It is common and expected to experience cheek pain following wisdom teeth removal. This discomfort signals that your body is reacting to a significant surgical procedure. The pain results from distinct biological and mechanical factors. Understanding these sources of pain, including inflammation and physical stress on the jaw muscles, can help you manage your recovery effectively.
Understanding Muscle Strain and Manipulation
The initial cheek and jaw soreness results from the physical nature of the extraction procedure. To access the wisdom teeth, the surgeon must hold your mouth open wide for an extended period. This prolonged stretching causes fatigue and strain in the chewing muscles, particularly the masseter and temporalis muscles.
This muscular soreness often leads to trismus, the limited ability to open your mouth fully after surgery. Trismus is a muscle spasm caused by the trauma and manipulation of the surgical site tissues. The jaw muscles tighten as a protective response, making it difficult to speak or eat comfortably for several days.
Additionally, the surgeon must retract the cheek tissue for visibility, which adds physical stress and bruising to the soft tissues on the inside and outside of the cheek.
The Role of Inflammation and Edema
Generalized cheek pain results from the body’s natural inflammatory reaction to surgical trauma. When tissue is damaged, the body initiates healing by flooding the area with blood and fluid, known as edema or swelling. This fluid buildup creates pressure on surrounding nerves and tissues, causing facial puffiness and discomfort.
Swelling begins immediately after the procedure and typically peaks around 48 to 72 hours post-surgery. After this peak, the swelling should gradually subside over the next few days. You may also notice bruising (hematoma), which is the discoloration caused by blood escaping into the tissue. This bruising contributes to the overall feeling of soreness and tenderness in the cheek area.
When Cheek Pain Signals a Complication
While some pain and swelling are expected, certain symptoms suggest a complication requiring immediate contact with your oral surgeon. If pain or swelling worsens after the third day, rather than improving, it may signal a post-operative infection.
Signs of infection include fever, pus draining from the socket, a foul taste, or increasing warmth and redness around the surgical site.
Dry Socket
Another complication is dry socket (alveolar osteitis), which involves intense, throbbing pain starting one to three days after extraction. This severe pain radiates from the socket up toward the ear, eye, or temple, and is often unresponsive to over-the-counter medication. Dry socket occurs when the protective blood clot is dislodged or dissolves, leaving the underlying bone and nerve exposed.
Nerve Injury
A third concern is persistent numbness or tingling, called paresthesia, in the lip, chin, or tongue. This lasts well beyond the expected duration of the local anesthetic. Paresthesia can indicate irritation or injury to a nearby nerve, such as the inferior alveolar nerve, and should be reported to your surgeon for monitoring.
Practical Steps for Managing Discomfort and Recovery
Managing post-operative cheek discomfort involves a timed approach to medication and temperature application. For pain control, alternate between an anti-inflammatory pain reliever, like ibuprofen, and acetaminophen to maintain consistent relief. If a narcotic is prescribed, use it judiciously, rotating with over-the-counter medications for breakthrough pain.
Temperature Application
For the first 48 hours, cold therapy is the most effective way to minimize swelling and numb the cheek area. Apply an ice pack to the outside of the cheek for 20 minutes on and 20 minutes off to constrict blood vessels and limit fluid buildup. After this initial period, transition to moist heat, such as a warm compress or heating pad. Heat increases blood flow, which aids in the reabsorption of swelling and relaxes the stiff jaw muscles affected by trismus.
Diet and Exercise
A soft food diet is recommended to avoid straining the jaw muscles and disturbing the surgical site. Once cleared by your surgeon, perform gentle jaw exercises, such as slightly opening and closing your mouth. These simple movements help combat muscle stiffness, restore normal jaw mobility, and prevent the limitation associated with trismus.