After tooth extraction, recovery of the extraction socket starts immediately. Bleeding occurs in the socket and nourishes the tooth socket. To control the bleeding, simple pressure is applied by the gauze. It also helps in formation of blood clot in the socket. Blood clot promotes the healing process. After 1-2 days, the socket is filled by soft tissue. Growth of the bone surrounding the socket occurs later and the socket is filled completely.
Tooth Extraction Recovery
In cases of simple tooth extraction, recovery occurs in 7-10 days whereas in case of surgical extraction, it may take 3 weeks to 3 months for recovery to take place depending on the degree of damage to the dental tissues. In cases of simple extraction, healing after 7-10 days is good enough that a person can eat hard and crusted food without any pain or discomfort. Healing in the oral cavity is faster as compared to the skin because of rich blood supply of the area. If a cut is there on the skin, then it takes longer time to heal than a cut in the oral cavity.
Healing of the extraction socket
There are 5stages of healing of the extraction socket:
Stage 1- Hematoma and clot formation
Stage 2- Granulation tissue formation
Stage 3- Replacement of granulation tissue by connective tissue
Stage 4- Replacement of connective tissue by fibrillar coarse bone
Stage 5- Replacement of immature fibrillar coarse bone by mature bone
Immediately after the extraction, bleeding occurs in the extraction socket and there is clot formation inside the socket. Clot refers to the thick, viscous, coagulated mass of blood. There is vasodilatation of blood vessels of periodontal ligament and migration of leucocytes in and around the clot. As the clot contracts, the gum tissue which is unsupported after the extraction, cover and place the clot at its position. The hours after the Tooth Extraction are critical, for if the blood clot is dislodged, the Tooth Extraction recovery may be greatly delayed and may be extremely painful.
Within a week, granulation tissue is seen around the clot and there is proliferation of cells around the socket. There is organization of clot and alveolar socket margins are resorbed.
Healing is the body's response to injury in an attempt to restore normal structure and function.
Healing occurs by 2 ways:
Healing by first intention (Primary union) and
Healing by second intention (Secondary union)
In case of healing by primary intention, there is not much loss of cells and tissues. The ends of the flap will approximate in some time and the tooth extraction recovery will occur in some time whereas in case of healing by secondary intention, there is extensive loss of cells and tissues. The ends of the flap don't approximate and the healing occurs from bottom to the top and from margins inwards. Healing by secondary intention is slow as compared to faster healing by primary intention.
Healed Extraction Socket
Complications in Tooth Extraction Recovery:
It is a post-operative socket which lacks the physiological clot both in quality and quantity in which the blood clot disintegrates exposing an infected necrotic socket wall.
The condition derives its name from the fact that after the clot is lost the socket has dry appearance because of exposed bone.
It is also called as Alveolitis sicca dolorosa, Alveolalgia, Alveolar osteitis, Post-operative osteitis, Localized acute alveolar osteomyelitis.
It may occur due to frequent and forceful spitting after extraction, smoking or excessive traumatic extraction. Disintegration of clot may be due to infection of the wound. Bacterial enzymes hyaluronidase and fibrinolysin causes lysis of clot.
The bone of the socket becomes necrosed, grayish bone is seen from the socket and bad odor is present at the socket and pus is minimal or not at all.
For the treatment of dry socket, dressing of Zinc oxide Eugenol is placed in the socket and repeated after few days. Antibiotics and analgesics are not effective if used alone because of poor vascularity of the necrosed bone.
Fibrous healing of the Extraction wound:
Fibrous healing of an extraction wound is an uncommon complication, usually following a difficult, complicated or surgical extraction of a tooth. It is found commonly when there is loss of periosteum along with loss of labial, buccal and lingual cortical plates.
This loss of cortical periosteum causes improper healing and scar tissues are found at the site. These fibrous connective tissue may ossify a little or not at all.
For the treatment, excision of the lesion for the purpose of establishing a diagnosis will sometimes result in normal healing and subsequent bony repair of the fibrous defect.
The various factors which affect the healing or the recovery of Extraction socket are:
Diet of the patient
General health of the patient
Age of the patient
Use of birth control pills
Length of surgery
Degree of difficulty of extraction
Expertise of the surgeon
Oral hygiene maintenance by the patient
Smoking: Smoking decreases extraction socket wound recovery. it decreases the blood supply to that area and brings toxic products to the area. Due to negative pressure because of smoking, the clot may get dislodged and cause dry socket occurs. That is why it is advised to avoid smoking for few days after the tooth extraction.
Smoking after Tooth Extraction and Delayed Healing
Alcohol consumption: Alcohol causes delay in the healing process. Alcohol consumption should be avoided by the patient few days after the tooth removal.
Diet of the patient: Protein, vitamins and minerals deficiency slows down the healing process.
General health of the patient: In cases of patients with diabetes, anemia, ischemia etc, the healing of the extraction socket will take place slowly than a normal healthy person.
Age: Healing is faster in young but is normal in old age unless associated with diabetes or ischemia.
Use of birth control pills: If a woman is taking birth control pills and gets her tooth extracted, then the chances of dry socket are more due to high level of estrogens. Dry socket delays the healing process.
Infection: In cases of infection like that in dry socket, delayed secondary healing occurs and it takes longer time for healing than the normal extraction socket healing.
Length of the surgery: The longer the surgery is, the more is the irritation to the gums and the surrounding tissues and more will be the healing time. Extraction socket with tooth removed with very little trauma to the surrounding tissues.
Tooth Removed with Little Trauma to Soft Tissue
Expertise of the surgeon: The aim of the dentist should be to cause as little laceration of the gums as possible. There should be minimum of trauma to the gums during the tooth removal. More is the trauma, more will be the time taken by the socket to recover after tooth extraction.
Oral hygiene maintenance: After the tooth extraction, the socket area should be kept clean. If there are food deposits around the socket, it will take longer time to heal. It is advised to maintain a good oral hygiene after the tooth removal, eat from the other side of the socket and keep the socket clean.
Medicaments: Certain medicaments like corticosteroids delay the healing process of the socket.
To promote faster healing and to avoid any complications, the patient should follow the instructions given by the dentist or the oral surgeon. Pain and discomfort occurs when the mouth heals. Following the instructions given by the dentist is all that is needed. The dentist should be informed if there is excess of bleeding, swelling, or persistent and severe pain or there is any reaction of the medications given by the dentist. The dentist should schedule a follow up examination to ensure that the socket is healing properly.