What does this mean?
After an extraction the socket fills with blood, the clot that forms covers the wound, and new tissue begins to build underneath it. This process has a pain curve of its own: pain is at its highest on the first day and then eases a little each day. In other words the expected direction is downwards, and the need for painkillers falls as healing goes on.
What tells the causes apart is not how severe the pain is but what it does on which day. Pain that had begun to ease and then returns on the second or third day, stronger than before, suggests that the clot covering the socket has not stayed in place. Pain that never eases, pain with numbness alongside it, and pain that carries on although the extraction site looks healed are separate paths from one another.
Where the pain travels also carries information. Pain spreading to the ear and the temple, fluid passing into the nose after an upper back tooth has been taken out, bare bone visible in the socket, or lasting numbness in the lower lip each point towards different structures. Pain that continues while nothing can be found at the extraction site is a heading of its own; where pain is felt is not always where the damage lies.
Pain that carries on after an extraction is most often to do with the healing process itself, although the nerve, the neighbouring sinus and the bone can all enter the picture. Which day the pain began and where it spreads settles much of the distinction.
Likely causes
What helps at home?
- Note down day by day which day the pain started, whether it is rising or easing, and where it spreads; this course is the most telling piece of information at the examination
- Do not poke the socket with your tongue, your finger or anything sharp; you may dislodge the tissue that is only just forming
- Take painkillers in the way your dentist has told you; pressing a tablet against the wound or the gum causes a chemical burn
- Do not start leftover antibiotics on your own decision; medicine taken before the cause has been seen clouds the picture and delays the assessment
- If the pain is rising rather than easing after the second or third day
- If numbness in your lower lip, your tongue or your jaw is continuing
- If fever, facial swelling or difficulty opening your mouth has joined the picture
- If water passes into your nose when you drink, or foul-smelling discharge comes from your nose
- If you can see bare bone at the extraction site and the area has not closed for weeks
Frequently asked questions
- How many days does pain last after an extraction?
- In healing without problems, pain is at its highest on the first day and then eases steadily over the following days; it settles noticeably within a few days. The direction is what matters. If the pain rises again after it had begun to ease, it needs to be assessed even if only a short time has passed.
- If I start antibiotics, will the pain go?
- The most common cause of severe pain after an extraction is not infection but the loss of the clot covering the socket, and in that picture antibiotics do not take the pain away. Starting medicine before it has been seen which cause is involved does not change the outcome and delays the treatment that would help.
- My pain carries on but the extraction site looks normal, is that possible?
- It is possible. Pain that carries on while the socket looks healed can be to do with an injury at a nerve ending, or with the pain itself having become persistent. If this picture is not recognised, healthy neighbouring teeth may be treated unnecessarily; that is why what the pain is like matters more than where it is felt.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.