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Wisdom teeth or third molars generally erupt into the mouth between the ages of 17 and 25. These molars come in behind our 2nd molars which came in at about 12 years old. Most people develop 4 wisdom teeth, while others may develop less or even sometimes more than 4. Wisdom teeth commonly become an issue because of lack of room or odd positioning. Wisdom teeth can affect other teeth in the mouth by moving them, damaging root structure or causing tooth decay or periodontal issue. Wisdom teeth can come in sideways, horizontally, backwards, or even become impacted (partially or fully  unable to erupt into the mouth). When these complications arise, it is recommended that the wisdom teeth are removed to avoid permanent damage to other teeth.

What To Expect Following Wisdom Teeth Extraction

While most wisdom teeth extractions go quite easily with little to no pain or complications. There can always be complications no matter how minor they may seem. These can include:

-Bleeding. This is quite normal following any type of oral surgery. It is not unusual to see slight bleeding or oozing into the saliva following wisdom teeth extraction. Excessive bleeding ( mouth filling with blood) is not normal and your dentist or surgeon should be contacted immediately. The general instructions given by your doctor to control this oozing or slight bleeding is to bite down on a fresh gauze pad for about 30 minutes. You can repeat if necessary. This usually does the trick but if more action is needed biting on a moist tea bag will help even further. Tea bags contain tannic acid which helps with clotting of the blood. Activity should be limited directly following surgery. If bleeding continues or you are unsure of what to do, call your dentist immediately.

-Pain/Discomfort. Some minor pain following wisdom teeth removal is normal. A dull ache is expected after the local anesthesia wears off. This usually will subside on its own over 8-12 hours following surgery. Your dentist or surgeon will evaluate what may be necessary for pain management based upon your particular surgery. For more severe pain your dentist or surgeon will give you a prescription pain medicine. It is important to note that most prescription pain medication is much stronger and will make you groggy and reduce your reflexive actions. Driving as well as alcohol intake should be avoided while on these painkillers. The pain should begin to subside within 8-12 hours and be almost gone by end of 2nd day. If pain persists call your dentist immediately as you may be experiencing dry socket. A dry socket occurs when the blood clot gets dislodged prematurely from area where the tooth was extracted. Symptoms of severe and/or throbbing pain at the surgical site 3-4 days following surgery, that does not respond to pain medication, can indicate a dry socket in the area of the wisdom teeth. If this occurs call your dentist so they can relieve your pain.

-Swelling. Another very normal complication of wisdom teeth removal. Swelling can usually be found around the mouth and sides of the face. The swelling can be controlled or minimized by the use of ice packs. After 36 hours, ice has little beneficial effect and can be replaced with the application of moist heat to the sides of the face. Moist heat has been found to be helpful in reducing the swelling and increasing the range of motion of your jaws. Most swelling will subside over the course of 3-4 days.

-Dietary Restrictions. Initial nutritional intake should be in liquid form or very soft foods. It is best to avoid chewing on side where wisdom teeth were extracted. Drinking fluids is especially important to avoid dehydration. Stay away from sharp, crunchy foods that can lodge themselves into the extraction site. You need to eat and drink so that you will heal and the stronger you will feel, but not too much if you are experiencing nausea. Do not use a straw when drinking as you may dislodge the clot and cause a dry socket or increased bleeding.

-Nausea/Vomiting. Developing nausea is a real possibility especially if general anesthesia was used. Limit food intake until nausea subsides and try to drink a carbonated beverage (coke or ginger ale) it will help ease your upset stomach.

-Maintain Dental Hygiene. Keeping the mouth clean is important. Rinsing should not be performed the day of surgery. The day after surgery you can rinse 5-6 times a day using a saltwater mix (cup of warm water with a teaspoon of salt). Your doctor will let you know when brushing in the area can resume.

-Bruising/Discoloration. In some cases, this can happen and is very normal. Occurs when blood forms beneath the tissues causing black, green, blue, or even yellow discolorations on the skin. Usually occurs 2-3 days after surgery. Application of moist heat to the area may speed up the healing process.

-Infection. Your dentist may place you on a course of antibiotics if there is an infection present. The Antibiotic prescription should be completed as directed by your dentist and pharmaceutical instructions.

-Jaw Stiffness. This can occur from the jaws being open and stretched for an extended period of time. Normally goes away within a day or two.

Less Likely Wisdom Teeth Complications

-Numbness. This can happen and is generally temporary. Be aware that you can bite your lip or tongue while you are numb so be careful. If the numbness persists call your dentist immediately.

-Fever. Development of a fever is a rare occurence following wisdom teeth removal but it can happen. If the temperature lasts more than a few hours or does not go back down after taking Tylenol or Advil call your dentist.

-Dry, Cracked Lips. This can occur from your lips and mouth being stretched during surgery. Most dentists can minimize this by using vaseline on your lips and skin before surgery to keep them moist.

-Irregular Bony Projections. In some cases, patients may feel bony projections with their tongue. This is the bony walls that housed your wisdom teeth. These projections may need to be removed by the dentist if they persist.

Wisdom Teeth Conclusion

It is important to remember that we are all individuals and our bodies will react differently to different events such as wisdom teeth surgery. Many of us will have no complications beyond pain and slight swelling, but for others, bigger complications may arise. It is important to maintain an open line of communication with your dentist in case an issue arises.

Dry socket (also called alveolar osteitis) is an extremely painful dental condition that can occur after removal (extraction) of a permanent adult tooth.

Having a tooth removed is generally not something anyone looks forward to. Most people understand there will be some level of discomfort following the procedure.  Many are given a prescription for pain medication before leaving their dentist. Most people in fact do not even need to get the prescription filled. However, when a patient experiences what is called a dry socket the pain can become quite intense and linger for days.

Very few people are affected by dry socket. The development of Dry socket after a tooth extraction occurs in only about 2-3% of patients. For those who experience dry socket it can be a very scary experience. Fortunately dry socket is treatable.

A dry socket occurs when the blood clot at the site of the tooth extraction has never fully formed, has broken free, or has dissolved before the wound has had a chance to fully heal. The blood clot is the protective layer for the underlying bone and nerves, it begins the process of healing so that gum tissue and bone can refill the area. When the clot is gone the bone and nerves are now exposed to the outside air, food, fluid, and anything else that enters the mouth. This can lead to a dry socket with sharp, aching pain that can last for 5-6 days, and in the case of a patient taking fosamax type drugs the pain can last for weeks.

A dry socket is considered the most common complication following tooth extractions. It happens more frequently with extraction of impacted wisdom teeth, in patients with poor blood flow to the socket, (smokers, patients taking fosamax), delayed healing (diabetics ).  The pain begins to build and develop about 2-4 days following the procedure.

Signs and Symptoms of Dry Socket

Signs and symptoms of dry socket may include:

-Sharp, aching pain within 2-4 days after a tooth removal.

explanation of dry socket

Graphic explanation of dry socket…image courtesy of Dental Care Matters

-Partial or total loss of the blood clot at the tooth extraction site. You would be able to visually notice a deep hole or space where tooth used to be, that weeps fluid when pressed vs a blood clot overlaying the site.

-Bone that is visible upon visual examination in the socket

-Pain that radiates from the socket to your ear, eye, temple or neck on the same side of your face as the extraction

-Abnormally bad breath or a foul odor emanating from your mouth. This will coincide with having a bad taste in your mouth as well.

-If you have swollen lymph nodes around your jaw or neck, this is a sign of infection and you need to be seen by your dentist immediately.

Over the counter medications by themselves will not control the symptoms. Your dentist or oral surgeon will need to begin treatments to lessen pain and allow for healing to take place.

Treatment of Dry Socket

Taking a nonsteroidal anti inflammatory drug (NSAID – aspirin or ibuprofen) can help to ease the pain but probably will not be enough to take it away completely. When the pain persists you should call your dentist immediately. The dentist may prescribe you a stronger pain medication to allow the pain to subside for you or give you anesthesia in the office to relieve some of the symptoms for a little while anyway.

paste for dry socket

Paste for Dry Socket

What will your dentist need to do for the dry socket? Your dentist will need to numb and clean the tooth socket. This will allow for  removal of any debris from the space where the tooth once was, and allow for rebleeding into the site. The dentist may then fill the socket with a medicated dressing or a special paste to promote healing and soothe the symptoms. Patients with dry socket dressings generally need to come back to be seen by the dentist every day until the pain subsides. The dressing needs to be changed daily. Warm cloth on the outside of the face also helps promote blood flow.

An antibiotic may also be prescribed at this point to prevent an infection from forming. At home care will include rinsing with salt water and being careful what you eat and how you eat it, ( avoiding the side where the dry socket is ).

The site will usually heal completely following treatment in 1-2 weeks.

Who is most likely to get a Dry Socket?

Some patients will be more likely than others to get a dry socket after a tooth extraction. These include the following:

-Smokers. Patients who smoke have twice the chance of developing dry socket over those who do not. Smoking also is believed to slow the healing process.

-Poor Oral Hygiene. Those with poor oral hygiene will have an increased risk due to the amount of bacteria in the mouth. Will be difficult to maintain a sterile field when removing tooth.

-Having wisdom teeth (3rd molars) extracted. Increased trauma to area during procedure is one of the indicators for increasing the possibility for the development of dry socket. 3rd molars tend to be more difficult to remove especially if they are fully or partially impacted.

-Previous history of dry socket. If you have had dry socket previously, you are more likely to develop it after another extraction.

-Use of birth control pills. Contraceptives which contain estrogen effect the blood clotting system of the body. So we see an increased incidence in dry socket in patients on oral contraceptives.

Rinsing and spitting a lot or smoking after having a tooth extracted also can increase your risk of getting dry socket. These activities will increase chances of the blood clot becoming dislodged.

Following the removal of a tooth it is very important to follow all instructions given to you by your dentist. If you are unsure of anything you must ask or call back. At first sign of pain or discomfort call your dentist to be sure it is not something more serious. As always, maintain a regular schedule visiting your dentist, as well as keeping an open communication with your dentist. This will make you feel comfortable asking questions and knowing you are getting the proper information to care for your oral health.