After wisdom tooth removal: your first week, day by day

Most of what goes wrong after a wisdom tooth extraction is avoidable, and almost all of it happens in the first 48 hours. Here is what to expect and what to do.

The first 24 hours

Bite firmly on the gauze for 30 to 45 minutes. Slight oozing and pink saliva through the day is normal; a mouthful of fresh blood is not. If bleeding persists, place a fresh gauze or a damp tea bag and bite steadily for another 30 minutes, sitting up rather than lying down.

Take the painkiller you have been given before the local anaesthetic wears off, not after the pain arrives. Cold pack on the cheek, 15 minutes on and 15 off. Sleep with an extra pillow.

The two mistakes that cause most problems both happen here: rinsing and smoking. Both dislodge the blood clot that is supposed to fill the socket. So do straws, spitting and hot drinks. Leave the area completely alone for the first day.

Days two and three

Swelling peaks now. This is the point at which patients ring worried, and it is normal; a swollen cheek at 48 hours is a sign of ordinary healing, not infection. Jaw stiffness and a bruise tracking down towards the jawline are also normal and can look alarming.

Start gentle warm salt-water rinses after meals from the second day, and brush your other teeth normally while avoiding the wound. Soft, cool foods: yoghurt, dahi, khichdi, soup, mashed potato, custard.

Days four to seven

Swelling and stiffness should now be clearly improving each day. Most people are back to normal routine and normal food by the end of the week.

This is also when dry socket shows up, and the pattern is unmistakable: pain that was settling suddenly gets worse from day three or four, often radiating to the ear, with a bad taste. It means the clot has been lost. It is not dangerous and not an infection, but it is genuinely painful and it will not resolve on painkillers. Come in; dressing the socket relieves it quickly.

Stitches and follow-up

Dissolving stitches disappear within seven to ten days. Do not pull at them with your tongue. Complete socket healing takes several weeks beneath the surface even though you feel fine long before.

When to call rather than wait

• Bleeding that will not stop with 30 minutes of firm pressure.
• Swelling still increasing after day three, or spreading towards the eye or down the neck.
• Difficulty swallowing or breathing. This one means hospital, immediately.
• Fever, pus or a foul taste.
• Numbness of the lip or tongue that is still there the day after surgery.
• Pain that starts getting worse instead of better after day three.

Call or WhatsApp 0318 7779288. Do not wait for your review appointment. Fuller instructions are on the patient information page, and there is more about the procedure itself under wisdom tooth surgery.