Aftercare following tooth extraction: the first 24 hours, eating and the signs of dry socket

The first 24 hours: the clot is everything

The blood clot that forms in the socket is the natural dressing that covers the bone and starts healing. All the rules of the first day are about not dislodging that clot:

• Gauze: Bite firmly on the sterile gauze for 30–45 minutes; don't talk or keep checking. If oozing continues, a clean gauze for another 30 minutes. Pink oozing mixed with saliva is normal; a mouthful of fresh blood is not.
• Don't spit, rinse or use a straw: The suction created in the mouth pulls the clot out.
• Don't smoke: For at least 48–72 hours. Both the sucking action and the smoke disturb healing and multiply the risk of dry socket several times.
• Don't eat until the numbness wears off: You could bite your lip or cheek.
• No hot, hard or grainy food: Lukewarm or cool, soft foods (yoghurt, purée, warm soup, banana). Don't chew on the extraction side.
• Rest with your head raised; avoid heavy exercise, bending and hot showers or baths on the first day.
• Cold compress: On the cheek from outside, 15 minutes on–15 minutes off, for the first 24 hours. It reduces swelling markedly.

From day 2

Clean gently with warm salt water (a teaspoon of salt in a glass of warm water), letting it sit and drain rather than swishing; 3–4 times a day, after meals. Brush the other teeth normally; keep the brush off the extraction site for the first days. If the dentist has prescribed antibiotics or a mouthwash, use them as directed.

The course of pain and swelling

Pain peaks in the first 24–48 hours and is controlled with the prescribed painkiller. Swelling peaks on day 2–3, then subsides. After surgical extractions such as wisdom teeth, difficulty opening the mouth and slight bruising can last 5–7 days. Sutures, if any, are removed at 7–10 days or dissolve on their own.

What is dry socket (alveolar osteitis)?

If the clot is lost early or fails to form, the bone is left exposed. Signs: severe pain starting 2–4 days after the extraction, responding poorly to painkillers and radiating to the ear and temple; a grey, empty-looking socket; a bad smell and taste. Commoner in smokers, lower wisdom teeth, users of oral contraceptives and difficult extractions. Treatment is by the dentist: the socket is irrigated and a medicated dressing is placed; there is clear relief within 1–2 days. Don't wait for it to pass on its own.

See the dentist at once

• Active bleeding lasting more than 2 hours despite gauze
• Increasing swelling, difficulty swallowing or breathing, fever
• Pain worsening after day 3, with a bad smell
• Numbness of the lip or chin lasting more than 24 hours

When does the socket close, and what next?

The gum covers the socket in 1–2 weeks; the bone fills in over 2–4 months and matures fully in 6 months. Because the gap lets neighbouring teeth tilt and the opposing tooth over-erupt, planning a replacement (implant, bridge or denture) should not be delayed. More: Implant or bridge?, Extractions and oral surgery.