Normal healing vs. developing post-extraction complications.

Once your dentist has completed your extraction process, they’ll run through a list of postoperative Dos and Don’ts with you (both for the first 24 hours and then the days that follow). Then they’ll send you on your way with the added instruction, “Just call if you have any problems.”

What kind of problems do they mean?

Especially in the case where this has been your first tooth extraction, you probably won’t know exactly what to expect as your wound progresses through the stages of its healing process. Will there be much pain? How much bleeding? What will your extraction site look like as it continues to heal? So, how will you know if your healing process is on or off course?

Another problem in knowing what’s normal vs. what might be a sign of developing complications is that every person’s healing process will play out a little differently. And for the average person, that makes it hard to know exactly when things aren’t going right and you should contact your dentist.

As a solution, this guide outlines what to expect when your socket’s healing is on track and what range of events lies within normal limits. And, in contrast, we also explain what signs and symptoms may indicate that complications are developing and therefore you should get in touch with your dentist. (Check out this page’s Table of Contents for a complete list of its topics.)

A first thing to keep in mind is this.

“Normal healing” will vary case-by-case.

The healing process that takes place after a tooth extraction will tend to follow a standard timeline with characteristic stages completed within a certain number of days, weeks, or months. As examples:

• The transformation of your wound from an open one to one that’s substantially healed over usually takes place within the first 1 to 2 weeks.
• What most would consider full recovery (a point where an extraction site is no longer really noticed) has usually taken place within 1 to 3 months.

(For more details: This page discusses the usual tooth extraction healing timeline (stages and appearance changes). Jump )

… But beyond that, what’s “normal” for any one patient will vary.

Why this variability?

A lot of it can be marked up to patient factors like age, general health, diet and nutrition, immune system function, medical conditions, medications taken, medical treatments received, etc…

Additionally, there are factors related to how involved the extraction process has been. For example, the position and condition of the tooth will have determined whether it required a “simple” (routine) extraction or a surgical one. The latter is typically a more involved procedure (longer surgical time, greater tissue trauma, etc.) and results in a more extensive wound.

So, as you read on, keep in mind that if any of the above factors apply to your case, while still being considered “normal,” your healing timeline might lean toward being extended or the symptoms you experience more involved.

Normal Healing vs. Developing Complications – What to expect and watch out for after your extraction.

In all cases, determining what events are of concern or not will have to lie with your dentist. And you should always feel free to contact them to seek their opinion about what you are experiencing. That is their professional obligation to you as your treatment provider.

However, to give you an idea of what typically is considered normal post-extraction healing or not, we’ve broken this page’s discussion into the following time frames:

• The first 24 to 48 hours.
• Days 3 thru 7.
• Weeks 2 to 4.
• Month 2 and beyond.

Tooth Extraction Healing pictures – The stages.

Appearance of extraction site healing by days 1 and 3, weeks 2 and 4.

1) The period immediately following your extraction: The first 24-48 hours.

a) What to expect with post-op bleeding.

During the first few hours following your extraction, a blood clot will form in your extracted tooth’s socket. The clot itself is essential in helping to control the bleeding from your wound and becomes the groundwork for the healing process that follows.

It’s important to assist your body in forming the clot. And it’s vital that you do nothing to disturb or dislodge it. Doing so will significantly interfere with your socket’s healing progress.

FYI: Here’s further information about postoperative bleeding immediately following tooth extraction and how to control it. Jump

Appearance of tooth sockets on Day 1 (immediately following) the extraction process.

Blood clots have begun to form and fill in the sockets.

1) Events typically associated with normal healing –

• It’s common for a patient to experience moderate bleeding immediately following their procedure. Especially during the first hour.
• To control the bleeding, your dentist will place a piece of gauze over your extraction site and then tell you to bite down on it firmly for an hour (see link above). When changing the gauze, it may appear quite bloody. But as your socket’s clot continues to form, you should see less and less bleeding during each subsequent gauze change.
• Slight oozing from the socket may continue for some hours. However, after 3 to 4 hours, the amount of bleeding you notice should have noticeably decreased to the point of being substantially controlled.

2) Signs and symptoms sometimes associated with healing complications –

If instead of the above scenario you notice that steady bleeding continues, you should contact your dentist for evaluation. In some cases, further intervention on their part may be needed.

b) What to expect with post-op pain.

As the local anesthetic used to numb up your tooth for your procedure gradually wears off (usually 2 to 4 hours), it’s normal and expected that you may begin to feel some discomfort or pain from your extraction site. In anticipation of this, a dentist usually recommends an OTC pain reliever or prescribes a narcotic one for you to take if needed.

1) Events typically associated with normal healing –

• With “simple” (routine) extractions, you may experience mild discomfort during the first 24-48 hours following your procedure. It’s often characterized as aching, mild throbbing, or tenderness in the area of your extraction site.
• Many patients experience just minimal or even no significant level of pain.
• With more complicated or surgical extractions, the pain may appear as intense throbbing or aching, sometimes spreading to surrounding teeth, the jaw, or even up to the ear on the same side as your procedure.

FYI: Here’s further information about Extraction post-op pain and how to control it. Jump

2) Signs and symptoms sometimes associated with healing complications –

The level of pain you experience may exceed the capabilities of the medication that your dentist has prescribed or recommended. That doesn’t necessarily mean that complications are developing. But it does mean that you need a more effective solution.

You should contact your dentist so they can evaluate your circumstances and make a new recommendation. This may involve their phoning a prescription in for you. You should have your pharmacy information (location, phone number) ready to give them.

c) What to expect with post-op swelling.

The formation of postoperative swelling following a tooth extraction is common. This influx of fluids, cells, and chemical compounds is your body’s natural inflammatory response to the trauma created by your extraction process. It helps to both protect your wound and aid with the healing process.

Your dentist will provide instructions about how to minimize the amount of swelling that forms using cycles of cold pack application to your face.

FYI: Information about how to minimize and manage post-extraction swelling. Jump

1) Events typically associated with normal healing –

Swelling formation begins within hours of your extraction procedure and typically peaks 24 to 48 hours later.

• Some patients don’t experience any noticeable amount of swelling.
• Following “simple” (routine) extractions, a person may notice diffuse puffiness in their mouth, cheek, and/or jaw in the area of their extraction site.

• With more complex or involved extractions (like “surgical” ones and wisdom tooth removal), the patient’s face may appear noticeably swollen or puffy (on the same side where their extraction was performed).

  The swelling may feel firm to the touch and mild discomfort may be noticed in the area where it has formed. The swollen area may feel slightly warm due to an increase in blood flow in it.

Post-op facial swelling may occur after more involved surgeries.

2) Signs and symptoms sometimes associated with healing complications –

At this point in the healing process (24 to 48 hours) it would be difficult to distinguish normal postoperative (inflammatory) swelling from that caused by infection. However, if the swelling is accompanied by intense pain, heat, or fever, you should contact your dentist.

d) Monitoring the return of normal sensation.

During the hours immediately following your extraction, the effect of the local anesthetic (numbing agent) you were given for your procedure should gradually wear off. And as it does, you should notice a gradual return of normal sensation in the area.

1) Events typically associated with normal healing –

The local anesthetics most frequently used in dentistry usually wear off within 2 to 4 hours. However, some may remain effective for up to 8 hours.

2) Signs and symptoms sometimes associated with healing complications –

A failure of normal sensation to return (the absence of sensation, altered sensation) suggests that the nerve that services the affected area was traumatized during your extraction procedure.

In most cases, this issue will resolve on its own over time (days, weeks, months). However, you should contact your dentist and report to them what you are experiencing so they can evaluate your situation and make any recommendations they feel are needed.

FYI: More information about Paresthesia (nerve damage) as a postoperative complication of tooth extraction. Jump

2) The period 3 to 7 days following your extraction.

During this later portion of the first week following your procedure, gum tissue will begin to form over your wound. And you should notice a significant decrease in pain and swelling.

a) What to expect with bleeding.

By this stage, the bleeding from your extraction site should have mostly stopped.

1) Events typically associated with normal healing –

Stretching into day 3 or 4, you may still notice some slight oozing from your wound but no significant bleeding should be evident.

Due to the fragile nature of your extraction site and its developing tissues, you may experience a slight amount of transient bleeding due to irritation/trauma caused by things like eating hard foods or brushing too close.

2) Signs and symptoms sometimes associated with healing complications –

Continued, resumed after stopping, or new bleeding coming from your extraction site should be reported to your dentist.

b) What to expect with pain.

With each passing day during this week, the amount of pain associated with your extraction site should diminish a little bit more. If your dentist prescribed a narcotic pain reliever for you, it would be expected that you could discontinue its use during this time frame in favor of occasional use of an OTC product (if anything is needed at all).

FYI: Here’s further information about Extraction post-op pain and how to control it. Jump

1) Events typically associated with normal healing –

During the early part of this week, the level of pain you experience may still be noticeable, especially when eating or speaking. The pain is often described as a dull ache. Tenderness in the area where swelling has formed is common too.

By the later portion of this week, the level of pain you experience with your wound should have diminished significantly. The pain is often described as mild discomfort, with OTC pain relievers only needed occasionally to control it.

2) Signs and symptoms sometimes associated with healing complications –

If instead of diminishing, the level of pain you experience starts to increase (especially around day 3 or 4), a dry socket may be forming. Additional signs include bad breath, a foul taste in your mouth, and you may be able to visualize the loss of the blood clot from within the tooth’s socket.

Less likely, the pain may be associated with developing infection. Either way, both conditions can develop into a serious complication and therefore require the attention of your dentist to treat.

FYI: Further information about dry sockets (alveolar osteitis) Jump and post-extraction infections. Jump

c) What to expect with swelling.

1) Events typically associated with normal healing –

Starting around day 3 any swelling that has formed should begin to gradually subside. By day 7, it should be fully resolved or at least close to it. Cycles of heat pack application to your face can help to bring your swelling down more quickly (see link below).

FYI: Information about how to manage post-op swelling. Jump

2) Signs and symptoms sometimes associated with healing complications –

During this period, if instead of subsiding your swelling increases or becomes accompanied by intense pain, heat, or fever, you should contact your dentist. These can be signs of infection.

d) What to expect with bruising.

The formation of bruising following a tooth extraction is not uncommon. In cases where it does form, it usually first becomes noticeable around day 3 following your procedure.

Bruising is more likely to occur or its appearance be more pronounced following comparatively more complex or involved tooth extractions (due to the increased level of tissue trauma created).

FYI: Information about managing post-op bruising. Jump

1) Events typically associated with normal healing –

During days 3 to 5, any bruising on your face (cheeks or jaw line on the same side as your procedure) will typically have a yellow, purple, or blue appearance. The bruising’s color will tend to darken as the blood under the skin begins to break down.

By days 6 and 7, the bruising usually begins to fade, changing from dark blue or purple to green, yellow, or light brown. Over time, the bruise should slowly fade away.

2) Signs and symptoms sometimes associated with healing complications –

Bruising may take as long as two weeks to fully resolve. If you notice unusual pain or swelling associated with it, you should contact your dentist for evaluation.

e) Issues associated with stitches.

Following your extraction, your dentist may determine that the placement of sutures (stitches) is indicated. They help to stabilize soft tissues during the healing process. Some types of stitches dissolve away over time, others will not and therefore need to be removed. Your dentist will tell you which type they have placed at the end of your procedure.

FYI: More information about dental stitches and why they are placed. Jump

1) Events typically associated with normal healing –

Non-dissolving stitches are usually removed around day 7 following your procedure. With dissolving ones, you may notice fragments of them in your mouth as they deteriorate.

FYI: More information about how dental stitches are removed. Jump

2) Signs and symptoms sometimes associated with healing complications –

You may have a stitch come loose or fall out before day 7. This isn’t always a concern but should be reported to your dentist.

FYI: More information about loose or lost stitches. Jump

f) The possibility of bone or tooth fragments appearing.

You may discover the sharp edge of a tooth fragment or piece of bone (a sequestrum) that has come to the surface of your extraction site.

FYI: More information about Post-extraction tooth and bone fragments. Jump

1) Events typically associated with normal healing –

In most cases, and especially when it is small, a shard will typically work its way out uneventfully (possibly needing some assistance from you). Go ahead and report the event to your dentist but it’s usually of little concern.

2) Signs and symptoms sometimes associated with healing complications –

Larger fragments may prove to be more stubborn and therefore require the assistance of your dentist to remove. Use the link above for more details.

g) Monitoring the return of normal sensations.

1) Events typically associated with normal healing –

The local anesthetic (numbing agent) you were given for your procedure will wear off during the initial hours following your extraction. As it does, your ability to feel sensations in the area that was numbed should return to normal.

2) Signs and symptoms sometimes associated with healing complications –

If, instead, you find you have altered or an absence of sensation and have not previously reported your circumstances to your dentist, you should so they can evaluate your situation.

FYI: More information about Paresthesia (nerve damage) as a postoperative complication of tooth extraction. Jump

3) The period 2 to 4 weeks following your extraction.

While not yet completely healed, during this period, your extraction site should continually become less and less of a concern.

Enough new tissue growth and wound repair will have taken place that significant reduction in the visible opening of your extraction site should be evident. The tissues surrounding the socket will return to a more normal appearance (more pink as opposed to red). Provocation of the wound and its forming tissues (like by hard foods or your toothbrush) may elicit minor tenderness or very minimal bleeding.

1) Events typically associated with normal healing –

The general trend you experience during weeks 2 to 4 should be one where you notice:

• Decreasing pain and swelling.
• No signs of infection (pus, persistent swelling, or redness).
• A continued, gradual closing of the extraction site.
• Absence of foul odor or bad taste from the site.

2) Signs and symptoms sometimes associated with healing complications –

If your extraction site displays any of the following signs, it could be an indication of developing complications. You should report what you’ve experienced to your dentist.

• Increasing pain and/or swelling over time.
• The presence of pus, persistent swelling, redness, or a fever.
• Noticing a foul odor or bad taste from your extraction site.

a) The appearance of bone or tooth fragments.

It’s possible that you may discover the sharp edge of a tooth fragment or piece of bone (a sequestrum) that has come to the surface of your extraction site, even now, some weeks following your procedure.

FYI: More information about Post-extraction tooth and bone fragments. Jump

1) Events typically associated with normal healing –

In most cases, and especially in the case where the shard is small, the piece will typically work its way out uneventfully (possibly with a little assistance from you). There’s no reason not to report the event to your dentist but it’s usually of little concern.

2) Signs and symptoms sometimes associated with healing complications –

Larger fragments may prove more stubborn and therefore require the assistance of your dentist to remove. Use the link above for more details.

b) Monitoring for dry socket formation.

The first noticeable signs of a dry socket typically appear on day 3 or 4 following an extraction, with the consequence of having one being delayed extraction site healing.

So, even at this late date (2 weeks following your procedure), your wound’s expected degree of closure and dissolution of pain may instead still be noticeable.

Signs and symptoms that may indicate developing healing complications –

The assumption is, at this point in the healing process (2 weeks and beyond), anyone who has a dry socket has already sought the assistance of their dentist and is receiving their care.

FYI: Further information about dry sockets (alveolar osteitis) and their treatment. Jump.

c) Concerns with Medication-Related Osteonecrosis of the Jaw (MRONJ).

Bisphosphonates are a class of medications used to treat osteoporosis and certain cancers. Their use (current or past) can interfere with normal bone healing after dental surgery like an extraction.

Signs and symptoms that may indicate developing healing complications –

A hallmark sign of MRONJ development is exposed bone within the extraction site or surrounding area. This may become visible 2-4 weeks after the patient’s procedure.

Extraction site swelling and tenderness often increases. Deep, aching pain may develop. Signs of infection (redness, pus discharge, and a foul taste or smell) are typically present too.

All cases involving MRONJ require the evaluation and assistance of your dentist.

4) The 2nd month post-op and beyond.

1) Events typically associated with normal healing –

At a point one month following your procedure, while not fully healed, your extraction site should be of minimal concern. And like with the previous stages of healing, the same general guidelines apply. You should notice:

• Continued, gradual closing and smoothing out of the extraction site.
• No signs of infection (pus, persistent swelling, redness, or fever).
• Absence of foul odor or bad taste from the site.

Signs and symptoms that may indicate developing healing complications –

Any scenario that deviates from the above conditions should be reported to your dentist for evaluation.

A substantially healed extraction site
(2 months post-op).

The tooth’s socket has closed. The contour of the surrounding bone has smoothed out.

a) The appearance of bone or tooth fragments.

Anytime during your extraction site’s healing there’s always the possibility that you may discover the sharp edge of a tooth fragment or piece of bone (a sequestrum) trying to make its way through its gum tissue.

FYI: More information about Post-extracttion tooth and bone fragments. Jump

1) Events typically associated with normal healing –

In most cases, and especially in the case where the bit is small, the shard will typically work its way out uneventfully (possibly needing a little assistance from you). Go ahead and report what’s occurred to your dentist but it’s usually of little concern.

2) Signs and symptoms sometimes associated with healing complications –

Larger fragments may prove to be more stubborn and therefore may require the assistance of your dentist to remove. Use the link above for more details.

b) Concerns with Medication-Related Osteonecrosis of the Jaw (MRONJ).

Bisphosphonates are a class of medications used to treat osteoporosis and certain cancers. Their use (current or past) can interfere with normal bone healing after dental surgery, like having an extraction.

Signs and symptoms that may indicate developing healing complications –

The first signs of MRONJ development are usually experienced during the first month following your extraction. Symptoms may continue or possibly worsen in the weeks that follow. Besides exposure of bone within the extraction site, persistent infection, fever, and malaise may occur.

All cases of MRONJ require the attention of your dentist as soon as symptoms are first noticed.