The first 3 days after a tooth extraction: what to do and what to avoid

When a tooth comes out, it leaves behind a socket in the shape of the root, and within minutes this socket fills with blood. The blood clots. This clot does three jobs at once: it is the plug that stops the bleeding, the cover over the bone and nerve endings underneath, and the scaffold on which new tissue will be built. That is why all the rules for the first few days come down to the same thing: avoiding anything that could dislodge the clot.

What puts the most strain on the clot is a change in pressure inside the mouth. Drinking through a straw, drawing on a cigarette, spitting forcefully and swishing water noisily around your mouth all create suction or pushing forces and can lift the fresh clot out of the socket. Hot drinks, alcohol and strenuous exertion, for their part, increase blood flow to the area and can restart oozing that had stopped. That is why, on the first day, 'I will leave my mouth alone' is often the best care of all.

What normal healing looks like frightens a lot of people, yet it is exactly what is expected. On the first day you will see a dark red, even almost black, clot in the socket. On the second and third days, the top of the clot becomes covered with a whitish or yellowish layer. This layer is not infection or food debris; it is fibrin and healing tissue forming on the surface of the wound. Do not scrape it, and do not try to clean it away with a toothbrush or your finger.

Pain and swelling follow a certain curve. The numbness wears off within a few hours and the aching begins. As the NHS describes it, pain and swelling start to improve after a day or two. Tightness at the angle of the jaw, not being able to open your mouth fully and mild discomfort when swallowing are common, especially after lower molar and wisdom tooth extractions. After a tooth with straight roots that comes out easily, most of this does not happen at all.

What you should look at is not how things look on any one day but the direction they are going. If each day is a little better than the one before, healing is on track. Pain that had eased flaring up again after the second or third day, spreading to your ear and temple and leaving a bad taste in your mouth points to a different picture; we cover this separately on our dry socket page. Bleeding that fills your mouth despite pressure is covered on our page about bleeding after a tooth extraction.

The gum over the socket closes within a few weeks, while the bone underneath takes months to reshape. This is exactly the period when the question of what will replace the extracted tooth becomes important, because the bone changes fastest in the first few months. The first three days are not the time to make that decision. But your first check-up is exactly the right time to ask your dentist: 'What can be done in this gap, and when?'

The two lists below show the factors that genuinely change how the first few days will go. Seeing yourself in the second list does not mean there will be a problem; it means you need to follow the rules a little more strictly and tell your dentist about these things before the extraction.

The following is everything you need to do during the first 72 hours. If the dentist who did your extraction gave you different instructions, theirs take priority, because they have seen your socket.

1. 1

   Gauze: bite down, do not check

   Bite firmly on the gauze placed in your mouth after the extraction and wait for as long as your dentist tells you, usually about half an hour, without taking it out to check. Every check starts the clotting all over again. It is normal for your saliva to be pink once the gauze comes out. If the oozing continues, repeat the same pressure for 20 minutes with a clean, damp, folded piece of gauze.

2. 2

   Eating and drinking: once the numbness wears off

   While you are still numb, do not eat and do not drink anything hot; you could bite a cheek or tongue you cannot feel, or burn your mouth. Once the gauze is out, you can drink water: in sips and without a straw. On the first day, eat things that are easy to chew, such as yoghurt, lukewarm soup, mashed potato or milk pudding, and keep food on the side where the extraction was not done. Very hot tea, crusty bread, seeds, nuts and grainy foods that could get into the socket are put off for the first few days.

3. 3

   Keeping your mouth clean: no rinsing on the first day

   For the first 24 hours, do not rinse your mouth and do not spit; swallow any saliva that builds up, or lean forward and let it run out on its own. From the second day, stir a teaspoon of salt into a glass of warm water, move the water slowly around your mouth and lean over the sink to let it run out; do this several times a day, especially after meals. If your dentist has prescribed an antiseptic mouthwash, use it only for as long as you were told.

4. 4

   Brushing: other teeth as normal, without touching the socket

   On the evening of the extraction, or the next morning at the latest, brush your other teeth as usual; a clean mouth is good for the socket too. For the first two or three days, clean the teeth right next to the extraction site very gently with a soft toothbrush, and do not press the brush onto the socket. Get rid of toothpaste by leaning forward and letting it run out, not by spitting. Keep your tongue and fingers away from the socket.

5. 5

   Swelling and pain: cold, head raised, medicine on time

   On the first day, hold an ice pack wrapped in a thin cloth against the outside of your cheek for 10–20 minutes at a time, with breaks in between; do not put ice directly on your skin or inside your mouth. For the first two nights, sleep with your head raised on an extra pillow. Take the painkiller your dentist recommends, in the way and at the times they advise; medicine taken before the pain sets in works better. Do not put a painkiller tablet on the socket: it burns the lining of the mouth.

6. 6

   Activity, work and exercise

   Spend the day of the extraction resting. After a simple extraction, you can usually go back to a desk job the next day. Running, weights, football, gym workouts, the sauna, the Turkish bath and long hot showers are put off for the first 72 hours, because anything that raises your pulse and blood pressure can restart the bleeding. Give the pool and the sea a miss for the first few days too. If you had sedation, do not drive that day.

These aids do not all come into play at once, but one after another. Knowing which one works on which day makes the first three days noticeably easier.

The following are not rare mishaps but common habits that drag out healing for no reason. All of them are within your control.

The sequence below describes the expected course after a simple extraction. After a difficult extraction, each stage may take a day or two longer. What you should look at is the direction: are the symptoms easing or getting worse?

1. The first 1–2 hours

   The gauze is in your mouth and you are still numb. Keep talking and spitting to a minimum, and do not eat. You can start using a cold compress. As the numbness wears off, the aching begins; take your painkiller at the time your dentist told you.

2. The first 24 hours

   The day for protecting the clot. Pink saliva is normal. No rinsing, spitting, straws, smoking, alcohol or strenuous exertion. Eat lukewarm, soft food, and sleep with your head raised. Do not be alarmed if you see a faint pink mark on your pillow in the morning.

3. The second day

   Swelling and jaw tightness may become more noticeable on this day, especially with lower molars. You start cleaning gently with warm salt water. You may begin to see a whitish layer over the socket; this is a normal sign of healing.

4. The third day

   The turning point. For most people, pain and swelling ease noticeably, and painkillers are needed less often. You gradually start chewing more, but hard and grainy foods still stay away from the extraction side. Pain that starts getting worse on this day, however, is not the expected course.

5. The first week

   The edges of the gum draw closer together and the socket gets smaller. If you had stitches that do not dissolve on their own, they are usually removed after a week to ten days. You carry on with salt water and gentle brushing; you can gradually return to exercise during this period.

6. The first weeks and months

   MedlinePlus states that the socket heals in 1–2 weeks, while the bone takes longer to recover. It is normal to feel a dip where the socket was for a while. This is the right time to talk about what will replace the extracted tooth, because the bone changes fastest in the first few months.

This page covers care after an extraction; it does not promote a treatment. Even so, it helps to know from the start the factors that decide how the first few days will go and what will be needed to replace the extracted tooth:

How difficult the extraction is

A tooth with straight roots and a wisdom tooth buried in the bone that is removed through an incision and in sections do not make for the same three days. Stitches, check-up appointments and time off work all vary with this difference.

Where the extracted tooth was

With back teeth, healing affects chewing; with front teeth, appearance and speech. What will go in its place, and how long you can wait, also vary accordingly.

General health and the medicines you take

Blood thinners, diabetes and conditions that affect the immune system may call for extra precautions and more frequent check-ups. Mentioning these before the extraction makes what follows simpler.

What happens to the gap

After a tooth is extracted, the bone reshapes. When an implant, bridge or denture plan is discussed before the extraction or soon after it, the options stay wider; when it is discussed months later, some additional steps may come into it.