Wisdom tooth removal, or third molar extraction, is a common minor oral surgery. Because the procedure requires manipulating bone and soft tissues, the body initiates a natural inflammatory response, resulting in predictable visual changes both inside and outside the mouth. Understanding these post-operative appearances is important for identifying normal healing and distinguishing it from potential complications. The healing process follows a defined, visible timeline as the body repairs the trauma.
The Immediate Appearance of the Extraction Site
Directly following the surgery, the internal appearance focuses on the extraction site. Gauze is placed over the area to apply gentle pressure and encourage blood clot formation. Once the gauze is removed, the socket should be filled with a dark red or maroon blood clot. This clot acts as a biological bandage, protecting the underlying bone and nerve endings.
The gum tissue around the socket may appear swollen or slightly bruised. You will also notice sutures holding the gum flaps together. These stitches can look like thin black threads or loops, and they are either dissolvable (vanishing over the next week or two) or require removal by the surgeon.
Expected External Changes (Swelling and Bruising)
The most noticeable external change is facial swelling, which is the body’s natural reaction to surgical trauma. Swelling typically begins a few hours after the procedure and continues to increase over the next couple of days. It will peak between 48 and 72 hours post-surgery, causing the cheeks and jawline to look noticeably puffed out and asymmetrical.
Accompanying the swelling, many patients experience bruising on the skin of the face and neck. As blood breaks down beneath the skin, the bruise displays a variety of colors, progressing from purple or blue to shades of green and yellow. This discoloration is most commonly seen along the lower jaw and upper neck area. Both the swelling and the bruising should begin to subside noticeably by Day 4 or 5 and fully resolve within two weeks.
Appearance of the Healing Socket Over Time
The healing of the extraction socket is a dynamic process that is often a source of anxiety for patients. The initial dark blood clot that fills the socket is gradually replaced by new tissue beginning around Day 3 to Day 7. This new tissue, called granulation tissue, is a soft, regenerative material that serves as the foundation for bone and gum growth.
Granulation tissue often appears grayish-white, pale pink, or creamy-yellow, covering the initial dark clot. This appearance is a positive sign, indicating the formation of the protective fibrin plug that shields the underlying socket, and is often mistaken for pus or food debris. As weeks pass, the gum tissue slowly closes over the area, and the deep socket indentation gradually becomes shallower. Full remodeling of the bone and smoothing of the gum line can take several months, but the visible surface of the wound is usually covered with pink gum tissue within a few weeks.
Visual Signs of Complications
While healing involves expected visual changes, certain appearances signal a complication. The most well-known complication is alveolar osteitis, commonly called dry socket, which occurs when the protective blood clot is lost prematurely. Visually, a dry socket appears as a noticeably empty socket where the dark clot is absent. The underlying jawbone may be visible as a stark white or off-white surface.
Signs of infection typically manifest several days after the surgery. A noticeable visual cue is the presence of pus, which appears as a thick, opaque yellow or white discharge emanating from the socket. Additionally, a spreading redness in the surrounding gum tissue, extending far beyond the immediate edges of the wound, can suggest a bacterial infection. These visual indicators warrant immediate attention from a dental professional.