Did you know that not every wisdom tooth extraction needs a follow up appointment? Sure, the severely impacted ones typically do have one follow up visit but the fully erupted ones may not. That is a fairly standard protocol across most dental offices.
Although that may leave you wondering about your healing progress after the surgical procedure. Not to be captain obvious but there is a giant gaping hole where that third molar used to be. How would your dentist even know if your wisdom tooth hole is healthy and healing the right way?
Surprisingly, your body’s healing capabilities are more powerful than you might think because most of them heal uneventfully. Nonetheless, we’ll walk you through the recovery process so that you can be assured and get rid of your worries.
Healthy wisdom tooth hole
A healthy wisdom tooth hole should be devoid of symptoms.
- No pain
- No irritation
- No swelling
- No bleeding
- No inflammation
- No purulence (pus)
If you’re experiencing any of the signs or symptoms from above, it may be an indication that your socket is not healthy.
Normal progression of wisdom tooth socket healing
After the extraction, the wisdom tooth hole progresses through multiple stages of healing before the gums close up. Each stage looks physically different from the next and it often looks “weird” to the average person. That is why we’re here to explain and describe to you what is a normal socket should look like at each step.
The four stages of a healthy healing wisdom tooth socket:
- Blood clot. You will see a blood clot inside of the socket on the first two days. It will look red or some variation of it. The purpose is to help stop the bleeding after the extraction.
- Granulation tissue. The next few days after the clot will transition over to the formation of granulation tissue. This new tissue essentially fills in the empty socket. Patients often describe its appearance as weird white stuff in the wisdom tooth hole.
- Black hole. Finally what comes after the granulation tissue would be a “black hole.” If you see a black hole in the wisdom tooth socket, it means you’re at the end stages of healing. It looks black because the gums have closed enough that light cannot easily reach into the hole. Since it is devoid of light, the socket will just look black.
- Fully healed. When the hole completely closes, the healing process is considered done. What you’ll see is just normal light pink gums.
Essentially the color of the hole will transition from red to white and then to black. Ultimately socket will completely close up and all you’ll see are pink gums.
Just in case, be sure to follow all of the aftercare instructions which will minimize the chances of complications and maximize your recovery.
Unhealthy wisdom tooth hole
An unhealthy wisdom tooth hole will come with a chock full of symptoms. All of them are unpleasant and none of them are what you would want.
- Pus in socket
- Exposed bone
These symptoms are usually a result of a post-surgical complication from taking out the wisdom teeth. There are a couple of conditions which manifest these symptoms.
- Dry socket
- Gum infection
- Uncontrolled bleeding
- Osteonecrosis of the jaw
A dry socket is a complication that occurs when the blood clot fails to form, thus leaving the jaw bone exposed. The exposed bone is extremely sensitive to external stimuli and that makes it a very painful post-op condition.
Signs of a dry socket:
- Missing blood clot
- Worsening pain
- Exposed bone
The gums can get infected afterwards if you don’t keep the surgical site clean. Food and various debris can become lodged into the gums thus causing it to swell up.
Signs of a gum infection:
- Presence of pus
It’s not common but sometimes you can end up with an abscess even after the tooth has been removed. This can happen if some of the bacteria escape the cleansing and repopulate. It is more likely to happen if you weren’t prescribed antibiotics after the procedure.
Signs of an abscess:
- Severe facial swelling
If your tooth socket is bleeding uncontrollably without any signs of stopping, that is the very definition of an unhealthy wisdom tooth hole. Healthy ones should cease bleeding after biting on gauze for about 3 hours.
If it continues to bleed beyond that despite using gauze, it may indicate that you’ve an undiagnosed bleeding disorder. If that is the case you need to contact your dentist as soon as possible to have it stopped. Afterwards you should check with your primary care physician to get a definitive diagnosis.
Osteonecrosis of the jaw (ONJ)
A rare complication after wisdom teeth removal is osteonecrosis of the jaw, which is when the jaw bone does not heal. The socket stays open and leaves exposed bone. Most commonly, this condition is related to taking medication (bisphosphonates) for osteoporosis.
Symptoms may include the following:
- Exposed bone
How to tell when socket is healed
The wisdom tooth hole is considered fully healed when it has completely closed and it is asymptomatic. On average, it takes about 4-6 weeks for complete socket closure.
If you’re healthy without any medical conditions, the time it takes will be on the shorter end. If you’ve pre-existing medical conditions such as diabetes or bleeding disorders, it may take longer for it to heal.
What if it doesn’t close?
Every wisdom tooth socket should close when given enough time. The only exception where we see failure for closure is if you have osteonecrosis of the jaw. Typically that only happens if you have some type of bone disorder that prevents bone remodeling and healing.
Most often we see ONJ as a result of patients taking bisphosphonates for osteoporosis. The bisphosphonates is a type of medication which prevents your body from breaking down bone. Unfortunately, breaking down bone and repairing it are a necessary part of the healing process for a wisdom tooth hole.
This is why dentists always screen patients for whether they have osteoporosis and if they are taking any bisphosphonates. If you do, you may need your extraction to be done with a specialist or at a hospital.
For the most part, you can consider your wisdom tooth hole to be healthy if you are devoid of any symptoms. As long as it is not bothering you, you should have faith in your body’s immune system and its ability to repair itself. In due time, the socket should close all on its own without any intervention from you.
However there are rare instances where complications may arise and you can end up with an unhealthy third molar socket. Typically all of these conditions will present with symptomatic signs. You’ll know because something will feel off about it!