What to do after wisdom tooth removal, how long it will hurt, complications

From this article you will learn:

Wisdom tooth removed - how long will it hurt?
what are the complications?
How long does it take for gums to heal after wisdom tooth removal?

The article was written by a dental surgeon with more than 19 years of experience.

According to statistics, after the removal of a wisdom tooth, inflammation of the socket of the extracted tooth occurs in 25-30% of cases. For example, after the removal of any other groups of teeth, inflammation occurs only in 3-5% of cases. This is due: firstly, to the higher complexity of removing wisdom teeth, and secondly, to the fact that they are surrounded by a large amount of soft tissue.

The last circumstance is very important, because the presence of moving soft tissues in the area of the extracted tooth socket often leads to the loss of the clot - its loss or even destruction. If the socket of the extracted tooth is not closed by a blood clot, inflammation will inevitably develop in it.

Gums after wisdom tooth removal (normal) –

When wisdom teeth are removed, stitches are almost always required. This is necessary because these teeth are located deep in the soft tissues and in this place the mucous membrane is very mobile. The absence of sutures in this situation can lead to prolapse of the clot and inflammation. But if the patient has a long jaw and there is enough space for the wisdom tooth, the socket will look traditional (Fig. 3).

To learn how the sockets of extracted teeth should normally heal, and how to speed up this process, read the article: “How long should gums take to heal?”

Why complications often occur after wisdom tooth removal -

It must be said that the severity of negative symptoms after wisdom tooth removal directly depends on the degree of traumatic removal. In turn, the incidence of trauma depends not only on the simple or complex position of the tooth in the jaw, but, first of all, on the qualifications of the dental surgeon.

For example, surgeons often spend 1-2 hours trying to remove a patient’s wisdom tooth with just forceps and an elevator - instead of immediately making an incision in the gum, drilling out some bone around the tooth and/or sawing the tooth crown into several parts (after that, removing each root by separately), and spending only 15-20 minutes on it.

Another main cause of complications after complex wisdom tooth removal is the use of a drill by the surgeon, the surgical tip of which is not water-cooled. As a result, a thermal burn of the bone occurs, followed by severe pain and the development of suppuration in the socket of the extracted tooth.

Important: thus, the main causes of inflammation and other complications are the mistakes and negligence of the dental surgeon during the removal process. However, a lot also depends on the doctor’s prescriptions. Correct prescriptions dramatically reduce the risk of developing inflammation of the socket.

How do dental surgeons remove wisdom teeth?

Typically, removing an upper wisdom tooth is easier than removing a lower wisdom tooth. This is due to the fact that the bone tissue of the upper jaw is softer and more porous, and therefore it is much more difficult to break off one of the roots (when removing a tooth from the socket). However, on the other hand, if the doctor does break off the top of one of the roots, then removing it from the upper jaw will be much more difficult. The latter is due both to the lack of good visual access and to the fact that working with thin elevators necessary to extract the root apex from the socket is much more dangerous in soft bone.

The bone tissue of the lower jaw is much denser, and lower wisdom teeth almost always have massive and/or often curved roots. Therefore, the roots of the lower wisdom teeth generally break off more often than the upper ones. But the doctor always has the opportunity to reduce the risk of such an outcome by taking an x-ray that will show us the shape and position of the roots in the jaw. If there is a risk of breaking off the root during tooth extraction, a good doctor will first saw it into pieces, after which he will separately remove the roots and parts of the crown. All this usually takes less than 15 minutes, but you come to understand this with experience.

But most often you can find a different picture, when the doctor uses all his might to loosen the tooth with forceps or tries to dislocate the tooth from the socket with an elevator, but one of the roots suddenly breaks off. Then the doctor begins to either pick at the wound for a long time with a thin elevator, or drill out the bone tissue (to get to the broken off tip of the root). In both cases, very significant trauma is caused to the jaw, which will lead to severe pain and inflammation of the wound in the postoperative period. Therefore, experience and understanding of the extraction strategy play a big role, and sometimes even a very complex tooth, on which one doctor can spend a whole hour, another may need only 5-10 minutes.

Simple and complex wisdom tooth removal –

Thus, removing the eighth tooth can be either simple or complex. In some cases, we can assume in advance that there will be a difficult removal. Here are a few options at a glance: 1) we need to remove a tooth that has not yet erupted above the mucous membrane, 2) on the x-ray we see curved roots, 3) the tooth has a strong slope towards the 7th tooth, resting against it with the crown in the cervical area, 4) the tooth has a horizontal position in the jaw, 5) the crown of the tooth is almost completely destroyed and there is no way to “catch” on it with instruments.

Variants of the position of the wisdom tooth in the jaw -

With similar options for the position of the wisdom tooth (as in the radiographs above), we plan a complex extraction in advance. But even removing such teeth with the right strategy may not be too difficult, taking only 15-20 minutes. Below we will describe in detail how simple wisdom tooth removal is carried out, and also show one of the options for complex removal.

What to do after wisdom tooth removal to avoid complications -

What to do after wisdom tooth removal will depend on the complexity of the removal. If the removal was simple (that is, it was not accompanied by an incision in the gum and cutting out the bone), then standard recommendations after removal will be sufficient. If the removal was difficult or was carried out against the background of purulent inflammation, then the following must be added to these recommendations...

Antihistamines - these drugs are also called antiallergic. Taking them will reduce the swelling of the soft tissues of the cheek after removal, which will certainly appear the next morning, and in addition, they enhance the effect of analgesics. It is best to take Suprastin. This is a very strong drug, but with a hypnotic effect. Therefore, we recommend taking it in the first 2-3 days after removal shortly before bedtime (once a day).

NSAID-based analgesics
Read also: Filtek (Filtek) Supreme XT Flow OA3 - restoration fluid material (1 x 2 g)
– it is best to use analgesics from the NSAID group (non-steroidal anti-inflammatory drugs), which have both analgesic and anti-inflammatory effects. These include products based on ibuprofen, ketoprofen, etc.
It is best to start taking these medications before your anesthesia wears off. Read about the right choice of medications at the link above. It is best to use them for the first 3 days, then as needed.

Antibiotics – after a complex extraction, or if the removal was carried out against the background of inflammation in the tooth, taking antibiotics is mandatory. Because After tooth extraction, a bone wound is formed, then antibiotics should be specific to bone tissue. At the moment, the most popular antibiotics among dental surgeons are several drugs.
Firstly, Amoxiclav. The dosage for adults should contain 500 mg of amoxicillin and 125 mg of clavulanic acid. At this dosage, the drug is taken only 2 times a day. However, if you previously experienced diarrhea after taking antibiotics, then it is better to purchase another drug - Unidox-solutab in soluble tablets (taken 100 mg 2 times a day, 5 or 6 days).
Very often, doctors also prescribe a drug from the Soviet past - Lincomycin capsules 0.25 (adult dosage - 2 capsules 3 times a day, for a total of 5-6 days). It is inexpensive, effective, but kills the entire intestinal microflora, causing you to suffer from dysbacteriosis later.

Anesthesia for removal of the upper wisdom tooth

As a rule, before extracting the “eight”, they resort to local painkillers - injections with articaine, lidocaine and other drugs with a similar spectrum of action. The dentist makes 2 injections - from the side of the palate and on the outside of the upper jaw. This allows you to obtain a powerful anesthetic effect, which manifests itself within 2-5 minutes after administration.

In the case of the eighth tooth, located in the mandibular region, at least 9-10 minutes are required due to the increased bone density in this area.

However, the pain syndrome can make itself felt within 2-3 hours after surgery, which requires additional use of painkillers and anti-inflammatory drugs.

What are the complications after wisdom tooth removal?

When a wisdom tooth has been removed, what to do after removal will directly depend on the symptoms that you experience. It must be said that according to statistics, complications after wisdom tooth removal occur in almost every 4th patient. Most often, patients encounter the following symptoms indicating the development of complications:

severe spontaneous pain,
pain when cold or hot water gets on the wound,
swelling of the soft tissues of the cheek,
unpleasant odor from the socket of an extracted tooth,
painful swallowing
difficulty opening the mouth,
temperature,
bleeding,
the appearance of a hematoma on the face.

Pain after wisdom tooth removal –

Having a wisdom tooth pulled out, how long will it hurt is the most common question patients ask. How much your gums hurt after wisdom tooth removal directly depends on the degree of traumatic removal. Normally, pain after wisdom tooth removal should not be very strong and, once it occurs, it should gradually only decrease. After a simple removal, the pain usually goes away completely in 1-2 days, and after a complex one, normally in no more than 3-5 days.

If you have a wisdom tooth pulled out and the pain immediately after removal is very strong and practically does not decrease in the first days, this indicates that the removal is excessively traumatic and the possible development of inflammation of the socket of the extracted tooth (alveolitis). Here you need to urgently go to the dentist for a second examination. In the worst case scenario, pain can last up to 3-4 weeks.

Symptoms of inflammation of the wisdom tooth socket - upon examination, you can see that the socket is empty, or it is filled with food debris and necrotic decay of a blood clot. Sometimes patients feel sharp/moving bone fragments with their tongue. There is always pain, there is always an unpleasant smell from the hole. The mucous membrane is swollen and red. Such symptoms are characteristic of a mild form.

However, in some cases, inflammation of the socket occurs with abundant formation of pus, swelling of the cheek, difficulty opening the mouth and painful swallowing. And it must also be said that if you experience pain when responding to cold or hot water, this clearly indicates the presence of an exposed area of bone. In any case, only a dentist can help you.

Inflammation of the socket of an extracted wisdom tooth: video

Below you can see what inflammation of the sockets of removed wisdom teeth looks like in the video. Please note that in video 2, when you press on the gums in the area of both removed wisdom teeth, thick pus comes out of the patient’s sockets.

Reasons for the development of alveolitis - if the patient rinses his mouth vigorously in the first days after extraction, this can lead to a blood clot falling out of the socket of the extracted tooth. This leads to inflammation in 100% of cases, because... the hole is immediately filled with food debris and microbes from the oral cavity. But in most cases, alveolitis still develops due to the fault of the doctor -

traumatic removal,
fragments or slightly movable bone fragments are left in the socket,
when cutting out the bone, the doctor used a drill tip without water cooling, which led to overheating and necrosis of the bone,
the doctor was too lazy to suture the mucous membrane above the hole (in some cases this can lead to exposure of a section of bone in the next few days),
The doctor did not prescribe antibiotics after a complex extraction, or in the case when the tooth was removed due to inflammation.

Important: alveolitis is the most common complication after wisdom tooth removal. If the described symptoms occur, you should immediately run to the doctor and treat alveolitis. From experience I can say that when a doctor sutures a hole even after a simple removal, the number of cases of alveolitis development is almost zero. In addition, studies have shown that suturing the socket reduces the severity of pain after removal by 30-50%. Therefore, before removal, you should definitely ask the doctor to suture your hole, even if you have to pay extra for it (about 500 rubles for 2 stitches).

Is it painful to remove a wisdom tooth?

The most common question we hear from patients is whether it hurts to remove a wisdom tooth. Correctly administered anesthesia by a doctor eliminates pain during the removal process (of course, if you do not abuse analgesics, as well as alcohol and drugs). However, in the comments to this article you can read that the reviews of a small part of patients about wisdom tooth removal say that they experience severe pain and that “never again in their life.” And as an experienced dental surgeon, I will comment on this in detail.

Pain during tooth extraction – this most often happens when a wisdom tooth is removed from the lower jaw. The fact is that in this case, so-called “mandibular” (torusal) anesthesia is administered. This type of pain relief is quite complicated, because... the tip of the needle should be located strictly at a certain point - approximately in the middle of the inner surface of the lower jaw branch. This is where the nerve that innervates the teeth on this side of the lower jaw passes. Removal will be painful when the doctor is not very experienced or hastened.
Thorusal anesthesia (technique) –
In this case, the following will indicate a well-placed anesthesia: half of the lower lip on this side, as well as the tip of the tongue, should become very numb. Numbness occurs in about 5-10 minutes, after which the doctor usually asks you whether your lip and tongue are numb. If the numbness is weak, it is better to ask the doctor to give another injection of anesthetic. It is better to use drugs based on articaine as anesthetics (for example, Ultracaine containing vasoconstrictors). If you were given regular lidocaine without vasoconstrictors, the effectiveness of anesthesia will be lower.
But removing a wisdom tooth in the upper jaw does not require complex anesthesia techniques. In the upper jaw, the bone is quite soft and porous, so the anesthetic easily penetrates through the bone tissue. The injection is made into the gum - approximately in the projection of the roots of the upper wisdom tooth. After administration of the anesthetic, pain relief occurs within just 5 minutes and usually lasts from 15 to 45 minutes (depending on the choice of anesthetic). The usual symptoms you should experience are numbness in the cheek and part of the roof of your mouth.
Read also: Philips Sonicare DiamondClean electric toothbrush review
Pain after tooth extraction – when patients complain of pain associated with the removal of wisdom teeth, in 90% of cases this is pain that occurs after the removal. In this case, the reason is severe tissue trauma during a complex extraction, or as a result of the development of inflammation of the socket of the extracted tooth. Unfortunately, sometimes a quick 5-minute procedure for removing a wisdom tooth often ends in a week of nightmare, which occurs due to alveolitis of the socket of the extracted tooth. In some cases, it is the patients themselves who are to blame for not following the doctor’s recommendations after removal.

To summarize, the removal process itself is more scary than painful. In this case, the pain begins after removal, and it can be associated either with the excessive trauma of the removal (i.e., the doctor did not perform the operation quite competently), or with the fact that the patient could rinse out a blood clot from the wound. Well, we also forgot to say that there is another option for removing a wisdom tooth - this is removal under general anesthesia (not too pleasant, but not scary).

Swelling after wisdom tooth removal –

If you have a wisdom tooth removed and your cheek is swollen the next day, then in some cases this is normal.
Normally, after simple removal, swelling rarely develops, and most often it occurs in people with an abundance of subcutaneous fat on the face. Such swelling most often becomes noticeable only in the morning of the next day. Normally, after a complex removal, swelling gradually develops immediately and gradually increases, becoming maximum the next morning. Usually the swelling is stable over the next 1-2 days, after which it begins to slowly decrease. If, against the background of swelling, there is no increasing temperature or pain, but on the contrary, all symptoms slowly decrease, then everything is OK.

When removing an upper wisdom tooth, swelling of the upper cheek may occur (even if the removal was simple). The appearance of edema in this case is due to the fact that the area where the upper wisdom teeth are located is very richly supplied with blood, and therefore swelling of the surrounding soft tissues occurs. If the removal of the upper wisdom tooth was difficult or was carried out against the background of inflammation, then the occurrence of edema is all the more not surprising.
When removing lower wisdom teeth -

swelling is natural if the removal was complicated (an incision was made, a bone was drilled, a tooth was sawed), or the tooth was removed due to inflammation. Swelling of the surrounding soft tissue near the removed lower wisdom tooth can lead to painful swallowing or difficulty opening the mouth.

When to sound the alarm - if swelling continues to increase over the next 1-2 days after removal, pain and temperature may also increase, pain when swallowing increases, and the mouth opens less and less - all these are unfavorable symptoms indicating suppuration. If you have at least one of the symptoms listed, you need to urgently run to the dentist.

Important: to ensure that swelling does not appear after wisdom tooth removal or is minimal, it is advisable to take antihistamines (Suprastin is best) for the first 2-3 days before going to bed - once a day before bed. Antihistamines have not only an antiallergic effect, but also a decongestant.

Complex removal of an upper wisdom tooth

As part of this procedure, drills are used, and the gingival tissue is dissected and the dental socket is sutured. Swelling after such removal of the upper wisdom tooth is considered a normal manifestation. The reason for this operation is the eruption of the tooth in a horizontal position, under a layer of bone tissue.

Procedure steps:

Initially, the site of future intervention is anesthetized.
The gum is dissected and part of it is peeled off using a scalpel.
A hole is created in the bone tissue. In this case, special tips and cutters are used to provide a cooling effect.
Full or partial extraction is performed.
The dental alveolus is thoroughly washed with an antiseptic solution.
The bone wound undergoes plastic surgery, and the detached part of the gum is returned to its place.
Suturing the alveolar cavity and stopping bleeding.

After implementing all the sequential steps and removing the upper wisdom tooth, the specialist makes recommendations regarding further care.

Temperature after wisdom tooth removal –

If the tooth was removed NOT due to inflammation - if your wisdom tooth was removed, the temperature may well rise to 37.5 degrees, but only on the first evening.
The body sometimes reacts to injury with just such a low-grade fever, even if the tooth was not removed due to inflammation. This is especially true if the removal was difficult. Normally, the next morning after removal, the temperature should disappear (24stoma.ru). When to sound the alarm: if the temperature does not subside the entire next day after extraction, and even more so continues to increase, then this indicates suppuration of the hole of the extracted tooth. All you need to do is run to the dentist.

If the tooth was removed due to purulent inflammation, in this case the temperature may be higher than 37.5. But normally, from the next day the temperature should decrease progressively. If it persists and, even more so, increases (this indicates an increase in inflammation), you need to urgently go to the dentist.

Bleeding after wisdom tooth removal –

Usually, in the socket of an extracted tooth, blood clots instantly, but with increased pressure or injury to a large vessel, prolonged bleeding may occur. Bleeding after wisdom tooth removal is not a big deal if it occurs while still in the dentist’s chair. The doctor will then immediately suture the wound with suture material and/or place a hemostatic hemostatic sponge into the socket of the extracted tooth (Fig. 8).

However, very often bleeding after tooth extraction occurs after leaving the clinic. Experienced doctors, to be on the safe side (especially if a large tooth is removed and the patient has a history of hypertension), usually always put 1-2 sutures on the wound, just to prevent bleeding. In addition, suturing allows the wound to heal faster.

Bleeding after removal of the upper 8th tooth: video

More detailed information on the possibilities of stopping bleeding at home is in the article: → “How to quickly stop bleeding after tooth extraction”

Hematoma after wisdom tooth removal –

A hematoma appears due to the fact that a vessel in the soft tissues has been injured. There is no point in blaming the doctor for this, because... When administering anesthesia, the doctor does not see where the vessels pass in your soft tissues. The needle can injure such a vessel and after a few days the skin may appear blue. Gradually it will pass.

However, the formation of a hematoma may require additional measures. A hematoma often festeres after the removal of a wisdom tooth. In this case, already on this day or the next day after removal, the patient experiences swelling of the cheek, a feeling of fullness, pain, and a slight fever. Here you need to urgently consult a doctor, because... when the hematoma suppurates, an incision is required to release the pus.

Should an impacted wisdom tooth be removed?

This is the main question that worries not only patients, but also specialists. There is no universal solution here, since everything depends on the specific clinical case. If you believe the statistics, impacted teeth are more often removed than preserved, but this decision is due to a number of reasons:

if the impacted wisdom tooth hurts and regularly bothers the patient;
in case of incorrect position relative to the dentition (in this case, removal of an impacted dystopic wisdom tooth is almost always required);
when carious lesions are observed on a partially impacted tooth (there is a risk that caries will spread to adjacent teeth or lead to complications);
if there is a fistula or abscesses;
with pericoronitis (that is, inflammation of the soft tissues surrounding the tooth);
when a cyst is observed on an impacted tooth;
if there is a risk of osteomyelitis (inflammation of bone tissue).

The decision about whether to remove an impacted wisdom tooth should be made by the attending physician, but the patient's opinion should also be taken into account. If there are no complications and the tooth does not bother you, then there is no need for removal.

We answer frequently asked questions from patients -

If you have a wisdom tooth removed: what to do after removal, what to rinse with, how quickly the hole will heal and when it will be possible to treat your teeth... We answer all questions separately.

How to rinse your mouth after wisdom tooth removal -

It is best to rinse your mouth after wisdom tooth removal with the antiseptic Chlorhexidine. This drug is sold in every pharmacy and costs only about 30 rubles per 100 ml bottle. Please note that you can only rinse your mouth slowly, because... Strong rinsing can cause a blood clot to fall out of the socket of the extracted tooth. The latter will lead to the development of inflammation.

How long does it take for gums to heal after wisdom tooth removal?

How long it takes for the gums to heal after wisdom tooth removal depends on the complexity of the removal. Typically, you must wait 1 week to begin treatment after wisdom tooth removal. But after a complex removal, the gums may take longer to heal (up to 10-14 days), which will depend on the degree of traumatic removal. If inflammation occurs in the hole, healing may take 20-30 days. We hope that our article on the topic: Wisdom tooth removal, how much it hurts, turned out to be useful to you!

Sources:

1. Dental education of the author of the article, 2. Based on personal experience as a dental surgeon, 3. National Library of Medicine (USA), 4. “Pathology of wisdom teeth eruption” (Rudenko A.), 5. “Qualified removal of third molars” (Asanami S.).