1. How long does the anesthetic last?
Generally, the anesthetic lasts 2-4 hours depending on the type, amount, and injection technique. When anesthetic is injected in the lower teeth, patients will feel numb for a longer time and over a wider area compared to injections in the upper teeth.
2. How many days does it take for a tooth extraction wound to fully heal?
The wound from tooth extraction appears as a socket or hole shaped like the root of the extracted tooth. On the first day after extraction, blood will ooze from the wound. Then the blood will start to clot and form a plug to stop the bleeding. After that, the body will repair the tissue attachment, build bone, and epithelial tissue in sequence. When the extraction wound fully heals, the socket will close and be covered by the gums.
Normally, patients will have blood oozing on the first day. When biting on gauze, the bleeding will gradually decrease until it stops. The extraction wound will gradually heal, become shallower, and smaller within 1 week, but it takes about 1 month for the wound to fully heal.
3. How long does it take for a wisdom tooth surgery wound to heal?
Generally, if the wisdom tooth surgery is not complicated, the healing time is similar to other tooth extractions, which is within 1 week. However, if the surgery is complicated, involving tooth or bone cutting, the healing time may be longer than usual.
For wisdom tooth surgery or extraction with sutures, patients should return to the dentist for examination and suture removal 7-14 days after the extraction.
4. How should you take care of yourself after tooth extraction or wisdom tooth surgery?
- After tooth extraction or wisdom tooth surgery, bite on the gauze firmly for about 1 hour before spitting it out. If bleeding continues, bite on a new clean piece of gauze for another hour.
- If bleeding does not stop after extraction or surgery, do not suck on ice. Instead, use ice wrapped in cloth or a cold gel pack to apply externally on the area of extraction or surgical wound.
- Do not rinse your mouth or use mouthwash on the first day. If necessary, rinse gently because rinsing may dislodge the blood clot and cause pain at the wound site.
- Brush your teeth as usual but be careful around the extraction or surgical wound.
- If you experience pain, take painkillers as prescribed by your dentist. For some patients prescribed antibiotics, complete the full course to prevent infection.
- Do not use fingers, toothpicks, or any objects to pick or poke the wound, and do not suck on the wound.
- You may work and carry on daily activities as usual but avoid heavy exercise.
- Do not drink alcohol or smoke during the first few days.
- If you experience any abnormal symptoms, promptly return to see your dentist.
- For surgical wounds or wisdom tooth surgery wounds, apply ice wrapped in cloth or cold gel packs within 1-2 days after surgery to reduce swelling and pain.
- Return to the dentist for suture removal about 7-14 days after surgery.
5. What is the appropriate age for wisdom tooth surgery?
The appropriate age for wisdom tooth surgery is 16-20 years because at this stage the roots are not fully developed, about ½ to 2/3 of the root length. The bone covering the wisdom tooth is not very hard, making it easier to cut the bone and tooth, reducing damage to the adjacent molar tissues. This age group is generally healthy, usually without chronic diseases, with good healing ability. Surgical wounds heal quickly, bone regenerates fast, and complications are minimal or mild.
Therefore, people in this age range should be examined for the presence of wisdom teeth in the mouth and have an X-ray to check the position and condition of the wisdom teeth so the dentist can plan appropriate treatment.
6. What are the consequences of leaving wisdom teeth untreated?
- Causes inflammation of the gums covering the wisdom tooth (Pericoronitis) due to food debris trapped under the gum flap covering the wisdom tooth, combined with bacterial infection, causing gum inflammation, pain, swelling, and redness.
- Causes decay in adjacent teeth because the wisdom tooth pushes against them and food debris gets stuck in the tight spaces, making cleaning difficult.
- Causes periodontal disease (Periodontitis) because the wisdom tooth pushes against adjacent teeth, exerting pressure on the bone around the tooth roots, leading to bone loss on the side of the teeth, causing periodontal problems such as tooth mobility and gum recession.
- Resorption of adjacent tooth roots due to pressure from the wisdom tooth.
- For patients with removable dentures who have undetected impacted wisdom teeth embedded in the bone under the gums, prolonged denture use may cause pressure on the gums, leading to bone resorption covering the wisdom tooth. The wisdom tooth may then emerge from the bone or gums, requiring surgery at an older age when health may be poorer and surgery more complicated.
- May cause cysts and tumors of the wisdom tooth (Odontogenic cysts and tumors).
- May cause unexplained toothache or headache.
- Impacted wisdom teeth in the jawbone weaken the bone in that area. If injured or subjected to trauma, the bone may fracture more easily than normal.
- For orthodontic patients, wisdom teeth should be removed to facilitate orthodontic treatment or prevent crowding after treatment, as pressure from wisdom teeth may cause teeth to tilt or newly erupted wisdom teeth may interfere with retainers fitting properly.
7. What symptoms occur after surgery and how severe are the pain and swelling?
- After wisdom tooth surgery, patients may experience complications such as bleeding from the wound, wound inflammation, and possible numbness.
- If bleeding occurs, bite firmly on gauze for 1-2 hours. Bleeding will slowly ooze during the first 24 hours and then gradually stop.
- Wound inflammation symptoms include pain, swelling, redness, heat, and loss of function in the area, such as limited mouth opening. Usually, inflammation is temporary and symptoms gradually decrease within 2-3 days.
- Pain after tooth extraction is usually mild and can be relieved with painkillers. Pain typically appears within the first 12 hours after extraction and gradually decreases, lasting no more than 2 days.
- Swelling usually occurs during the first 2-3 days and then subsides. Ice wrapped in cloth or cold gel packs can be applied to the surgical area to reduce pain and swelling. If swelling worsens, infection may be present, and the patient should return to the dentist for further treatment.
- Numbness after wisdom tooth surgery is uncommon and mostly occurs with lower wisdom tooth surgery due to nerve injury or trauma during surgery in deep positions. Patients may feel numbness in the lips or tongue, reduced sensation similar to anesthetic effect, or tooth sensitivity in the lower front teeth. Speech, mouth movement, and hearing are usually unaffected. If the nerve supplying the tongue is affected, patients may feel tongue thickening, tingling, or altered temperature sensation. This usually recovers normally but may take from 2 weeks to 1 year depending on the severity of nerve trauma. Sometimes vitamin B supplements are given to help nerve recovery and reduce numbness.
8. If pain persists severely after surgery or extraction and painkillers do not help, and it is a symptom of Dry Socket (Alveolar osteitis), what should be done?
- Dry socket (Alveolar osteitis) commonly occurs after tooth extraction, especially lower wisdom tooth surgery. It happens when the blood clot in the socket dissolves partially or completely, leaving the bone surface exposed. This usually occurs 3-4 days after extraction, causing moderate to severe pain that may radiate to the ear and head. The extraction wound may have a foul odor and abnormal taste. The wound appears gray due to inflamed tissue. The exact cause is unknown but may be due to several factors such as:
- Difficult tooth extraction or wisdom tooth surgery causing injury to the bone socket.
- Infection causing dissolution of the blood clot in the socket.
- Frequent rinsing or sucking on the wound after extraction or surgery causing the blood clot to dislodge, or smoking.
If patients have these symptoms, they must return to the dentist for treatment as follows:
- Take an X-ray to check for foreign objects or remaining tooth roots.
- Clean the extraction wound with saline. Gray decomposed blood clot debris may come out but do not curette (scrape) the wound as it may interfere with healing and increase pain.
- Apply medication to relieve pain inside the extraction wound. Various medications include analgesic dressing, which is gauze soaked with pain relief medicine (clove oil mixed with vaseline). If infection is present, iodoform gauze (gauze soaked with iodoform powder mixed with glycerine) may be used, or Alvogyl, which has both pain relief and antiseptic properties. Alvogyl is a brown fibrous material placed directly into the socket. Its components include Butamben (anesthetic), Eugenol (pain relief), and Iodoform (antiseptic).
- Patients should return for wound cleaning and medication changes daily or every other day for 3-6 days depending on pain severity.
- Take painkillers to relieve symptoms. Antibiotics are not necessary for all patients.
Treatment of dry socket aims to reduce pain from the extraction or surgery wound, not to speed up healing. Normally, if untreated, pain will gradually decrease and resolve on its own but may take 10-20 days.
Dr. Pinthura Chantravaradit
Orthodontic Specialist Dentist
Dental Center, Phyathai 2 Hospital
