After the traumatic experience of having a tooth extraction, you probably couldn’t stop yourself from smoking. For smokers, drawing that puff can take the edge off of your anxiety and decrease the mental stress.

We understand that smoking may be a coping mechanism for you but you need to be aware of the consequences of doing so after an extraction. Is it worth the risk or should you knuckle down and try to find an alternative in the meantime?

Table of Contents

Adverse effects

Smoking after an extraction may lead to many deleterious consequences for wound healing and socket closure.

Dry socket. A dry socket is an extremely painful dental condition that may develop after a tooth extraction. It happens when the blood clot fails to form. One study found that 13.2% of cigarette smokers developed the condition after an extraction.
Non-stop bleeding. The suction pressure from inhaling cigarette smoke can dislodge the blood clot. If the clot comes out, the extraction site will begin bleeding again until another clot is able to form.
Delayed healing. Smoking results in release of catecholamine which causes vasoconstriction and decreased blood perfusion. Since blood is the medium which transports the nutrients for healing, the socket healing will be delayed. Studies have shown that a single cigarette can reduce peripheral blood velocity by 40% in one hour.
Reduced bone regeneration. Studies have shown that high doses of nicotine will diminish osteoblast function and that leads to reduced bone regeneration. Osteoblasts are cells that are responsible for building and repairing bone.
Increased risk of infection. Smoking suppresses the immune system by affecting neutrophil function. The neutrophils are the body’s first line of defense against infection.

Overall, research has typically shown that smoking in general leads to more complications following surgeries or dental implant failures.

Note: If you received stitches after the procedure, having sutures does not make it any safer to smoke. You will still experience all of the adverse effects even with them in your mouth.

Side effects of smoking in general

Aside from the consequences of smoking after a tooth extraction, there are plenty of negative side effects on the mouth in general.

Carcinogenic. Smoking can cause various types of cancer such as in the lungs and even on the tongue. Can you imagine what the treatment would be for tongue cancer? It is exactly what you’re picturing.
Gum disease. Smoking is a risk factor for the extent and severity of periodontal disease such as gingivitis and periodontitis. Studies have shown that former smokers experience less attachment loss than current smokers but more than those who’ve never smoked. The more attachment loss you have, the higher the risk for to tooth loss.
Stains teeth. The tar from smoking will stain your teeth to a brown or black color. Unremoved tartar can also incorporate the smoking tar and make it even less sightly. You should be more vigilant with your dental cleanings if you’re a smoker.
Tooth decay. Smokers often develop dry mouth as a side effect. A decrease in salivary flow can increase the risk of getting cavities. Saliva offers a protective effect in buffering oral pH and also washing away bacteria.

Smoking and Dry socket

The most severe consequence of smoking after a tooth extraction is the increased potential of developing a dry socket. A dry socket (alveolar osteitis) is a dental condition in which the blood clot fails to develop in the tooth socket.

Due to the lack of a blood clot, you end up with sensitive exposed bone. The most painstaking result of that is an unbearable excruciating toothache. Our patients often tell us that it feels worse than before the infected tooth was extracted. That is how bad it can be and hopefully it’ll dissuade you from doing it.

How smoking leads to alveolar osteitis is still a mystery. The mechanism still eludes clinicians and researchers even to this day. However, what we do know is that the process seems to be biological in nature and not mechanical. Intentionally removing the blood clot via smoking, spitting, rinsing, or drinking through a straw does not result in a dry socket.

What are my chances of getting it from smoking?

It is not guaranteed that you’ll end up with a dry socket if you smoke but it’ll certainly increase the chances of you getting it. Here are some accompanying statistics from a research study.

Dry socket prevalence = 4.8% (838 total extractions)
Non-surgical extractions = 3.2%
Surgical extractions = 20.1% of dry sockets
Smokers (9.1%) had 3x the risk vs non-smokers (3%)
Prevalence for single tooth extractions (7.3%) vs multiple teeth removal (3.4%)

None of the studies reported 100% certainty of getting the condition if you smoke. However you’re basically gambling if you choose to take a puff of that cigarette.

Does it matter what you smoke?

There is no difference in developing a dry socket from what you smoke. They will all increase the chances of you getting the condition.

Cigarettes
Weed (marijuana)
Cigars
Shisha (water pipe)
Hookah

There was one study which compared shisha smoking with cigarettes and they found no statistical difference. The conclusion was still smokers having three times the risk as a non-smoker.

Smoking with stitches

Unfortunately, even if you had stitches placed in the socket, it will not prevent you from getting alveolar osteitis. Once again, researchers are uncertain as to how it develops but we do know it is a biological process. Mechanically placing sutures will not prevent it.

What to do if you smoked

There is no way to undo the effects of smoking after you’ve done it nor is there anything you can do to fix it. If you end up with a dry socket then that is unfortunate. If nothing happens then consider yourself lucky. After all, smoking merely increases the chances of you getting it and does not guarantee it.

Nevertheless, please try your best to NOT smoke if you can because the condition is extremely painful if you get it. We’re warning you that it is not worth the risk at all.

Treatment

There is no cure for alveolar osteitis because only palliative treatment exists. Your dentist can help you lessen some of the pain but cannot get rid of it for you. You will have to bear through it until it heals on its own. Yes, it will go away on its own when given enough time.

Induce bleeding. Drill small holes into the jaw bone to stimulate bleeding for healing.
Curettage and irrigation. Scrape the inside of the socket and irrigate it.
Place stitches. Having stitches may decrease food, water, and air from touching the exposed bone.
Dry socket paste. A special eugenol based medication in the form of a paste that can be placed inside of the socket. It was designed to be soothing and help alleviate socket pain. The dry socket paste is typically left inside of the hole for 3-5 days. It does not need to be removed since it gets washed out all on its own during the healing process.
Mouth rinse. Frequently rinsing with salt water can help reduce pain and promote healing by keeping the surgical site clean. It’ll also reduce chances of dry socket.
Pain medication. Ibuprofen, acetaminophen, or even opioids can help reduce pain.

When can you smoke after a tooth extraction?

You should wait at least 5 days after your tooth extraction before you attempt to smoke again.

Studies have shown that the onset of dry socket symptoms generally occurs within 2-4 days after an extraction. We recommend waiting at least 5 days, which gives you an extra day as a buffer. The 2-4 days is the average but you could always be an outlier, which is why we suggest adding a day to be extra safe.

As a disclaimer, there is a possibility that 5 days may not be enough for your particular situation… Honestly, the best thing to do would be to quit smoking altogether if you wanted to minimize the chances of getting it.

Smoking 24 hours after tooth extraction

Smoking within 24 hours after an extraction is the most dangerous time to smoke. Studies have shown that smoking on the first day has the highest chance of getting a dry socket. The incidence of it was statistically significant when compared to the second day.

Smoking the first day is the worst.
It is safer to smoke on the second day than the first.
Risk decreases with each subsequent day.

How to smoke after tooth extraction without getting dry socket

It is near impossible to prevent dry socket from smoking after an extraction because we don’t even know what causes it. The research data simply shows that smoking increases your risk by a factor of three but there is no explanation as for why.

Nonetheless, there has been some advice which is disseminating around the internet about smoking with gauze. To be crystal clear, smoking with gauze will not prevent a dry socket after a tooth extraction. However we do have to say that doing so with gauze is better than not using it at all.

How to smoke with gauze after an extraction:

Fold gauze in half twice to form a small square.
Place gauze over the socket.
Smoke as you usually do.
Discard gauze after you’re done.

Just to reiterate, we do not believe that using gauze will decrease the chances of you developing alveolar osteitis. We also do not condone smoking for any reason.

Smoking after wisdom teeth removal

Dry socket is a potential complication after wisdom teeth extractions and smoking only increases the risk for it.

As a matter of fact, the chances of developing the condition actually increases in the case of impacted wisdom teeth removal. According to one study, the incidence was 1-5% for all extractions but could be up to 38% for mandibular wisdom teeth.

One of the current theories is that traumatic extractions may cause alveolar osteitis. Of course the most traumatic extractions are the severely impacted third molars.

Takeaway

There are many adverse effects from smoking after getting your tooth removed but the most prominent would be a dry socket. It is an extremely painful condition which will make you wish you never smoked.

Please try not to smoke for at least 5 days after your procedure. Although you may still be unlucky and end up with the condition even if you waited that long! That’s just a disclaimer.

Last but not least, don’t forget to review all of the dos and don’ts for tooth extraction aftercare. It’s not just smoking that you have to avoid!

I Smoked After a Tooth Extraction