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.

Is it painful to have a wisdom tooth removed?

Everything is very individual and depends on the volume of dental procedures that need to be performed in order to extract the tooth. According to statistics, the upper “eights” are easier to remove than the lower ones, and a fully erupted crown is easier to grasp with forceps than an impacted one.

The removal process is carried out under local anesthesia, so the patient does not feel any particular physical discomfort. Some time after the local anesthetic wears off, pain of varying severity may be present. The more tissue was damaged during the removal of a tooth or its parts, the higher the likelihood that it will not be possible to do without taking analgesics.

The most unfavorable situation is when a tooth grows from the horn of the upper jaw and is located horizontally in the bone, resting its chewing surface on the side of its neighbor. Here you cannot do without an operation, which can take an hour or more.

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
– 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.

How is an impacted tooth removed?

Removing an impacted tooth is a complex surgical procedure that can only be successfully performed by an experienced dental surgeon. Removing impacted dystopic wisdom teeth is considered especially difficult due to its incorrect position. On average, the procedure itself takes about half an hour, but in particularly difficult situations, tooth extraction can last more than two hours. In addition, it is believed that removing an impacted wisdom tooth in the lower jaw is more difficult than removing an impacted wisdom tooth in the upper jaw. This is explained by the fact that the bone tissue in the lower jaw is denser, so the tooth can be extracted more easily. However, the upper impacted wisdom tooth is removed using the same technology, so there are no big differences here.

Stages of removing an impacted tooth:

Consultation, diagnostic procedures. Sanitation of the oral cavity. Often, several days before the procedure, sedatives and vitamins are prescribed.
Anesthesia (general anesthesia, sedation, local anesthesia - depending on the complexity of the case and the wishes of the patient).
An incision is made and the gum is pulled back to access the bone tissue. Can be performed using a scalpel or laser. The second method is more modern and less invasive, but the cost of the procedure increases significantly.
Preparation of bone tissue using a special bur to access an impacted tooth.
Extracting the tooth using special forceps (elevators) or sawing it into several parts and removing each piece separately. The second method is considered more predictable and safe.
Plastic surgery of soft or hard tissues, suturing (if necessary), treating the area with antiseptic and anti-inflammatory solutions.

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.

In what cases is deletion not required?

The tooth erupts without causing discomfort, has the correct position and direction of growth.
The wisdom tooth does not interfere with neighboring teeth, does not provoke their displacement or deformation.
An overgrown extreme molar does not interfere with the installation of dental structures.
In the case where the molar has a correctly erupted antagonist tooth.
If treatment of the affected tooth is possible.
The erupted wisdom tooth has the correct shape and does not injure the cheek and soft tissues of the oral cavity.
Simply put, if the wisdom tooth has erupted safely and does not cause any trouble or discomfort, you should not touch it.

Even if a molar is affected by caries, but it is possible to cure it, the priority is treatment rather than extraction. The potential consequences and complications after removal are many times more complex than the treatment procedure.

When the figure eight is removed, inflammation, infection, and gumboil may develop, which will require complex and lengthy therapy. It is much easier and cheaper to cure caries or periodontitis that affects wisdom teeth.

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 worth keeping wisdom teeth?

A number of experts believe that it is advisable to remove figure eights in adolescence, when their root system has not yet fully formed, and the jaw bones have not acquired the density characteristic of adult patients. Others are of the opinion that the teeth that erupt later than others are best left in the dentition if:

the tooth is positioned correctly in the jaw bone, grows vertically and is fully erupted without forming a pocket over it;
the tooth is available for dental manipulation in case of caries development;
the root system and the condition of the tooth crown make it possible to use the “eight” as a support for a prosthesis;
There is enough space on the jaw and the appearance of another “combat unit” will not provoke crowding of the teeth.

The main problem with wisdom teeth is that they are not involved in the act of chewing, so their surfaces are much less easily cleaned of bacterial plaque and tartar. Inspection of a crown located in the depths of the oral cavity by the person himself is difficult, especially in cases where part of it is covered by the gum. This causes the formation of complications of an advanced carious process.

Particular attention should be paid to impacted teeth that are located in the soft tissue of the gums or jaw bone. In fact, this is a “time bomb” that can explode at any moment. The “figure eight” located in the tissues can become inflamed, simulating the symptoms of acute otitis media and pharyngitis. The active inflammatory process is accompanied by a significant rise in temperature, pronounced intoxication. It can be difficult to make a diagnosis in such conditions, since the problematic tooth may not show itself in any way, and doctors of several specialties will have to be involved in the diagnosis.

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.
Read also: Instructions for use ARTICAINE + EPINEPHRINE

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.

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.

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.

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.).