Healing of gum tissue after wisdom tooth extraction

Many patients are curious about the progress of gum tissue healing after wisdom tooth extraction and how long the recovery takes. Wisdom tooth extraction can be a simple or complicated procedure and alveotomy (removal of wisdom teeth) falls into the category of complicated extractions. This procedure should be entrusted to an oral surgeon’s hands because sometimes complications may arise. One of them is slow healing of the gum tissue.

Why is wisdom tooth extraction sometimes very complicated?

Wisdom tooth extraction, also known as third molar extraction, is an oral surgical procedure in which the tooth is separated and removed from the tooth socket (also called dental alveolus).

The difficulty of the extraction depends on several factors:

• shape
• size
• position
• location of the tooth in the jaw.

When it is assessed that the tooth extraction will be challenging, it means that it is necessary to remove part of the gum tissue, bone, or both.

Although they erupt last, wisdom teeth often cannot fully erupt or remain trapped due to some obstacle. Therefore, we talk about impacted or retained wisdom teeth, depending on whether it is a mechanical obstruction or some other obstruction. As long as the wisdom tooth does not cause problems, we do not recommend its extraction.

During the extraction, a scalpel is used to make an incision in the gum tissue (gingiva). Very often, due to the size and position of the tooth, it needs to be sectioned into several pieces to be removed. While complicated tooth extraction usually takes a few minutes, the extraction of wisdom teeth (third molar) sometimes takes longer than half an hour.

Is recovery from wisdom tooth extraction painful?

Wisdom tooth extraction does not hurt because it is performed under local anaesthesia, but the patient may feel pressure on the tooth or hear the cracking of the bone. After the local anaesthesia wears off, the patient may start to feel pain and it is recommended to take pain relievers (analgesics).

How does the patient’s recovery progress – healing of the gum tissue after wisdom tooth extraction

When an oral surgeon removes a tooth, the wound is sutured, and a thick layer of gauze is placed on it, which the patient needs to bite down on firmly to stop bleeding and initiate the healing process. This means waiting until a blood clot forms. The gauze is usually removed after 15-20 minutes and the patient is then sent home.

Swelling, mild bruising and discomfort are entirely common occurrences. These can last from 3 to 14 days, depending on the patient’s sensitivity. We recommend applying cold compresses to the side of the face where the tooth was extracted.

After a tooth extraction, the body forms:

• a blood clot
• a new bone tissue.

How does the gum tissue heal after wisdom tooth extraction?

Placing sterile gauze on the sutures immediately after tooth extraction and stitching the wound to stop bleeding is the first step in the gum tissue healing process. We advise patients to bite down firmly on the gauze and hold it in place for about 20 minutes without talking to create strong pressure on the wound and prevent further bleeding. The next phase is the formation of a blood clot, which is a sign that the gum tissue healing after wisdom tooth extraction is progressing naturally.

How long does it take for the wound to heal?

Healing of the gum tissue after wisdom tooth extraction is not a straightforward process – a new blood vessels begin to form on the third or fourth day and two weeks later, the wound is covered with new mucous membrane.

After 2-3 days, the wound becomes whitish due to the rinsing of red blood cells by saliva and the proliferation of fibrin, which is a normal healing process. During this time, new blood vessels are formed and the new mucous membrane develops within two weeks. Bone regeneration takes the longest; starting six weeks after extraction and ending six months after tooth removal.

Guidelines for proper gum tissue healing after wisdom tooth extraction

The first 24 hours are crucial for proper wound healing and the patient is strictly advised to:

○ Avoid touching the wound with their fingers or tongue.
○ Avoid sneezing or coughing in the first hour after the extraction.
○ Avoid raising their arms above the area of tooth extraction, because the increased blood pressure can cause additional bleeding.
○ Rest, because stress-free rest ensures normal blood pressure, which helps blood clotting, i.e. wound healing.
○ Not to sleep on the side where the tooth was removed during the first few days to prevent the wound from unnecessary overheating.
○ In the first few days, eat liquid or soft, mashed (puréed) cold food or food at room temperature and avoid hot, crispy, hard or granulated food to avoid irritating the gum tissue or allowing food particles to get trapped in the wound between the sutures.
○ Avoid spicy and sticky food.
○ Avoid hot drinks and carbonated (fizzy) beverages.
○ Bite on the opposite side of the extracted tooth.
○ Not to rinse their mouth for 48 hours after tooth extraction, especially with alcohol-containing mouthwash.
○ Avoid drinking alcoholic beverages for the first 24 hours.
○ Not to smoke in the first few days after the procedure, especially not in the first 24 hours.
○ Avoid any kind of physical exertion for the first two days.
○ It is not advisable to drink through a straw due to the suction pressure that can cause bleeding.
○ Not to expose themselves to the sun on the first day after tooth extraction. The patient should forget about sunbathing for a few days!
○ Initially, avoid brushing the wound and the area around it until it begins to heal properly.

Possible complications after wisdom tooth extraction

Slight oozing of blood is a common occurrence one or two days after wisdom tooth extraction, but if bleeding persists and becomes more significant, one should consult a dentist immediately.

Complications include:

• Gum infection
• Alveolitis
• Bleeding that does not decrease or stop even after 24 hours
• Premature elimination of the blood clot, which can lead to painful inflammation
• Reduced sensation in the mouth and lips even after the local anesthesia wears off
• Fracture of the jawbone, which can occur if the wisdom tooth extraction was exceptionally complicated
• An opening in the sinus cavity after a tooth is removed from the upper jaw.

Practice shows that a high percentage, up to 96%, of tooth extractions go smoothly without any problems. Although complications occur in 4% of cases, this issue needs to be taken seriously due to the potential occurrence of a dry socket.

Dry socket (Alveolar Osteitis or Alveolitis Sicca)

A dry socket represents a disruption in wound healing. The condition of a dry socket occurs when blood does not form a clot at the site where the tooth was extracted. Synonyms for dry socket include painful socket, dry socket, local osteitis and alveolar neuritis.

It should be noted that a dry socket does not occur solely because a blood clot fails to form; it can also occur due to its premature separation from the tissue. Therefore, we mentioned that the patient should not touch the wound with their tongue immediately after extraction, nor should they rinse their mouth vigorously in the first few days. In fact, the bone is exposed, and nerve endings become more exposed, which is quite painful and slows down the healing of the gum tissue after wisdom tooth extraction. This usually occurs on the second or third day after tooth extraction.

A dry socket is a common occurrence with impacted or trapped teeth, especially wisdom teeth. If this happens to you, do not attempt any self-treatment. Instead, seek the assistance of a dentist or oral surgeon who will stimulate bleeding at the wound site to create a new blood clot.

Are you a smoker and need to have a wisdom tooth extracted? Keep in mind that alveolitis most commonly occurs in smokers who continue smoking immediately after tooth extraction.

Infection

You should promptly visit a dentist if you notice any signs of infection:

• High body temperature and fever
• Persistent bad breath even after brushing your teeth
• Bitter taste that does not go away after rinsing with saltwater
• Intense, continuous pain despite taking pain relievers
• Swollen gums
• Swollen glands in the neck
• Pain at the extraction site
• Tooth sensitivity
• Numbness in the mouth
• Swelling that does not subside
• Excessive bleeding that does not stop
• Pus within the open wound.

If the blood clot disintegrates, which can occur 2-3 days after tooth extraction, it leads to local inflammation of the socket wall, making wound healing more challenging. Intense, strong, and sometimes throbbing pain usually occurs 3-4 days after tooth extraction, especially at night while lying down. More intense pain occurs after traumatic extractions and during tooth extractions when inflammatory processes are ongoing.

Did you know that predisposing factors for pain include:

• inadequate and insufficient nutrition?
• lack of vitamins E and D?
• failure to form a blood clot?
• dislodgement of the blood clot?
• infection of the blood clot?

Torn nerve endings are exposed to external mechanical, chemical and thermal irritations or are irritated by toxins from bacteria.

Treatment objective

Before establishing a diagnosis of alveolitis, an X-ray of the socket is taken to ensure that no fragments of the root, foreign bodies or alveolar bone have remained in the wound, as these can cause pain. The goal of alveolitis treatment is to form a new blood clot that should fill nearly the entire socket.

Due to these complications, we recommend that you entrust the extraction of wisdom teeth to the most experienced hands, those of an oral surgeon who specializes in this procedure and possesses the skills and special instruments for wisdom tooth extraction.