Tooth Extraction / Allogenic Bone Graft

You have just had a tooth extracted. Proper care in the hours and days following your procedure is essential to promote healing, prevent infection, and avoid complications such as dry socket. Please read and follow these instructions carefully.

The first 24 hours — critical period

The first 24 hours are the most important for healing. A blood clot will form in the extraction socket — protecting this clot is your top priority.

• Bite firmly on the gauze pad placed over the extraction site for 30–45 minutes after your appointment. If bleeding continues, replace with a fresh piece of gauze and bite for another 30 minutes.
• Do NOT rinse, spit forcefully, use a straw, or smoke — the suction and pressure can dislodge the blood clot and lead to dry socket.
• Do NOT touch the extraction site with your tongue, fingers, or any object.
• Apply an ice pack to the outside of your cheek — 20 minutes on, 20 minutes off — for the first 24 hours to minimize swelling.
• Keep your head elevated, even while resting or sleeping. Use an extra pillow to prop your head up.
• Avoid strenuous physical activity for at least 24–48 hours — increased blood pressure can restart bleeding.

Managing bleeding

Some oozing and light bleeding mixed with saliva is normal for the first 24 hours and may make your saliva appear pink or red. This is expected.

• If active bleeding occurs, fold a clean piece of gauze into a firm pad, place it directly over the socket, and bite down with steady pressure for 30–45 minutes without checking.
• A moistened tea bag can be used as an alternative — the tannic acid helps promote clotting. Bite firmly for 30 minutes.
• Avoid rinsing or spitting, as this disrupts clot formation.
• If heavy bleeding does not slow or stop after 1–2 hours of direct pressure, contact our office or go to an urgent care clinic.

Swelling & bruising

• Swelling is a normal part of healing and typically peaks at 48–72 hours before gradually improving.
• Apply ice packs during the first 24 hours only — 20 minutes on, 20 minutes off. Ice is not effective after the first day.
• After 48 hours, switch to warm moist heat to help resolve swelling and stiffness.
• Bruising on the cheek, jaw, or neck may appear 2–3 days after the procedure. This is normal and will fade over 7–10 days.
• Keeping your head elevated — including while sleeping — helps reduce swelling.

Pain & discomfort management

• Begin taking pain medication before the local anesthetic wears off so you stay ahead of the discomfort.
• Ibuprofen (Advil®, Motrin®) is preferred when possible — it treats both pain and inflammation. Take as directed on the label with food.
• Acetaminophen (Tylenol®) can be alternated with ibuprofen for stronger pain control.
• If prescription pain medication was provided, take it as directed and avoid driving or operating machinery while taking it.
• Pain should gradually improve each day. If pain suddenly worsens after 3–4 days, this may indicate dry socket — contact our office promptly.
• Avoid aspirin, as it thins the blood and can increase bleeding.

Dry socket — know the signs

Dry socket (alveolar osteitis) occurs when the blood clot is lost or fails to form, exposing the underlying bone. It is the most common complication after extraction.

• Symptoms typically appear 3–5 days after extraction and include a sudden increase in pain, a throbbing ache that may radiate to the ear or jaw, and a visible empty or grayish socket.
• Dry socket is more common after lower molar extractions, in smokers, and in patients taking oral contraceptives.
• It is NOT an infection, but it is very painful. Contact our office if you suspect a dry socket.
• Do NOT try to treat dry sockets at home. Call us as soon as possible.

Eating & drinking

• Wait until the numbness has fully worn off before eating to avoid biting your cheek or tongue.
• Eat soft, cool foods for the first 24–48 hours: yogurt, applesauce, mashed potatoes, smoothies (eaten with a spoon — no straws), scrambled eggs, soup (lukewarm, not hot).
• Avoid hot foods and beverages for the first 24 hours — heat can dissolve the blood clot.
• Do NOT use a straw for at least 72 hours — the suction can dislodge the clot.
• Chew on the opposite side of your mouth and gradually return to a normal diet as healing allows, typically within 3–7 days.
• Avoid alcohol for at least 24 hours, or longer if you are taking prescription pain medication or antibiotics.
• Stay well hydrated — drink plenty of water.

Oral hygiene

Keeping your mouth clean is essential for preventing infection — but you must be gentle around the extraction site.

• Do NOT rinse your mouth at all for the first 24 hours.
• Starting the day after your extraction, rinse gently with warm salt water (½ tsp salt in 8 oz warm water) after meals and before bed. Let the water fall out of your mouth — do not spit forcefully.
• If prescribed a chlorhexidine rinse (Peridex®), begin using it as directed the day after your extraction.
• Brush your teeth normally, but avoid the extraction site for the first 24 hours. After that, brush very gently around the area.
• Do not use an electric toothbrush directly over the extraction site until the socket has closed (approximately 1–2 weeks).
• Avoid flossing immediately adjacent to the extraction site until your provider confirms it is safe at your follow-up.

Activity & lifestyle

• Rest for the remainder of the day following your procedure.
• Avoid strenuous exercise, heavy lifting, or vigorous activity for at least 48–72 hours — physical exertion raises blood pressure and can restart bleeding or dislodge the clot.
• Do not smoke or use any tobacco or nicotine products for at least 72 hours (2 weeks if bone graft placed) — ideally longer. Smoking is the single greatest risk factor for dry socket/graft failure and significantly delays healing.
• Avoid alcohol for at least 24 hours or while taking prescription medications.
• Sleep with your head elevated on an extra pillow for the first 1–2 nights.

Medications & antibiotics

• If antibiotics were prescribed, begin taking them as directed and complete the entire course — even if you feel better before finishing.
• Take all medications with food to minimize stomach upset.
• If you experience a rash, hives, difficulty breathing, or other signs of an allergic reaction, stop the medication and seek emergency care immediately.
• Inform our office of all medications you currently take, as some can affect healing or interact with prescribed medications.

Allogeneic bone graft & ridge preservation

A bone graft was placed in your extraction socket today to preserve the bone and prepare the site for a future dental implant or other restoration. The graft material is derived from a carefully processed and sterilized donor source. Please follow these additional instructions to protect the graft and support healing.

Protecting the graft site

• Do NOT disturb the graft site. Avoid touching, probing, or pressing on the area with your tongue, fingers, or any object.
• Small white or tan granules near the extraction site are normal — this is graft material. If a larger amount of material falls out or you are concerned, contact our office.
• A membrane or collagen plug may have been placed over the graft to contain the material and protect healing. Do not attempt to remove it — it will either dissolve on its own or be removed at your follow-up appointment.
• Avoid pulling or stretching the lip to look at the site, as this can stress the sutures and disrupt the graft.

What to expect during healing

• More swelling, bruising, and discomfort than a standard extraction is normal and expected — this reflects the additional procedure performed.
• The graft site will appear to fill in and close over the coming weeks as soft tissue heals. Full bone maturation takes 4–6 months.
• Sutures placed over the graft site should not be disturbed. They will either dissolve in 2–3 weeks or be removed at your follow-up appointment.
• You will be scheduled for a follow-up visit at approximately 1–2 weeks to assess soft tissue healing and graft integrity, and again at 4–6 months before implant placement or the next phase of treatment.
• A cone beam CT (CBCT) scan may be taken prior to implant placement to assess the volume and quality of bone regeneration.

Your follow-up & healing timeline

Healing occurs in stages. Here is a general timeline of what to expect:

• 24–48 hours: Blood clot forms and stabilizes. Swelling peaks around day 2–3.
• 3–5 days: Pain and swelling begin to decrease. Soft tissue begins to close over the socket.
• 1–2 weeks: Gum tissue closes over the extraction site. Most discomfort resolves.
• 3–6 months: The underlying bone gradually fills in and remodels completely.

A follow-up appointment may be scheduled to check healing. If stitches were placed, we will advise you on their timeline — dissolvable sutures typically dissolve within 7–10 days. Non-dissolvable sutures will need to be removed at a follow-up visit.

If you are interested in replacing the extracted tooth, please ask us about your options — implants, bridges, and partial dentures are all available. We recommend discussing tooth replacement sooner rather than later, as the bone in the extraction area begins to resorb over time.

Questions or concerns? We are here to help. Call 512-472-5633 or email info@koladentistry.com.

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