Patient Guide
After your tooth extraction: a day-by-day guide
Healing after an extraction is mostly about protecting the blood clot in the socket for the first few days. Here is what to do, day by day, with a checklist you can print.
Reviewed by Dr. Claudio Tocchio, Oral & Maxillofacial Surgeon, Dentistry at Vitality Health
After a tooth extraction, bite firmly on gauze for 45 minutes to an hour, then rest and leave the socket alone for the first 24 hours: no rinsing, spitting, straws, smoking or hot food. From day two, rinse gently with warm salt water after meals and eat soft foods. Most discomfort peaks on day two or three and improves from there. Pain that gets worse after day three may be a dry socket and needs a call to us.
When a tooth is removed, a blood clot forms in the empty socket. That clot is the start of healing: it protects the bone and nerve endings underneath and becomes the scaffold for new gum and bone. Almost every aftercare rule in this guide comes down to one aim: keep the clot in place for the first three days.
This guide applies to simple and surgical extractions, including wisdom teeth. If you were given specific instructions for your case, those take priority. Our extractions are carried out by Dr. Claudio Tocchio, our oral and maxillofacial surgeon, and our general dentists. See simple and surgical extractions for what the procedure involves.
What should I do in the first 24 hours?
- Gauze. Keep firm, steady pressure on the gauze pad for 45 minutes to an hour, however soggy it gets. Then take it out. Replace it with a fresh, folded, slightly dampened pad only if bleeding is still active. A little oozing that tints your saliva pink for the first day is normal. Constant bright red bleeding is not.
- Protect the clot. No rinsing, no spitting, no straws, no smoking or vaping, and do not poke the socket with your tongue or finger. All of these create suction or disturbance that can pull the clot out.
- Rest. Take the day off strenuous activity and keep your head raised, including on an extra pillow that night. Exercise raises blood pressure and restarts bleeding.
- Cold. A cold pack or a bag of frozen peas wrapped in a towel on the cheek, 20 minutes on and 20 minutes off, limits swelling on the first day.
- Pain relief. Take the first dose before the freezing wears off, as directed. Over-the-counter ibuprofen and acetaminophen, alternated or combined as we advise, manage most extraction pain. Avoid aspirin unless you take it daily for medical reasons, because it increases bleeding.
- Eat and drink. Soft, cool or lukewarm foods once the freezing has worn off, so you do not bite your numb lip or cheek. Drink plenty of water, from a glass.
Days 2 and 3: rinsing, food and swelling
From the morning after your extraction, start gentle salt-water rinses: half a teaspoon of salt dissolved in a cup of warm water, held over the area after meals and before bed, then allowed to fall out of your mouth rather than spat. This keeps the socket clean without disturbing the clot. Brush your other teeth normally but stay away from the socket itself.
Swelling and stiffness usually peak on day two or three, then start to go down. After the first 48 hours, switch from cold to warm compresses, which help the swelling drain. Some bruising on the cheek or neck is normal after a surgical extraction and fades within a week or two.
Soft foods that work well: soups (not hot), scrambled eggs, yogurt, smoothies eaten with a spoon, mashed potato, oatmeal, pasta, well-cooked fish, soft bread without crusts, applesauce and ice cream. Avoid seeds, nuts, popcorn, chips and anything crunchy that can lodge in the socket.
Days 4 to 7: getting back to normal
By the end of the first week the socket is closing over and most people are eating normally, chewing away from the site and still avoiding very hard or sharp foods. Continue the salt-water rinses until the gum has sealed. If stitches were placed, they usually dissolve within one to two weeks or are removed at your follow-up visit.
A little sensitivity and a firm feeling at the site are normal. Discomfort should be clearly improving every day. If it is not, read the dry socket section below and call us.
Smoking, vaping, alcohol and the dairy myth
Smoking and vaping
Do not smoke or vape for at least 72 hours, and for as long as you can after that; the Canadian Dental Association advises two weeks. The suction pulls at the clot, and nicotine and heat reduce blood flow to the socket. Smokers have several times the risk of dry socket and heal more slowly. If you use nicotine patches or gum, this is a good week to rely on them. Ask us about support if you would like to quit.
Alcohol
Avoid alcohol for at least 24 hours, ideally longer, and for as long as you are taking prescription pain medication or antibiotics. Alcohol thins the blood, irritates the wound, and interacts with many medications.
The dairy myth
You may have read that you must avoid dairy after an extraction. There is no good evidence for this in healthy patients, and it does not appear in Canadian guidance. Yogurt, milk and ice cream are soft, cool and useful in the first days. The one exception: if you are prescribed certain antibiotics, such as tetracyclines, dairy can interfere with absorption, and we will tell you.
How do I manage the pain?
Most extraction pain is well controlled with over-the-counter medication taken on a regular schedule for the first two to three days rather than waiting for pain to build. For many patients we recommend ibuprofen and acetaminophen together or alternated, at the doses on the packaging, unless a medical condition or another medication rules one of them out. Prescription pain medication is rarely needed after a simple extraction and is used for a short time after more complex surgery.
Pain should be at its worst on day one or two and then improve daily. Pain that stays severe or gets worse after day three is not normal healing. Read on.
What are the warning signs of dry socket?
A dry socket (alveolar osteitis) happens when the blood clot is lost or breaks down before the socket has healed, leaving bone exposed. It affects roughly two to five per cent of extractions, more often after lower wisdom teeth, in smokers, and in women taking oral contraceptives. It is very uncomfortable but not dangerous, and it is easily treated.
The signs: a throbbing ache that starts or worsens two to four days after the extraction, often spreading toward the ear or along the jaw; pain that is not controlled by the medication that worked on day one; a bad taste or smell; and a socket that looks empty or greyish rather than filled with a dark clot. If you have these, call us the same day. We will gently clean the socket and place a soothing medicated dressing, which relieves the pain within minutes to hours. Read more on our dry socket page.
When should I call the office?
- Bleeding that does not slow after 30 minutes of firm pressure on a fresh gauze pad, or that restarts heavily.
- Pain that increases after day three, or is not controlled by your medication.
- Swelling that grows after day three, or swelling with fever, a feeling of being unwell, or difficulty swallowing or breathing. Difficulty breathing is an emergency: go to the nearest emergency department.
- Numbness or tingling in the lip, chin or tongue that lasts beyond the day of the extraction.
- A bad taste or smell from the socket, or visible bone.
- Anything that worries you. We would rather hear from you.
Call (905) 479-7777. After hours, follow the instructions on our voicemail for urgent care, or see our emergency dentistry page.
Replacing the tooth: when can an implant be placed?
If the tooth is not being replaced right away, remember that the bone around an empty socket shrinks steadily in the first months. If there is any chance you will want an implant, the ideal time to protect the site is at the extraction itself with socket preservation, a small graft placed in the socket. If that was done, the implant is usually placed three to six months later. If it was not, we assess the bone with a 3D scan once healing is complete and plan from there.
In some cases an implant can be placed on the same day as the extraction. Whether that is possible depends on infection, the bone that remains and the position of the tooth; we will tell you at your consultation. See our page on missing teeth for the full range of replacement options.
Your printable aftercare checklist
Printable checklist
First 24 hours
- ☐ Bite firmly on the gauze for 45 minutes to an hour, then remove it. Replace only if bleeding is still active.
- ☐ No rinsing, spitting, straws, smoking or vaping.
- ☐ Rest, keep your head raised, and use a cold pack 20 minutes on, 20 off.
- ☐ Soft, cool foods only. Chew on the other side.
- ☐ Take pain relief as directed, starting before the freezing wears off.
Days 2 and 3
- ☐ Start gentle salt-water rinses after meals (half a teaspoon of salt in a cup of warm water). Let it fall out; do not spit hard.
- ☐ Brush your other teeth normally; avoid the socket.
- ☐ Soft foods: soups, eggs, yogurt, mashed potato, pasta, smoothies (spoon, not straw).
- ☐ Swelling peaks around day 2 to 3 and then improves. Switch to warm compresses after 48 hours.
Days 4 to 7
- ☐ Ease back to normal foods as comfort allows; still avoid hard, crunchy and very hot foods at the site.
- ☐ Continue salt-water rinses after meals until the socket has closed over.
- ☐ Stitches, if placed, dissolve or are removed at your follow-up.
Call us if
- ☐ Bleeding does not slow with 30 minutes of firm pressure on fresh gauze.
- ☐ Pain gets worse after day 3 instead of better, especially a throbbing ache spreading to the ear.
- ☐ Swelling increases after day 3, or you have a fever or difficulty swallowing or breathing.
- ☐ You notice a bad taste or smell, or can see bone in the socket.
- ☐ Numbness in the lip, chin or tongue lasts beyond the day of surgery.
Dentistry at Vitality Health · 4792 Highway 7 East, Markham · (905) 479-7777 · vitalitydentistry.com/extraction-aftercare
Common questions
When can I stop using the gauze?+
After 45 minutes to an hour of firm pressure, in most cases. Replace it only if bleeding is still active. Light oozing that colours your saliva pink for the first day is normal and does not need more gauze.
When can I rinse my mouth?+
Not at all for the first 24 hours. From the next morning, rinse gently with warm salt water after meals and before bed, letting the water fall out rather than spitting. Avoid commercial mouthwash, especially those with alcohol, for the first week.
When can I use a straw or smoke?+
No straws for at least three days; the suction can pull the clot out. No smoking or vaping for at least 72 hours, and ideally two weeks. Smoking is the single biggest avoidable cause of dry socket.
When can I eat normally?+
Soft foods for the first two to three days, then gradually return to your normal diet over the first week as comfort allows, chewing away from the site. Avoid hard, crunchy or seedy foods near the socket until it has closed over.
How do I know if I have a dry socket?+
Pain that starts or gets worse two to four days after the extraction, often throbbing and spreading toward the ear, with a bad taste or smell and a socket that looks empty. Normal healing pain improves each day; dry socket pain does the opposite. Call us the same day and we will treat it.
Sources: Canadian Dental Association: Care after minor oral surgery · Daly BJM, et al. Local interventions for the management of alveolar osteitis (dry socket). Cochrane Database of Systematic Reviews 2022
Questions after your extraction?
Call us at (905) 479-7777. If something does not feel right, we want to know today, not next week.