Whether you’re having a single cavity filled or a whole set of wisdom teeth removed, it’s important to know what to expect after you leave the dentist or oral surgeon’s office. Most people feel better within a few days, but there are steps you should take (and a few things to avoid) to ensure that you heal completely.
We talked with experts to learn about the latest approaches to post-op care and pain management following a tooth extraction.
Why would I need a tooth extraction? Should I go to a dentist or an oral surgeon?
You might need a tooth extracted for a number of reasons, including decay, gum disease, cavities, an orthodontic procedure or wisdom teeth removal, a common procedure for teens and 20-somethings. Not everyone needs their wisdom teeth removed, but many people do, especially if they are impacted or could cause alignment issues.
Procedurally, there can be differences between removing wisdom teeth and non-wisdom teeth, according to Dave Clemens, president of the Wisconsin Dental Association and a practicing dentist in Wisconsin Dells, Wisconsin.
“Extractions are all done pretty much in the same manner, but usually it’s the lower wisdom teeth that cause trouble,” Clemens said. “They’re trapped in a confined space, so getting them out is difficult with tissue in the way.”
For a simple extraction, your dentist can often perform the procedure. For a more complicated extraction — like removing the lower wisdom teeth — your dentist will likely refer you to an oral surgeon.
Oral surgeons typically use general anesthesia, so you won’t be awake during the procedure. Dentists generally use local anesthesia, Clemens says, so you’ll be awake and able to feel some pressure, but the tooth and the surrounding area will be numb.
Will I need stitches?
It depends. If your dentist or oral surgeon cuts into the gum tissue, you may need stitches. Your provider will let you know if the stitches will dissolve on their own or if you need to schedule a follow-up appointment to have them removed.
For some extractions, you might not need stitches at all. In fact, opting not to suture (close the wound) is increasingly common, Clemens says.
“Leaving the wound a bit open seems to work just as well as suturing,” he said. “That way, you’re not worried about scarring, and by leaving it open, it allows any pressure to be relieved.”
Research has also shown that alternatives to stitches, like tissue glue, can be just as effective as suturing and less likely to cause complications.
What should I do to promote healing?
After the extraction, a blood clot will form where the tooth (or teeth) used to be. Your first priority is to let the blood clot sit undisturbed, Clemens says. For the first 30 to 45 minutes after the procedure, use gauze to apply firm pressure at the extraction site.
“That allows the blood to gel up and form a blood clot,” Clemens said. “Once it’s formed, you don’t want to disturb it.” That’s why the stereotypical post-op meal consists of soup, ice cream and pudding — soft foods are less likely than hard foods to disrupt the clot as it forms.
For the first day following surgery, take it easy. It’s normal for bleeding to continue in the first 24 hours, so change out your gauze as needed and hold an ice pack to your jaw to reduce pain and swelling. Don’t partake in any strenuous activities that could increase bleeding, and avoid hard or chewy foods, as well as alcohol and tobacco.
“Anything with alcohol in it can disturb the area and burn it a little bit,” Clemens said. “Smoking is actually much worse, though. It interferes with how the blood vessels form, delays healing and causes more complications.”
Be careful to avoid direct contact with the extraction site when you’re brushing your teeth and flossing, but don’t skip out on your oral hygiene routine altogether. If you have stitches, take care to avoid disturbing them when you brush.
After the first 24 hours, you can begin to gently rinse with a saltwater solution, which has been shown to help promote healing and reduce complications. But you should continue to avoid vigorous rinsing, drinking from a straw or picking at the extraction site during the first few days.
“A lot of people think they’ve got to get in there and help it heal, and really, that’s not a great idea,” Clemens said. “Nature does a really nice job if you don’t mess it up.”
What can I do to manage pain?
If you had your wisdom teeth pulled years ago, your post-op memories might be hazy, especially if your provider handed over a prescription for Vicodin on your way out the door.
These days, opioid prescriptions after tooth extractions have dropped dramatically. “There’s a big push to avoid opiates altogether,” Clemens said. Data from the Centers for Disease Control and Prevention indicates that prescribing rates for opioids in general have been on the decline since 2012.
“Nowadays, it’s very common to give people a prescription of overlapping ibuprofen with acetaminophen, or Tylenol,” Clemens said. “It’s as effective as any narcotic.”
Studies have also shown that preemptively taking a nonsteroidal anti-inflammatory drug like ibuprofen before your procedure can be more effective for reducing pain than taking painkillers afterwards.
If you have a complicated procedure, your provider may prescribe a stronger medication. A short-term opioid prescription for three days or less is typically sufficient, according to Brett L. Ferguson, president of the American Association of Oral and Maxillofacial Surgeons.
If you take prescription painkillers, remember to properly dispose of leftover medication.
“People who are starting to create a dependency will search other people’s medicine cabinets and find their unused opiate drugs,” Clemens said. “You can help people out by not keeping them in your house.”
What complications should I watch out for, and when is it time to call my dentist?
Post-op complications are usually minor and resolve on their own, but it might take a few days before you bounce back to normal. “Most patients resume normal activities within five days,” Ferguson said.
You may experience swelling, bleeding, discomfort or dry socket, which occurs when the blood clot is disturbed or fails to form, exposing the bone and nerves to the air. If you notice a missing blood clot or feel severe pain at the extraction site, call your provider. You may be instructed to flush the socket with water from a plastic syringe to clear out food and debris and promote healing.
While it’s normal to be feel some pain after a tooth extraction, there are a few symptoms — including fever, nausea or severe swelling — that warrant an immediate call to your dentist or oral surgeon’s office.
“All of those things can be caused by a reaction to a medication or infection,” Clemens said.
If that’s the case, your provider will decide whether you should start a course of antibiotics to fight an infection or come back in to be evaluated in person.