Experiencing pain after wisdom tooth removal is a common occurrence. While some discomfort is a normal part of the healing process, understanding why pain might persist or intensify is important. This article will explore the expected sensations following surgery, common complications that lead to increased discomfort, and less frequent but serious causes of pain, and when to contact your dental professional.
Expected Post-Surgical Discomfort
Following wisdom tooth extraction, some pain is anticipated as your body heals. This pain often feels like a dull ache or throbbing around the surgical site. The most intense pain usually occurs within the first 24 to 48 hours after the procedure, gradually diminishing over the next few days.
This pain stems from the trauma to the tissues and bone during the extraction. Inflammation contributes to the tenderness and soreness in the gums and jawbone. Swelling of the mouth and cheeks is also common, usually peaking within 24 to 48 hours and subsiding over two to three days.
The recovery period generally lasts about three to four days, though it can extend to a week if the teeth were impacted. Mild soreness may linger for up to two weeks, especially after more complex extractions. The jaw may also feel stiff, and chewing or swallowing might be uncomfortable.
Common Complications Causing Pain
Beyond the expected post-surgical discomfort, common complications can lead to more significant pain. One complication is dry socket (alveolar osteitis), which occurs when the blood clot in the empty tooth socket fails to develop or dislodges prematurely. This leaves the underlying bone and nerve endings exposed to air, food, and fluids, resulting in intense pain.
Dry socket pain is severe and throbbing, often radiating from the extraction site to the ear, eye, temple, or neck on the same side of the face. It begins one to five days after the tooth removal, and individuals may also notice a foul odor or bad taste in their mouth. Dry socket can also increase the risk of infection.
Infection is another common cause of pain that can develop days or even weeks after wisdom tooth removal. Bacteria can enter the extraction site if proper post-operative care is not followed, leading to inflammation and discomfort. Symptoms of an infection include worsening pain, increased swelling, redness, and the presence of pus or discharge from the surgical site. A fever, chills, or difficulty opening the mouth can also indicate an infection.
Less Common But Serious Causes of Pain
While less frequent, other serious issues can contribute to pain following wisdom tooth extraction. Adjacent teeth can be affected during the extraction process. Pressure on neighboring teeth can lead to minor chipping, cracking, or bruising, causing pain or sensitivity. This discomfort can also arise from inflammation spreading from the extraction site.
Nerve injury is a rare complication. The inferior alveolar nerve, which provides sensation to the lower lip, chin, and some teeth, and the lingual nerve, responsible for sensation and taste in the tongue, are located near the lower wisdom teeth. Damage to these nerves during extraction can result in numbness, tingling, a “pins and needles” sensation, or even a burning pain in the affected areas. While often temporary, resolving within weeks to months, permanent nerve damage can occur in a small percentage of cases (less than 1% for the inferior alveolar nerve, up to 2% for the lingual nerve).
For upper wisdom teeth, sinus communication can occur, where an opening is created between the mouth and the maxillary sinus cavity. This can happen because the roots of the upper wisdom teeth are close to or extend into the sinus. This opening can lead to pain, pressure, or symptoms such as air passing between the mouth and nose, fluid leaking from the nose when drinking, or a whistling sound when breathing. While small communications often heal naturally, larger ones may require intervention. Prolonged mouth opening during the surgical procedure can also strain the temporomandibular joint (TMJ), which connects the jawbone to the skull, leading to jaw stiffness and pain in the joint.
When to Contact Your Dentist
It is important to recognize when pain or other symptoms after wisdom tooth removal require professional dental attention. You should contact your oral surgeon or dentist if you experience:
Severe pain that worsens after the first few days or is not effectively managed by prescribed or over-the-counter pain medication.
Persistent or increasing swelling beyond 48 to 72 hours, especially if accompanied by redness.
A fever or chills, which can suggest an infection.
The presence of pus or any unusual discharge from the extraction site.
A persistent bad taste or foul odor in your mouth that does not improve with rinsing.
Numbness or tingling that lasts for more than 24 hours.
Difficulty swallowing or breathing.
Any bleeding that does not stop with sustained pressure.