Wisdom tooth extraction creates a wound that heals in a predictable sequence, and understanding the visual changes at the extraction site and on your face helps manage anxiety during recovery. The initial appearance, the progression of healing over the first week, and the long-term closure of the socket must be understood. Expecting these normal visual signs helps distinguish a healthy recovery from a complication requiring professional attention.
Appearance Immediately Following Surgery (The First 24 Hours)
The extraction site is characterized by a blood clot, the body’s natural protective seal. This clot appears as a dark red or maroon, jelly-like mass filling the socket opening. Minimal bleeding, often a slight pink tinge mixing with saliva, is typical during the initial hours.
If viewed before the clot fully matures, the socket may look like a dark, open hole. Stitches, if used, will be visible across the gum edges as fine black threads or, if dissolvable, white or clear material. Gauze pads are initially placed over the site to encourage a stable clot and manage bleeding.
On the outside of the mouth, the first few hours show minimal outward swelling, though inflammation has begun. Facial swelling is not yet fully apparent, but a firm, cold pack can be applied to the cheek to limit its development. The jaw and cheek area may feel numb due to lingering local anesthetic, temporarily altering facial symmetry.
The Progression of Healing (Days 2 Through 7)
Facial appearance changes most dramatically between the second and third days. Swelling, a normal inflammatory response, typically peaks around 48 to 72 hours after surgery. This swelling can affect the cheeks, jawline, and sometimes extend down the neck, temporarily altering the facial contour.
Bruising (ecchymosis) may become visible on the jaw or neck skin from blood seeped into the tissues. This discoloration progresses through various shades, often starting as purplish and fading to green or yellow before resolving. Bruising and swelling should begin to subside noticeably after the third day, signaling the end of the acute healing phase.
Inside the mouth, the blood clot is replaced by granulation tissue. This tissue may appear white, gray, or yellowish, covering the socket opening, and should not be mistaken for pus or infection. By the end of the first week, the gum edges start to shrink and pull together as the socket begins to close.
Identifying Warning Signs and Abnormal Appearance
While some swelling and discoloration are expected, certain visual signs indicate a complication, such as a dry socket or infection. Dry socket (alveolar osteitis) occurs when the protective blood clot is lost, typically two to four days post-surgery. The socket appears empty, revealing a pale, whitish-gray bone surface instead of the dark, stable clot.
Infection presents with distinct visual characteristics. Thick, yellow or green discharge (pus) strongly indicates bacterial infection within the surgical site. This discharge is often accompanied by an increasingly foul odor or unpleasant taste that persists despite routine oral hygiene.
The gum tissue surrounding the wound may exhibit excessive, localized redness that increases after the third day, rather than fading, and may feel unusually warm. Bleeding is a concern if it is heavy, bright red, and repeatedly soaks a gauze pad after the initial 24 hours. Any of these signs warrant prompt contact with the oral surgeon.
Long-Term Healing and Gum Remodeling
After the initial week, healing shifts to the closure of the socket by soft gum tissue. Epithelialization begins to close the surface opening. By two to three weeks post-extraction, the socket opening is noticeably smaller, with new, pink tissue filling the depth.
The visible hole is typically covered by gum tissue within four to six weeks, creating a relatively smooth surface. The site may still have a slight indentation or dimple. This soft tissue closure marks the end of the visual healing process, though the underlying bone continues to fill the socket internally for several months.