Healing Of the Extraction Socket

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:

  1. Healing by first intention (Primary union) and
  2. 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:

Dry socket:

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:

  1. Smoking
  2. Alcohol consumption
  3. Diet of the patient
  4. General health of the patient
  5. Genetic predisposition
  6. Age of the patient
  7. Use of birth control pills
  8. Infection
  9. Length of surgery
  10. Antibiotic prophylaxis
  11. Degree of difficulty of extraction
  12. Expertise of the surgeon
  13. Oral hygiene maintenance by the patient
  14. Certain medicaments

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.



 User Comments on -  Healing Of the Extraction Socket

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Posted By : karen on 04-Jul-2015 02:58 AM
I have had a bottom back molar removed and now have dry socket . I am in excruciating pain after 3 days . My dentist put zinc packing in and was great but after 4 hours it came out . Now in agony again .

Posted By : Justin on 24-May-2014 08:00 PM
I had a molar extracted about 1 week ago and although there isn't a whole lot of pain there is like a black or dark red substance inside the extraction site. Is this a blood cot or is this something else like food? Also when is possible to go back to eating regular food without having to worry about the blood clot becoming dislodged?

Posted By : Bill Smith on 25-Nov-2013 06:50 AM
5 weeks after extraction although I have no pain it seems like there is a bulbous skin flap in the socket which moves about with the tongue or when eating food. It seems only to be anchored to the base of the socket not to the sides.I am type 2 diabetic. Should I be concerned or will it gradually disappear?

Posted By : Anamika Singh on 27-Aug-2012 09:09 AM

Posted By : Dr.Ritz on 21-Aug-2012 12:35 AM

Dear KATE, If the problem isn't subsiding then immediately report to the doctor who did your extraction and also consult a physician as delayed healing can be due to certain metabolic disorders. And you need to extra-precautious regarding your oral habits in case of infection post extraction.


Posted By : Kate on 20-Aug-2012 11:49 PM
Hello, to cut a long story short I had a very stubbon infection prior to tooth extraction, infection had cleared up enough for extraction to take place but very quickly infection took hold again AND I have a dry socket. I have been on various anti biotics for 5 continues weeks now and the infection just isnt clearing coupled with the dry socket I am in awful pain. I have now been refered to a hospital and am waiting for appointment. Extraction took place 6 days ago, how long can I expect this pain to go on for/when should I heal? I am a fit non smoking, non drinkinng 24 year old

Posted By : Mike on 11-Aug-2012 01:56 PM
Very imformative

Posted By : Dr.Ritz on 25-Jul-2012 12:35 AM
Dear EV, No the clot will not fill the whole cavity. Clot is actually a thick healthy coating that shields the area from outside bacteria and thus prevents infection. You don't need to worry as your extraction site is healing properly and it is not necessarily that the clot of two adjacent teeth should be connected. they can heal separately. Take care of not to poke the extraction site and brush gently using a soft bristles tooth brush. Even if in case you are suspicious then you can get your extraction site clinically evaluated.

Posted By : Dr.Ritz on 25-Jul-2012 12:35 AM
Dear EV, No the clot will not fill the whole cavity. Clot is actually a thick healthy coating that shields the area from outside bacteria and thus prevents infection. You don't need to worry as your extraction site is healing properly and it is not necessarily that the clot of two adjacent teeth should be connected. they can heal separately. Take care of not to poke the extraction site and brush gently using a soft bristles tooth brush. Even if in case you are suspicious then you can get your extraction site clinically evaluated.

Posted By : Ev on 24-Jul-2012 01:02 PM
Very informative article. Does the clot usually fill the whole cavity after extraction? I had a 2-root molar extracted 5 days ago, and I seem to have a clot in one root cavity and a clot in another one, but no clot "in between" It looks like two "root holes" are filled with clot, but it is dry between them. Does it look like a beginning of dry socket? I have to take 800 ibuprofen religiously to keep the pain at bay still :(

Posted By : Dr.Ritz on 23-Apr-2012 10:14 PM
Sharon, you don't need to worry as the pack will automatically come out after the healing process has completed. Don't prick or disturb that socket area as it may dislodge the clot. Moreover try n maintain good oral hygiene, do warm saline rinses twice daily, have liquid diet and don't use straw. If in case the pain is still there after the gauze pack is removed that consult your dentist immediately.

Posted By : Sharon on 23-Apr-2012 08:04 PM
I had 2 teeth extracted (right next to each other) and 1 of them started a dry socket and I went back to the dentist and he put that medication on gauze and stuffed inside the extracted area, and he told me it should come out by itself, probably the next day. However, it has now been 3 days and it is still there. Should I pull it out myself or should I leave it there or should I call the dentist again?

Posted By : smriti pradhan on 20-Dec-2011 09:08 AM
its really nice... thanx 4 ur information

Posted By : Dr Ritz on 11-Nov-2011 01:46 AM
Zinc oxide eugenol dressing is given to patient in case of dry socket for pain relief. Healing process doesn’t speed up with medicated dressing but it relieves the pain of patient. In case of dry socket, severe, throbbing radiating pain occurs which doesn’t regress by pain meds and antibiotics so zinc oxide eugenol dressing is given after cleaning the socket. Swab with medicated dressing is to be changed after 12-24 hours if pain persists.

Posted By : amphrey grace on 10-Nov-2011 07:04 AM
In the event of applying Zinc Oxide Eugenol to treat a dry socket, probably with a swab, can,t that swab be trapped in the socket as bone remodeling occurs? Thanks.

Posted By : Ariyo on 26-Oct-2011 10:47 PM
This is simply explanatory- nice job. kudos!

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