Post tooth extraction swelling. -

The characteristics of normal swelling. | Estimating how much to expect with your extraction. | How to prevent, minimize and bring down post-operative swelling.

It's not uncommon for a person to develop swelling after having a tooth pulled. And even though the precise amount that forms can vary widely among patients, there's a standard set of remedies used to minimize and manage it.

For the most part, this involves two phases:

Tissue swelling guidelines.

1) Characteristics.

a) Does swelling always occur?

Any tooth extraction has the potential to trigger postoperative tissue swelling. But the amount that actually occurs will vary from person to person, and procedure to procedure.

b) When is it most likely to occur?

As a rule of thumb, comparatively easier, less involved extractions are less likely to result in tissue swelling. The determining factor is generally the level of trauma that's been created during the surgical process.

Extractions that involve the following factors tend to create a comparatively higher level of surgical trauma.

  • Extensive soft tissue manipulation - The more the dentist must work with and handle the soft tissues that surround the tooth being removed, the greater the level of surgical trauma that's created.

    For example, the tissue might need to be incised and reflected back out of the way (flap procedure) so the dentist has adequate access to the tooth.

  • Bone tissue removal - In some cases (e.g. impacted or broken teeth), some of the bone tissue surrounding a tooth must be trimmed away before it can be removed. This creates a higher level of surgical trauma than when this step is not needed.
  • Extended surgical time - Increased procedure time typically correlates with a higher level of surgical trauma.


c) What's the normal course of events?

  • Post-surgical swelling typically peaks 2 to 3 days (48 to 72 hours) after your procedure. It may not be readily apparent initially until the day following your surgery.
  • It frequently involves aspects of the mouth, cheek, eye and side of the face, on the same side as the extraction site. There may be some bruising (black and blue areas) present too.
  • By day 4, the swelling that's formed should start to subside.
  • In most cases, it fully resolves by day 7 after the procedure.
  • On the 4th day, if your swelling hasn't begun to subside, or has shown evidence of increasing, you should contact your dentist so they can determine if an underlying problem exists.
  • Swelling that persists beyond 7 days should be evaluated by your dentist too.

d) How much should you expect?

Different types of tooth extractions typically involve different levels of surgical trauma, and therefore result in different degrees of swelling.

  • Run-of-the-mill extractions - If the tooth you're having removed is reasonably intact and has a relatively normal positioning in your jawbone, it's likely that your dentist will be able to tease it out without too much difficulty.

    If so, you may not experience any significant amount of swelling at all. Or, if you do, it's usually only mild and easily managed.

  • Difficult extractions - Teeth that are extensively decayed, broken or break during the extraction process may require additional surgical steps (tissue flapping, bone trimming) to remove. That can make these extractions comparatively traumatic. And as a result, mild to extensive swelling may form.
  • Impacted teeth - Extracting impacted teeth (like wisdom teeth) typically requires reflecting back gum tissue and removing (sometimes significant) quantities of bone.

    It would seem fairly unrealistic not to expect at least some, if not significant, swelling after having one removed. The extraction of lower wisdom teeth can be especially involved and therefore result in substantial swelling.

e) Where will the swelling occur?

Generally speaking, any swelling that forms will be in the soft tissues directly adjacent to your surgical area. (For example, it wouldn't be expected that having a back tooth pulled on the right side would cause tissue enlargement on your left side.)

However, larger amounts of swelling will involve ever more distant tissues.

  • With relatively atraumatic extractions (cases where minimal tissue damage has occurred), only the inside of your cheek immediately adjacent to your surgical site may show any sign of fullness or enlargement.
  • With more difficult procedures (like surgical extractions or removing several teeth), the amount of swelling that occurs may be quite extensive. It may extend around your mouth or into the side of your face. Even the soft tissue surrounding your eyes can be affected.

2) Treatment.

Stage 1: Minimizing the total amount of swelling that forms.

a) Cold (ice) application.

You can help to minimize the amount of postoperative swelling that forms by applying cold packs to the outside of your face in the region of your extraction site. This process can be started immediately following the completion of your surgery.

Here's an outline of a way that this technique can be implemented.

  • Select a cold source.

    You can use an ice bag, baggie or a surgical glove (ask your dentist for one) filled with ice. Or you might use a cold pack purchased from your local pharmacy, or even just a bag of frozen vegetables, like peas. This last suggestion works well because the bag will tend to conform to the shape of your face.

    Wrap the cold source you have chosen in a dish towel.

  • Application.

    Hold your cold source firmly against the outside of your face in that region directly adjacent to where your tooth has been pulled.

    Apply the cold pack for 15 minutes. Then, remove it and leave it off your face for 15 minutes. (15 minutes on, 15 minutes off.)

  • Treatment time frame.

    As best you can, repeat this on/off cycle over the course of the first 18 to 24 hours following your extraction.

    Beyond 24 hours this technique becomes less and less effective. Dentists vary in their opinion (so ask yours) but cold treatment is typically terminated in the range of 24 to 48 hours after your surgery took place.

  • Precautions.

    On the day of your extraction, you may still be numb. So, be careful not to create a temperature extreme that you might not be aware of. Cold application should only be performed during waking hours.

Why does cold (ice) therapy work?
  1. The cold environment created by an ice pack causes the blood vessels in the area to constrict (become narrower).
  2. This constriction in turn reduces the total volume of fluids that can be transported by and ooze out of the vessels into the surrounding tissues.
  3. As a result, a lesser amount of swelling forms.

b) Additional remedies.

Positioning your head so it's blood pressure is slightly reduced can help to minimize the amount of swelling that occurs.

  • The general idea is to keep your "head above your heart."
  • As opposed to lying down, sit (or recline) up right.
  • When lying down, elevate your head using 2 or 3 pillows.

Stage 2: Bringing the swelling down as quickly as possible.

Swelling that forms in response to the tissue trauma created during the extraction process can be expected to peak around 2 to 3 days after your surgery (48 to 72 hours). Once this point has been reached, you can help to bring it down more quickly via the application of warm compresses.

a) Heat application.

  • Select a heat source.

    A hot water bottle, moistened towel, or a heat pack purchased from your pharmacy can be used.

  • Precautions.

    The goal is to warm the swollen area, not to burn or scald it. So, manipulate the temperature of your heat source accordingly.

    Moist heat will be less irritating to your skin. So wrap your heat source in a lightly moistened dish towel. Lubricating your skin with petroleum jelly can help to minimize irritation too.

  • Application.

    Hold the heat compress against your face in the region of the swelling.

    Leave it in place for 20 minutes, then remove it and leave it off for the next 20. (20 minutes on, 20 minutes off.)

    Repeat this routine for several cycles, multiple times throughout your waking day.

  • Treatment time frame.

    This technique shouldn't be used until that point when your swelling has finally reached its peak, which is generally considered to be 48 to 72 hours after your extraction.

    That would typically mean starting this process on day 3 or 4 after your surgery. Dentists vary in precisely what they recommend, so you'll need to check with yours.

    This technique can then be used over the following days as you feel is required, until your swelling has resolved. Remember, this process doesn't bring your swelling down immediately, only more quickly than it would have otherwise. It may still take several days.

Why does heat therapy work?
  1. The warmth of the heat compress causes the blood vessels in the area to dilate (become enlarged).
  2. While dilated, the blood vessels are able to carry away the fluids that have caused your swelling more efficiently (a greater volume of liquid per unit of time).
  3. As a result, your swelling goes down more quickly.

Pay attention to your progress.

As mentioned above, swelling typically starts to resolve on its own by about day 4 after your surgery. If at this point it remains the same or has increased, you should report this fact to your dentist. Swelling that hasn't fully subsided by day 7 should be reported to your dentist also.


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