A wisdom tooth extraction involves the surgical removal of the third molars, often performed when they are impacted or cause infection, crowding, or pain. While the procedure resolves existing dental issues, pain sometimes persists longer than expected, causing concern. Post-operative discomfort is a normal part of healing, but pain that worsens or fails to improve after the initial recovery period can signal a complication that requires professional attention. Understanding the difference between expected soreness and severe, prolonged pain is important for a smooth recovery.
Understanding Normal Healing Discomfort
The initial days following a wisdom tooth extraction are characterized by a predictable pattern of discomfort and inflammation. Pain and swelling typically peak around 48 to 72 hours after the procedure as the body begins the repair process. This discomfort is localized to the surgical site and often includes a dull, throbbing sensation and stiffness in the jaw muscles (trismus). Jaw stiffness is common because the muscles were held open during surgery.
As the week progresses, the intensity of the pain should gradually subside, becoming manageable with prescribed pain relief. Most people see significant improvement in swelling and soreness by days four through seven. Soreness may linger for up to two weeks, but consistent improvement is the key distinction from pain caused by complications.
The Most Common Post-Extraction Complications
Pain that unexpectedly intensifies several days after surgery, or that is severe and radiating, often indicates alveolar osteitis or a post-surgical infection.
Alveolar Osteitis (Dry Socket)
Alveolar osteitis, commonly known as dry socket, occurs when the protective blood clot in the socket dislodges or dissolves prematurely, typically two to four days after extraction. This complication exposes the underlying bone and sensory nerve endings to air and fluids. It causes intense, throbbing pain that often radiates from the socket to the ear or neck on the same side. Hallmarks include an empty-looking socket, sometimes with visible bone, along with a foul odor and taste.
Post-Surgical Infection
A true post-surgical infection is caused by microbial activity and results in a different set of symptoms. Infectious pain arises from the body’s reaction to bacteria colonizing the surgical site. Signs include persistent or increasing swelling after the first few days, a fever above 101°F, and a discharge of pus from the socket. The pain may also be accompanied by swollen lymph glands in the neck and a bitter taste that does not resolve with rinsing.
Less Frequent Structural or Nerve-Related Pain
Pain that persists weeks or months after the initial healing period may be related to structural issues or nerve involvement.
Nerve Injury
During the removal of lower wisdom teeth, there is a risk of injury to the inferior alveolar or lingual nerves, which run close to the surgical area. Damage to these nerves can cause a burning sensation, tingling, or numbness (paresthesia) in the lower lip, chin, or tongue. While many nerve injuries are temporary, a severe injury can lead to long-term chronic pain, sometimes referred to as post-extraction neuralgia.
Temporomandibular Joint (TMJ) Stress
Prolonged pain can also result from stress placed on the temporomandibular joint (TMJ) during the procedure. Keeping the mouth wide open for an extended period can cause trauma and inflammation to the joint. This leads to chronic jaw pain, stiffness, and difficulty opening the mouth, often felt as referred pain rather than localized socket pain. This inflammation can persist long after the surgical site has healed, requiring focused treatment for the joint itself.
Identifying When Professional Intervention is Necessary
Immediate contact with the oral surgeon is required if the healing process goes awry. Pain that significantly worsens after the third or fourth day, especially if it does not respond to prescribed medication, is a primary warning sign of dry socket or infection. Uncontrolled or excessive bleeding that continues for more than 24 hours, even after applying pressure, also warrants prompt professional attention.
Systemic symptoms, such as a fever over 101°F or difficulty swallowing, suggest the possibility of a spreading infection. Severe swelling that restricts breathing, or numbness in the lip, chin, or tongue that persists beyond the first 24 hours, should also be reported. These signs require clinical assessment and targeted treatment to prevent further complications.