After a tooth extraction: what to eat, how long it hurts, when you can smoke and how to recognise dry socket

What should you do in the first hours after a tooth extraction?

In the first hours after a tooth extraction, one thing matters: that a blood clot forms in the socket and stays there. The advice from NHS hospitals agrees on this, and it is collected below in the order you will need it.

• Bite on a gauze pad and keep up the pressure for 10 to 15 minutes; if the bleeding returns, repeat with a fresh, damp pad.
• Do not rinse your mouth for 24 hours, even if you can taste blood.
• Do not chew for the first 4 hours, and take care not to bite your numb lip, cheek or tongue.
• Avoid hot drinks and alcohol for the first 24 hours.
• Do not smoke for at least 24 hours.
• Avoid exercise and heavy exertion for 48 hours.
• Take the painkiller recommended by the dentist before the anaesthetic wears off, following the leaflet and the dentist's advice.
• Brush your other teeth as usual, avoiding the area of the wound.

How does healing after an extraction go, day by day?

Healing after a tooth extraction follows a predictable rhythm: the first 2 to 3 days are the hardest, and after that pain and swelling ease with each day. After surgical removal of a wisdom tooth, pain and swelling can last up to 2 weeks (NHS), and after simpler procedures usually less.

The table brings together the advice of UK NHS hospitals (Guy’s and St Thomas’ and Newcastle) and the NHS website. If your dentist has given you different advice, follow theirs, because they know how your procedure went.

What can you eat after a tooth extraction?

After a tooth extraction, eat soft or liquid food until chewing becomes comfortable, usually for 1 to 2 days. Have your first meal only once the anaesthetic has worn off, because a numb lip and cheek are easy to bite or burn.

For the first days, foods that need no chewing are good: yoghurt, cottage cheese, scrambled eggs, cooled cream soup, mashed potato, porridge. Eat on the side opposite the wound, and do not pick food debris out of the socket with your tongue or a finger.

For the first few days, avoid hard and crunchy foods and anything that can get into the wound: nuts, seeds, pips, crisps. Put off hot food and drinks for at least 24 hours, and according to some advice for 2 days, because heat encourages bleeding.

How long does it hurt after a tooth extraction?

Pain after a tooth extraction is strongest in the first 24 hours and should ease after 1 or 2 days. After wisdom tooth removal, the NHS describes pain and swelling lasting up to 2 weeks, with improvement visible within the first few days.

More important than the pain itself is the direction it takes. Pain that lessens from day to day is part of healing. Pain that increases after a few days, does not respond to painkillers, or comes with an unpleasant taste, a fever or feeling unwell needs a check-up at the dentist.

Swelling behaves in a similar way: it appears within 48 hours, is usually at its peak after 2 to 3 days and goes down over the following week. Painkillers are chosen by the dentist to suit the patient's health and the other medicines they take.

The blood clot after an extraction: what does it look like and why does it matter?

The blood clot after a tooth extraction is a dark red plug of blood that fills the socket and protects the bone and nerve endings until new tissue grows over the wound. All the advice for the first 24 hours, from no rinsing to no smoking, serves one purpose: not to wash the clot out or disturb it.

Over the following days the surface of the wound may turn a lighter colour. If the pain is easing and the smell and taste in your mouth are normal, this is usually part of healing. An empty socket with visible bone instead of a clot, severe pain and an unpleasant smell point to dry socket.

Dry socket: symptoms, frequency and treatment

Dry socket (alveolar osteitis) is a painful condition in which the blood clot did not form properly or fell out before the wound healed. It usually appears 3 to 5 days after the procedure and causes increasing pain in the gum or jaw, an unpleasant taste and bad breath.

The review by Kolokythas et al. (2010) reports that dry socket occurs after 0.5 to 5% of routine extractions and after 1 to 37.5% of lower wisdom tooth removals, and about 10 times more often after surgical extractions. It occurred in 12% of smokers and 2.6% of non-smokers. Guy’s and St Thomas’ Hospital also lists the oral contraceptive pill as a risk factor.

Treatment of dry socket consists of gently cleaning the wound and placing a dressing with an antiseptic in the socket. If you suspect dry socket, see a dentist rather than waiting out the pain at home.

When can you smoke after a tooth extraction?

After a tooth extraction, do not smoke for at least 24 hours: that is the minimum break in the advice of the NHS hospital in Newcastle. The NHS website advises not smoking while the wound heals, because smoking increases the risk of infection.

Smoking also comes with a several times higher risk of dry socket: in the Kolokythas review it affected 12% of smokers and 2.6% of non-smokers. If a break from smoking while you heal will be hard for you, tell the dentist before the procedure so that they can take it into account in their advice.

Put off alcohol for at least the first 24 hours, because, like hot drinks, it encourages bleeding. If you are taking medicines after the procedure, ask the dentist whether they can be combined with alcohol.

When to see a dentist urgently, and when to go to the emergency department or call 112?

Most problems after a tooth extraction settle on their own, but a few symptoms need urgent help. Difficulty breathing, speaking or swallowing, swelling of the face or neck that grows quickly, and swelling reaching the eye are situations for the hospital emergency department (SOR) or a call to 112, the European emergency number.

Outside surgery hours there is the NFZ night and holiday dental service (NFZ is Poland's National Health Fund): on working days from 19:00 to 7:00, and round the clock at weekends and on public holidays. The free NFZ helpline 800 190 590 will tell you where the nearest point is.

• Bleeding that several rounds of pressure with gauze for 10 to 15 minutes do not stop: see a dentist urgently, and with heavy bleeding go to the SOR.
• Pain and swelling that are severe or getting worse despite painkillers: see a dentist urgently.
• Pain with an unpleasant taste in the mouth, a fever or feeling unwell: see a dentist urgently.
• Increasing difficulty opening your mouth: see a dentist urgently.
• Difficulty breathing, speaking or swallowing, swelling of the eye or sudden problems with vision: SOR or 112.
• Numbness of the lip, chin or tongue that has not gone by the day after the procedure: tell your dentist.

How aftercare following an extraction works at DentalBlue

DentalBlue in Białystok carries out extractions under local or general anaesthesia, and a follow-up X-ray can be taken in the clinic's own radiology unit. In the clinic's price list, the item “Opatrunek do zębodołu” (socket dressing) costs 100 zł, “Rewizja zębodołu z założeniem szwów” (socket revision with stitches) 200 zł, and removal of stitches placed at the clinic is free of charge. With pain you can come for a “Wizyta z bólem” (visit in pain: panoramic X-ray, consultation, examination and pain relief, 340 zł). The clinic is open Monday to Friday from 8:00 to 20:00 and on Saturdays from 8:00 to 16:00. The final scope and cost are set by the dentist, and prices may change.