Care After Wisdom Tooth Extraction: Care by Difficulty, When to Go Back, and Warning Signs

Why does care after wisdom tooth extraction differ by difficulty?

Simple and impacted extractions differ in wound size and whether stitches are needed, so the level of care and the recovery period differ [1]. A simple extraction of a wisdom tooth that has come through the gum leaves a small wound that often heals without stitches, but an impacted wisdom tooth lying inside the jawbone requires surgical steps such as opening the gum, trimming bone, or splitting the tooth to remove it, followed by stitches and stitch removal [1]. Because of this, even for the same wisdom tooth extraction, the amount and duration of swelling and pain, and whether you need to return, vary from case to case [1]. When DentStat analyzed 180 patient comments about care after wisdom tooth extraction in oral surgery, most were real-time questions about gauze, food, and cleaning schedules from people who had “just had it pulled,” and a recurring difficulty was trying to judge their situation from general precautions alone without knowing how difficult their own extraction had been [3].

I was not asked to come back for cleaning and got no prescription. Is that OK?

After a simple extraction, being told only to come back for stitch removal, without follow-up cleaning or antibiotics, is within the normal range [1]. If the wound is small and the risk of infection is judged to be low, the prescription and follow-up cleaning visit can be skipped, and this is not a sign of poor care but a choice based on the size of the extraction [1]. On the other hand, for impacted extractions or cases with inflammation, antibiotics and anti-inflammatory drugs are prescribed and follow-up visits for cleaning and stitch removal are arranged [1]. Whether you get a prescription or a follow-up visit is up to the clinic that did the extraction, and if pain or bleeding continues differently from what you were told, the standard is to contact that clinic [1].

Which signs mean I should go back to the clinic that did the extraction?

If, a few days after extraction, pain does not ease but gets worse and comes with a bad smell, you should go back [1]. This is a typical sign of dry socket, where the blood clot comes off and the bone is exposed, and it is relatively common after impacted lower wisdom tooth extraction [2]. Bright red bleeding that does not stop and keeps pooling, swelling that keeps spreading over time with fever, and dull sensation in the lip, chin, or tongue that lasts several days are also signs to have checked [2]. Lower wisdom teeth in particular sit close to the nerve that carries sensation, so temporary reduced sensation can occur depending on how impacted the tooth was, and the safe procedure is to tell the clinic that did the extraction if it continues [2]. Rather than waiting these signs out, the standard response is to have them checked at the oral surgery clinic that performed the extraction [2].

How should I adjust activity, air pressure, and plans after extraction?

On the day of extraction and for a few days after, the basic rule is to limit activities that increase bleeding and swelling [1]. Strenuous exercise, saunas, and drinking alcohol increase blood flow and can worsen bleeding and swelling, so avoid them for the first few days, and smoking and using straws are restricted because the suction can dislodge the blood clot [1]. Comments often asked about going to an amusement park or flying the day after extraction [3]; because pressure changes and long periods of activity can strain early recovery, discuss this with your dentist based on how difficult the extraction was and how you are recovering [1]. Once the anesthesia wears off, start with lukewarm, soft foods, and avoid spicy, hot, and hard foods for a few days [1].

Common myths and facts

Some believe you must bite the gauze as long and hard as possible, but the trick is to bite with moderate pressure for the time you were told so the pressure stops the bleeding, and biting too hard for too long can make you more uncomfortable [1]. Another common belief is that you should change the gauze often until the bleeding stops, but frequent changes and spitting can pull the blood clot away and slow down clotting [1]. Comments also showed anxiety that something went wrong because no medication was given [3], but skipping a prescription after a simple extraction can be within the normal range, so the standard is to check what you were told first [1]. Some people treat increasingly severe pain as part of recovery, but pain that gets worse over time is not a normal course and is a sign that you need to go back [2].

You can learn about the criteria for wisdom tooth extraction and how pain progresses in the wisdom tooth guide, the overall scope of oral surgery and complications in the oral surgery guide, and dental clinics by area in Find a dentist.