling begins almost immediately on the exterior of the face as a natural response to the surgical trauma. The cheeks on the side of the extraction will look visibly puffy, temporarily altering the facial contour. The ability to open the mouth may be limited, and the lower face often feels numb from the anesthetic.
Numbness can lead to temporary drooling or difficulty controlling the lips. If the surgical site required closure, fine sutures might be visible. These sutures appear as thin threads, often white, black, or blue, crisscrossing the gum tissue over the extraction site.
Visual Changes During the First Week
The initial swelling progresses over the first few days, typically peaking between 48 and 72 hours after surgery. After the peak, the puffiness of the cheeks should begin a gradual reduction. Bruising may also become visible externally, starting as a reddish-purple discoloration on the jawline or cheeks.
The bruising then transitions to shades of green and yellow as the body reabsorbs the blood pigments. This change in color is a normal, temporary part of the healing process.
Inside the mouth, the protective blood clot stabilizes and changes appearance. By day three or four, the clot often develops a whitish, grayish, or yellowish layer over its surface. This layer is fibrin, a protein matrix that forms the foundation for new tissue growth (granulation), and should not be mistaken for pus.
The gum tissue immediately surrounding the site may remain mildly red for several days. However, this localized redness should not be spreading outward.
Sutures, if used, will either remain intact or begin to break down, depending on the type. Dissolving stitches typically start to loosen and may fall out around day five to seven. As the week concludes, the socket visibly shrinks as the gum tissue starts to close over the healing site.
Identifying Signs of Complications
While some visual change is expected, specific cues can indicate a complication requiring professional attention. The most recognizable sign of a dry socket (alveolar osteitis) is an empty-looking socket. This occurs when the protective dark blood clot is missing or has dislodged.
This empty space may appear hollow, sometimes exposing the underlying white or grayish bone tissue.
Visual indicators of a localized infection include redness that spreads beyond the immediate margin of the surgical site. The most definitive sign of infection is the presence of pus. Pus appears as a thick, opaque discharge that is typically yellow, green, or white, sometimes accompanied by a foul taste or odor.
Swelling that worsens rather than improves after the third day is also a red flag. Swelling that begins to spread down the neck or throat area should be promptly evaluated.