A wisdom tooth extraction is a common surgical procedure. Understanding the normal healing progression is the best way to manage post-operative anxiety and monitor recovery effectively. The site of the removed tooth, known as the socket, undergoes a dynamic process of repair involving several distinct visual phases. The appearance transitions from a fresh wound to a fully closed soft-tissue site over several weeks.
The Immediate Post-Extraction Site (Days 1 to 3)
The most noticeable feature immediately following surgery is the formation of the blood clot, which acts as a biological bandage over the exposed bone and nerve endings. A healthy clot appears as a dark, maroon, or deep crimson mass that fills the extraction site and may have a slightly jelly-like consistency. This clot is fundamental to healing, protecting the underlying tissue from the oral environment and providing the necessary scaffold for new tissue growth.
Mild to moderate swelling in the surrounding gum tissue and potentially the cheek is normal, typically peaking around 48 to 72 hours after the procedure. This localized swelling is the body’s natural inflammatory response. Pinkish or reddish seepage, often referred to as oozing, may also be present in the saliva for the first 24 hours, but this is distinct from active, heavy bleeding that soaks gauze quickly.
If sutures were used, they will be visible as threads or knots across the wound opening, often appearing black, blue, or white depending on the material. The gums immediately surrounding the socket may look pale or whitish due to the trauma and local circulation changes, but this should resolve quickly. Protecting the initial blood clot is the primary concern during the first three days, as its stability dictates the success of the healing phase.
Mid-Term Healing: Visual Changes Over Time
After the third day, the extraction site transitions from a blood clot to regenerative tissue, changing color and texture. The dark blood clot is replaced by a protective layer known as granulation tissue, which signals the body is actively building a new foundation for the gums. This new tissue often looks grayish, whitish, or pale yellow, and patients frequently mistake it for pus, food debris, or an infection.
Granulation tissue is a soft, moist layer composed of new blood vessels, white blood cells, and collagen fibers, which eventually matures into normal gum tissue. As this process continues, the extraction site gradually shrinks in size, with soft tissues beginning to grow inward from the edges of the socket. By the end of the first week, the socket is substantially covered by this whitish tissue, and the surrounding gum redness should fade.
Dissolvable sutures begin to break down and fall out naturally between five days and two weeks after surgery. Non-dissolvable sutures remain intact until a dental professional removes them, typically around one week post-operation. The socket continues to fill in over the second and third weeks. By the end of this period, the soft tissue is usually closed, leaving only a slight indentation where the tooth once was.
Recognizing Complications: When the Site Looks Abnormal
While the healing process is usually predictable, certain visual signs indicate a complication requiring professional attention. One telling sign of a dry socket (alveolar osteitis) is the absence of the protective blood clot, leaving the socket looking hollow or empty. In this condition, the underlying bone may be visible, appearing white or grayish-white, and the site will lack the dark appearance of a healthy clot or granulation tissue.
Signs of a localized infection differ visually from normal healing tissue and may include thick, yellowish-green pus exuding from the socket. An infection is often accompanied by surrounding gum tissue that is excessively red, hot to the touch, or displays swelling that increases after the initial three-day peak. Unlike pale granulation tissue, infectious discharge typically has a creamy consistency and may be accompanied by a foul odor or taste.
Excessive or uncontrolled bleeding warrants immediate concern, as normal healing involves only minor oozing. If bleeding is heavy, persistent, and soaks through multiple layers of gauze after the first day, it may indicate a problem with clot stability or formation. Swelling that begins to spread rapidly toward the throat or eye, or an increase in redness extending beyond the surgical site, should also be considered an abnormal indicator.