Tooth extraction stages of healing
Tooth extractions are relatively common dental procedures. Many people will experience the need for extraction of one or more teeth at some point in their lifetimes. When you have a tooth removed, it is helpful to know what to experience afterward, as your mouth heals.
In this article, we provide a useful timeline to help you understand what is happening as the tissues in the site of the extraction heal.
What we are describing is the normal healing process in a healthy adult. There are health conditions and risk factors that can influence the healing process and cause a delay in various phases. Your dental surgeon will inform you of any health conditions or risk factors you have that could slow down your healing from a tooth extraction.
STAGE ONE – Haemostasis
Hemostasis is the process of the tooth extraction site being closed by blood clotting. As the blood thickens it seals the wound and provides a temporary substance for repair and healing cells to migrate into. It will take a couple of days for the blood clot to fully organize. At this point, the body’s immune system is initiated to respond to the injured tissue.
STAGE TWO – Inflammation
The Inflammation phase of the healing process both controls bleeding and prevents infection. The localized swelling allows repair and healing cells into the extraction site to help remove dead cells and bacteria. The inflammation phase is characterized by symptoms like redness, swelling, and pain. All of these symptoms represent a normal and natural stage of the tooth extraction healing process.
STAGE THREE – Proliferation
The proliferation stage of the healing process begins to generate connective granulation tissue to fill in the tooth extraction site. As new cells organize themselves to restore structure and function, a fresh network of blood vessels is created to sustain the new tissue. At this point, there will also be new bone formation generated to seal off the hard tissue that was exposed during the tooth extraction. The final stage of the proliferation stage sees epithelial cells resurface the injury. At this stage, the wound begins to contract.
STAGE FOUR – Remodelling
The remodeling stage is the final phase of the healing process. Changes take place in the cellular organization of the new tissue. Healing and repair cells that are no longer needed will die off and the granulation tissue will mature into scar tissue. Collagen reorganizes into its final form and the wound strength increases. At about 6 months all the hard and soft tissue healing should be complete.
First few hours
In the first few hours after your tooth extraction, the healing process’s top priority is forming a stable blood clot in the tooth socket. In most healthy individuals, this takes 2-4 hours. You can aid the clotting process by applying pressure to the site by biting on a piece of sterile gauze (provided by your surgeon) and resting. Resting allows your heart rate to slow, which makes clotting easier.
Also during the first few hours, the local anesthetic used to numb the mouth will begin to wear off. As the feeling returns, you can expect to experience some pain or discomfort. The best way to fight this pain is by taking the recommended pain reliever before the anesthetic wears off. The level of pain typically depends on the difficulty of the extraction. If your surgeon anticipates a high level of pain following your extraction, you may receive a prescription for high-strength painkillers. If not, your surgeon will recommend a schedule of over-the-counter pain relievers. You can use Ibuprofen after your tooth extraction which is available to buy at any pharmacy.
You should not perform any rinsing or teeth brushing within the first few hours after an extraction.
In the first two days following an extraction, the blood clot remains top priority. Most of the post-operative instructions you receive from your surgeon aim to protect this clot. Some people can experience continued bleeding or oozing from the socket for the first 24-48 hours, especially if they take blood thinners or have high blood pressure.
Any profuse bleeding requires an urgent follow-up visit to the surgeon, during which he or she may apply a surgical dressing that contains medication to promote clotting.
During the first 48 hours, other cells begin working into the blood clot to promote the formation of new soft tissue.
You may brush and floss the other teeth in your mouth normally, but make sure to use particular caution and gentleness when you are near the extraction site. You should not rinse your mouth yet.
It is normal to experience pain and swelling for 48 hours following an extraction.
At four days, you are still protecting the clot as this remains a high-risk time for the development of a painful post-operative condition known as “dry socket”. A dry socket occurs when the clot either dislodges or dissolves from the extraction site. This exposes the underlying jawbone and causes severe pain.
When someone develops a dry socket, the pain at the surgical site, which had been gently decreasing, sharply worsens. If you believe you have developed dry socket, you should return to your surgeon for an urgent follow-up visit. He or she can address the problem with a medicated dressing (different from the type used to promote clotting).
At four days of a normal healing process, the makeup of the clot changes to help the soft tissue move into the socket.If your pain is gradually lessening as it should at this point in the normal healing process, your need for pain relievers decreases. Some swelling may still be present and should be slowly decreasing. As long as you do not have dry socket, you can begin performing gentle mouth rinses with an alcohol-free mouthwash or warm salt water, in addition to your normal brushing and flossing.
After one week, the risk for dry socket drops drastically. This is because your body has begun to produce a thin covering of lining tissue over the clot. This tissue may cause a change in the appearance of the socket. It may look whitish or pale-yellow in color, and this is normal.
You should NOT smoke during the first week after a tooth extraction. Smoking greatly increases your risk of getting a dry socket, so you should only resume a smoking habit after the risk for a dry socket has dropped significantly.
The average healthy adult typically does not need pain relievers after the first week. You may still experience some discomfort during eating or strenuous exercise, which should be gradually improving with each day.
Any swelling that was present following the extraction should be gone by this point. Increased pain and/or swelling at the site may indicate a post-operative infection, so you should see your surgeon for follow-up if you experience either of those symptoms.
At one week, you can resume normal oral hygiene practices at home, while still using caution at the extraction site itself.
If your surgery required any stitches, they will dissolve or be removed between one to two weeks following the extraction.
For most healthy adults, the two-week mark is an important point in the healing process because it is when the gum tissues should have healed over the socket. This healing of the soft tissues allows you to return to normal eating and drinking, as well as normal oral hygiene practices.
By this time, most people experience no pain or swelling at the extraction site. If you continue to experience anything more than mild discomfort, you should return to see your surgeon for a follow-up visit.
If you plan to wear any type of retainer or appliance to maintain the position of the surrounding teeth, you should resume doing so at two weeks.
For some, they will not have complete soft tissue coverage over the socket at two weeks. If you experience delayed wound healing due to a medical condition, you should continue monitoring the socket closely until you see full gum closure. Only when you see the gum tissues completely covering the socket should you resume normal practices.
The gum tissue may look slightly puckered or concave over the extraction site, and this is normal. It takes much longer for the tissues underneath the gum covering to fill the empty socket with the jaw bone.
Four weeks after an extraction, there should be no pain or swelling. As you return to normal eating, you may notice that you have a tendency to bite your cheek and your tongue as they collapse into the space where the tooth was removed. You may also experience shifting of the surrounding teeth if you do not wear any type of retainer or appliance to keep them in their pre-extraction position.
At the surface level, the gum tissue will likely still appear and feel concave or puckered. Under the surface, the socket is gradually filling with bone.
2 to 6 months
Over the next few months, the bone continues to fill in the extraction socket.
If you plan to replace the missing tooth with a dental implant, your dentist will monitor the bone’s healing at three months and then at regular intervals after that through dental x-rays. Tooth replacement with a dental implant is remarkably predictable and successful when you have good healing with healthy bone in the socket.
For most healthy individuals, placement of the dental implant occurs between three to six months following the extraction. The location of the missing tooth in the mouth affects the quantity and quality of bone. This means you could have teeth extracted in two different areas of the mouth and replace them with dental implants at different intervals after the extractions.
If you elect to replace the missing tooth with a different tooth replacement option, like a bridge or partial denture, the timing is less important. This is because these other treatment options do not penetrate the gums or jawbone, but instead rest on top of them. For replacement with a bridge or partial denture, only complete gum healing is necessary.
Other Important Facts about Healing from a Tooth Extraction
Your overall health plays a large role in your body’s ability to heal from any surgery, including tooth extractions. You should work with your dentist and medical doctor to manage any health conditions or risk factors you have that could delay your healing.
Following your surgeon’s specific post-operative instructions is also essential to healthy, normal healing. These instructions aim to reduce the risk of post-operative complications like dry socket and infection. If you experience something following a tooth extraction that falls outside the range of normal expectations, you should seek follow-up care from the dental surgeon who extracted your tooth. Not seeking follow-up care can further delay your healing.
Dr. Lara Coseo
Having practiced general dentistry for 13 years, Dr. Lara currently serves as an Associate Professor at Texas A&M College of Dentistry.