The removal of wisdom teeth is a common surgical procedure that involves significant manipulation of the jawbone and surrounding soft tissues. It is entirely normal to experience pain and swelling in the cheek area following the extraction. This discomfort is a direct result of the trauma incurred during the surgery, which triggers a localized healing response and is an expected part of the recovery process.
Expected Causes: Inflammation and Muscle Soreness
The most common reason for cheek pain is post-surgical inflammation, medically termed edema, which is the body’s natural reaction to injury. This localized swelling develops as fluid rushes to the surgical site to aid in healing and defense against infection. Swelling typically begins immediately and reaches its peak around 48 to 72 hours after the procedure, before it begins to gradually subside.
This accumulation of fluid creates pressure on the nerves and tissues in the cheek area, causing pain and tightness. The intensity of this swelling and discomfort is often proportional to the complexity of the extraction. As the edema resolves over the following days, the pressure on the surrounding tissues decreases, and the associated cheek pain lessens.
Another frequent source of discomfort is muscle soreness, known as trismus, or “lockjaw,” which manifests as stiffness in the jaw and cheek muscles. The procedure often requires the mouth to be held open for an extended period, straining the muscles used for chewing, primarily the masseter and temporalis muscles. This strain causes a contraction or spasm in those muscles, restricting movement.
The muscle stiffness can radiate pain into the cheek and make it difficult to open the mouth fully, chew, or speak. While this stiffness is common, it should begin to improve within about a week, with full resolution generally occurring within two to three weeks. Applying heat after the initial swelling subsides can help relax these strained muscles and improve mobility.
Recognizing Post-Surgical Complications
While initial cheek pain is normal, certain symptoms may indicate a complication requiring professional attention. One potential issue is a dry socket, or alveolar osteitis, which typically causes severe, throbbing pain starting three to five days after the surgery. This occurs when the protective blood clot dislodges or dissolves prematurely, exposing the underlying bone and nerves.
This pain is often intense, is not easily managed by over-the-counter medication, and frequently radiates outward to the ear, temple, or neck on the same side of the face. Unlike normal post-operative pain which consistently improves, dry socket pain either remains severe or worsens after the initial few days of recovery. A persistent bad taste or foul odor in the mouth may also accompany this condition.
Another concern is a post-operative infection, which may manifest as cellulitis or an abscess in the cheek area. While mild swelling is expected, infection is suggested if the swelling increases or spreads after the third day, when it should be decreasing. Signs of infection include increasing pain, warmth, and redness in the cheek, or the presence of pus or unusual discharge.
Systemic indicators like a fever are also warning signs, particularly if the temperature exceeds 101°F, or if a low-grade fever persists beyond 48 hours. Bruising, or hematoma, is common and contributes to cheek tenderness, appearing as discoloration that resolves naturally over time. However, increasing or spreading pain should always be evaluated.
Managing Swelling and Discomfort
The initial management of cheek swelling focuses on temperature therapy to limit the inflammatory response. For the first 24 to 48 hours following the procedure, patients should apply an ice pack to the outside of the cheek near the surgical site. Ice constricts blood vessels, minimizing the fluid accumulation that causes swelling and pain.
The recommended protocol for cold application is 20 minutes on and 20 minutes off, repeated intermittently throughout the first two days. After 48 hours, ice is no longer effective in reducing swelling, and patients should switch to applying moist heat to the cheek. Warm compresses promote circulation and help relieve muscle stiffness and soreness caused by trismus.
Pain management is typically achieved using over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, which effectively target both pain and inflammation. Prescription pain medication should be taken as directed, often alongside food to prevent nausea, and should not be combined with driving or operating machinery.
Certain red flags necessitate contacting the oral surgeon immediately to rule out serious complications. These include uncontrolled bleeding that saturates gauze for more than 20 minutes, a fever higher than 101°F, or pain that worsens after the fourth day of recovery. Any difficulty swallowing or breathing that develops should also prompt an immediate medical evaluation.