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Healing After Tooth Extractions

Many things affect the healing process following a wisdom tooth extraction procedure, including the size and complexity of the extraction and the age, habits, and medical condition of the patient. However, while there are factors that may affect healing, generally speaking, the healing timeline is similar, if not the same, for all patients. During the first 24 hours following an extraction, vital healing processes have already begun. First, a blood clot forms, filling in the empty socket where the extracted tooth once was. This blood clot begins the healing process, stopping the bleeding from the wound and protecting the nerve endings and bone in the extraction site. While the area surrounding the extraction site may remain tender and swollen, the discomfort of the extraction will begin to subside within the first 24 hours of healing. Swelling around the extraction site, and possibly also the face, should peak within 72 hours and then begin to subside. New gum tissue will begin to form in the area of the wound within 12 hours of your extraction, and the platelets and other cells in the blood clot begin to form compounds that aid the healing process. Over time, the blood clot transforms into new cells and tissues that support the gums and allow the site to fully heal.

Depending on the complexity of your extraction, you’ll likely want to take the day following your procedure off from work for school to relax. This down time is beneficial as your anesthetic wears off and the extraction site stops bleeding, and you’ll also have time to read and process your dental health professional’s postoperative care instructions. Most patients have no difficulty returning to regular, non-strenuous activities, and even some moderate physical activity, the day after an extraction, especially when the extracted tooth has already erupted into the mouth. If, however, you have more rigorous or strenuous activities planned, be sure to talk to your oral surgeon to determine when it is safe to engage, and plan to err on the side of caution. If you’ve had a very involved extraction, especially one where sedation was used, you may be advised to limit your activities for the first 24 hours following an extraction procedure. Your ability to return to work may be determined by your comfort level and your appearance; for example, if your face is visibly swollen, you may prefer to take more time off from regular activities, and you’ll want to ask your oral surgeon about the safety of other activities. The level of care you are able to provide for yourself and for your extraction site immediately following your procedure can lay the groundwork for the healing that follows.

The gum tissue surrounding your extraction site will continue to repair itself in the weeks following the procedure. Gum tissue and other soft tissues in the mouth heal more rapidly than the body’s other tissues, like skin, and in most cases, gum tissue has sufficiently healed within 7 to 10 days following a procedure to allow for the removal of stitches at the extraction site. The amount of healing that has taken place will be affected by the size of your surgical wound, and, in the case of wisdom tooth extraction, you may notice an indentation in the area of your extraction for a long period of time following the procedure. Initially, this indentation may trap food and other debris and may need to be periodically irrigated to keep it clean. As the extraction site heals and healthy gum tissue forms over the socket, the blood clot that developed in the socket has begun to transform into a collagen-rich tissue that will eventually turn into bone, blood vessels, and the other living tissues that make up the mouth and jaw. These newly forming tissues are rich in blood vessels and must be handled with care as they form. They may feel tender to the touch, and they should be treated gently while eating or brushing. As the second week following an extraction draws to a close, the extraction site will become less and less sensitive and vulnerable and you will be able to resume normal activity with little regard for the site.

Into weeks three and four of healing, you may still see an indentation in the gums where your tooth was extracted; this indentation will be more significant and may last for a few months in cases where the extracted tooth was impacted. Inside the socket, cells are continuing to do their work, forming bone and the other scaffolding to support the healed socket. This bone tissue begins filling in the socket adjacent to its existing walls, from the bottom and the sides, gradually causing the socket to narrow and become more shallow as it fills in with new bone tissue. While the newly formed gum tissue may remain sensitive or tender, it is unlikely to bleed at this point in the healing process and is as resilient as the other soft tissues in your mouth. After a couple months of healing, your extraction site will have filled about ⅔ of the way with new bone, eventually filling completely. Then, it will take a few more months for this bone to strengthen and match the contours of the jawbone that surrounds it, while the newly formed bone matures and increases in density, eventually growing to match the adjacent bone in strength and vitality. If the tooth or teeth that were extracted are to be replaced, the bone is usually stable enough to support an implant within 6 to 8 months of the initial extraction; this can be determined with an examination and dental x-rays.

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