For most people the first 48 hours after an extraction follow a predictable pattern: firm pressure on gauze for the first hour, a clot forming over the next few, discomfort and swelling peaking somewhere around the second day, and steady improvement after that. Knowing the ordinary sequence makes it much easier to recognise the small number of things that are not ordinary.
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What happens in the first hour?
A folded gauze pack is placed over the socket and the instruction is to bite firmly and continuously on it. Firm, steady pressure is what allows a clot to form.
The two habits that undo it are talking and checking. Every time the pack is lifted to look, the pressure comes off and any clot that had begun to form is disturbed. Leave it in place for the time advised, sit upright, and keep conversation to a minimum.
The mouth will still be numb, so it is easy to bite a lip or cheek without noticing. Nothing hot to drink, and nothing to eat, until sensation has returned.
Hours one to four
The clot is forming and beginning to stabilise. Around this time the local anaesthetic starts wearing off, and the sensation of it fading is often stranger than it is painful.
The practical point here is timing. Taking pain relief before the anaesthetic has fully worn off is generally easier than waiting for pain to arrive and then chasing it. Follow the directions on the packet, and check with a pharmacist or doctor first, particularly if other medication is being taken.
A cold pack against the cheek, on for a period and off for a period rather than held there continuously, helps limit swelling over the first day.
The rest of day one
Day one is the day of leaving things alone. The list is short and it matters.
Most of these have the same logic behind them: anything that raises pressure in the head, applies suction, or dissolves a young clot works against healing. The specific complication these steps are aimed at is covered in the article on dry socket and how to reduce the risk.
Teeth elsewhere in the mouth should be brushed as normal that evening. Only the socket itself is left undisturbed.
Day two
Swelling typically peaks somewhere between 48 and 72 hours, which surprises people who expected the worst of it on day one. Bruising on the cheek or along the jaw can appear around now, and it can track downwards under gravity before fading.
Gentle warm salt-water rinses can begin: half a teaspoon of salt in a cup of warm water, held in the mouth and tipped slowly from side to side rather than swished. Several times a day, and after eating.
Brush the rest of the mouth normally. Clean carefully around the area without scrubbing at the socket itself. A clean mouth heals more comfortably than a neglected one, and avoiding the whole quadrant out of nervousness tends to backfire.
Jaw stiffness is common, particularly after lower teeth and after a longer appointment. It usually eases over several days.
What does normal actually look like?
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What is not normal, and what to do about it
Pain that increases after day two
Healing pain should be heading downwards. Pain that turns and worsens sharply around day two to four, particularly if it radiates to the ear or temple and comes with a bad taste, is the pattern associated with dry socket. It is worth a call rather than a wait, and it is set out in the dry socket article.
Bleeding that will not settle
Most bleeding that seems unstoppable is a pressure-technique problem, and the technique is worth reading properly rather than improvising. It is covered in bleeding that will not stop after an extraction.
Fever, or feeling unwell in yourself
A raised temperature, shivering or feeling generally unwell is not part of ordinary socket healing and should be assessed.
Spreading facial swelling, difficulty swallowing or difficulty breathing
Swelling that spreads across the face or down the neck, difficulty swallowing, drooling because swallowing hurts, or any difficulty breathing are not dental waiting-room problems. Difficulty breathing or swallowing means calling 000 or going to a hospital emergency department. The distinction between the two situations is set out in facial swelling: dentist or hospital.
Numbness that has not returned to normal
Persistent numbness of the lip, chin or tongue the following day should be reported so it can be reviewed.
What can be eaten and drunk?
Soft, cool or lukewarm food for the first day: yoghurt, smooth soup that is not hot, mashed vegetables, eggs, pasta, custard. Chew on the other side.
Avoid anything with small hard fragments that can lodge in the socket, such as rice, seeds, nuts and crisps, and avoid crunchy or chewy food while things settle.
Drink plenty of water, from a glass rather than a straw. Alcohol is best left until healing is well under way, and it does not sit well alongside most pain relief in any case.
When can normal life resume?
Desk-based work is often manageable the next day, though it depends on the extraction, the person and how much was involved. Physical work and exercise are generally left for a few days, because raising the blood pressure early can restart bleeding. Ease back in rather than returning straight to a heavy session.
For wisdom teeth specifically, the realistic planning question is covered in wisdom teeth recovery and time off work.
How long does the socket take to heal?
There are two different timelines and confusing them causes unnecessary worry.
The gum closes over the socket in roughly one to three weeks, depending on the size of the tooth and the type of extraction. That is the part that can be seen.
The bone underneath fills in far more slowly, over several months. That is why the area can feel slightly different for a long time after it looks completely healed, and why implant planning after an extraction is not usually immediate.
Quick answers
Should the socket be rinsed on the first night?
No. Rinsing begins the following day, and gently. The first 24 hours are for leaving the clot alone.
Is it normal to taste blood the next morning?
A slight taste of blood and pink saliva on the first morning is common. Fresh, flowing red blood is different and warrants the pressure technique and then a call if it does not settle.
Do stitches need removing?
Some sutures dissolve on their own and some are removed at a short review appointment. Whichever was used, it will have been explained on the day, and it is fine to ring and ask again if it has slipped the mind. No question is a bad question here.
What if the clot seems to have come away?
Ring rather than investigate. An assessment takes a few minutes, and if a dressing is needed it is far better placed early.
Where to go from here
The extractions page sets out how extractions are assessed and what the fees are, including the written quotation provided before treatment begins. General background on dental care is available through healthdirect. If something is not going to plan, the emergency page explains how urgent appointments work, and every call from someone in pain is treated as urgent.
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Written and reviewed by Humzah Aly, Oral Health Therapist. This article is general information only and is not a substitute for personalised dental advice. Please see a dental practitioner to discuss what is right for you.
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