After a tooth extraction: what's normal, and what isn't.

The moment a tooth is removed, a blood clot forms in the empty socket. That clot is not a problem — it is the foundation of healing. Over the following days the gum begins to close over it, and over the following months new bone gradually fills the space underneath.

Most of what you feel in the first week — a dull ache, mild swelling, a tender gum — is simply this process under way. Knowing the normal pattern makes it much easier to tell ordinary healing apart from the few things worth a phone call.

• Day 0–1: as the anaesthetic wears off, expect a mild-to-moderate ache and perhaps a little pink-tinged saliva. Light oozing on the first day is normal.
• Day 2–3: any swelling tends to peak here, then settles. Discomfort is usually well controlled with simple over-the-counter pain relief.
• Day 3–7: a clear, steady improvement. The gum starts to close over the socket and eating becomes easier.
• Week 2–3: the gum surface has usually healed over. The bone underneath keeps filling in quietly for several months.

The key signal is direction: pain should ease day by day. Pain that worsens after day 2–3 is the exception worth checking.

A metallic or slightly unpleasant taste, or a touch of bad breath, is common in the first few days. It comes from the healing clot, small amounts of trapped food, and the fact that you are rinsing and brushing the area more gently than usual. As the socket closes, it fades on its own.

After the first 24 hours, gentle warm salt-water rinses, keeping the rest of your mouth clean, and staying well hydrated all help. What is not routine is a persistent foul smell or taste combined with throbbing pain — that points to infection or dry socket, covered next.

Dry socket happens when that protective clot is lost too early — usually from smoking, drinking through a straw, or vigorous rinsing in the first day or two. The bone underneath is left exposed.

Signs: a sharp, throbbing pain that starts 2–4 days after the extraction (rather than easing), often spreading to the ear on that side, a bad taste or smell, and a socket that looks empty rather than clotted.

It is not dangerous, but it does need a dentist to clean and dress the socket — which relieves it quickly. To prevent it: no smoking, no straws, and no forceful rinsing or spitting for the first 24–48 hours.

First 24 hours: if it oozes, bite gently but firmly on clean gauze for 20–30 minutes. Do not rinse, spit, smoke, or use straws. Stick to soft, cool or lukewarm foods, and take any pain relief as advised.

After 24 hours: rinse gently with warm salt water two or three times a day, especially after meals. Brush your other teeth normally and clean carefully around (not into) the site. Keep hydrated, and ease back to firmer foods as comfort allows — avoiding hard, crunchy, spicy or very hot foods near the socket for several days.

Most extractions heal without any trouble. Contact a dentist promptly if you notice:

• bleeding that will not slow after 30 minutes of firm gauze pressure;
• severe or worsening pain after day 2–3, rather than improvement (possible dry socket);
• a fever, spreading swelling of the face or jaw, or pus (signs of infection);
• numbness that does not return once the anaesthetic should have worn off.

Difficulty breathing or swallowing is a medical emergency — seek urgent care, not a routine appointment.