Ibuprofen is my preferred painkiller as it has a more pronounced anti-inflammatory effect- though paracetomol and aspirin can be effective too.

For children, a children’s paracetamol preparation is advised.

If the extraction has been difficult and much pain or swelling is expected, the dentist may give you a prescription for something stronger over the counter. Commonly this will be a paracetamol/codeine preparation.

In these cases, the dentist may also give some steroid preparation for the inflammation, though this is not routine.

Do I need Antibiotics?

Antibiotics are incredibly useful and can be lifesaving drugs, however, the world has come to associate the word ‘antibiotic’ with making them better, and so almost expect to be given them as a matter of cause when anything is wrong.

The problem is, antibiotics are for bacterial infections; they will not have any effect (except placebo) on viruses and different drugs are specific to particular bacteria.

There is no strong evidence to suggest that prophylactic antibiotics (those given to prevent infection from occurring -not just because you have infection), reduce the rate of infection. In fact because of this, the UK has stopped giving them to prevent bacterial endocarditis. They believe the risk of a reaction to the drugs is higher and more serious, thus outweighing the potential benefits. In Australia, we are still required to cover certain high-risk patients for this condition.

The more we use them inappropriately – giving them out ‘willy-nilly’, the greater the risk, or evolution of resistant strains on which they will simply not work. You may have heard of MRSA (methacillin resistant staphylococcus aeurus), a bacteria responsible for numerous deaths when outbreaks in hospitals occur.

This is exactly what I am referring to, our most commonly used and effective drug- penicillin, no longer affects this bacteria. Add this to the severe allergic and sometimes fatal anaphylactic reactions that are another result of misuse, or over-use and you can understand why we need to be selective about who we give them out to.

So what do I want from you? A favour 🙂 I do ask for them occasionally… Please do not put the doctor or dentist under pressure for antibiotics, you don’t even really need to ask. If it is appropriate for your condition, it will be prescribed – if it is not, then it will be for a good reason; not because they want to see you suffer, or because they have a limited quota, it is quite simple, they don’t (according to their medical knowledge) feel it will help you.

Antibiotics are reserved for people where the likelihood of delayed healing will lead to post- operative (after the operation) infection. Your doctor/dentist/ oral surgeon will make this decision based on both your medical history and the difficulty of the procedure. They will also liaise with any medical specialists whose care you are under, such as a heart or orthopaedic surgeon and follow any recommendations they provide.

Prophylactic Antibiotics are generally given for anybody who:

• Has had radiotherapy to the head and neck

• Is at risk from bacterial endocarditis (depends on the country)

• Has severely compromised immune systems

• Anybody the doctor/dentist believes to be at particular risk.

Should you get an infection in your socket following the tooth extraction, with pus discharge associated fever and swelling, antibiotics would likely be given.

How do I Know it is Healing?

As a general guide, it is going to hurt a bit when the anaesthetic wears off- expect it. The longer and more difficult the procedure, the more uncomfortable it may be. Good news is, big holes heal up pretty much the same as small holes and the mouth has a remarkable ability to heal because of the rich blood supply it receives.

For routine extractions, most of my patients say the first day/night isn’t too bad, day two and three are pretty uncomfortable and then life returns pretty much to normal- even though it will continue to be a bit sore. That is assuming you have managed to establish a nice clot and have followed the extraction aftercare instructions.

You should expect the socket after day three to continually improve- you may get the odd day where it feels worse, but the basic trend is that of getting better.

If it is getting worse or becomes very painful and doesn’t seem to be settling, call your dentist and have them take a look- you may have a dry socket or infection.

What Problems Might I get Afterwards?

• Bleeding 

The dentist should not let you go until a clot has formed, though for one reason or another this might start bleeding later. You are not going to die from blood loss from having a tooth removed and the measures described above, should be sufficient to stop or slow the bleeding. If you are concerned or in any doubt, just contact your dentist or if you are that worried, your local emergency department.

• Bits of bone 

I have mentioned this elsewhere in this series, that on occasions, some bits of bony socket may be pushed up during the healing process. This is not a bit of tooth and there is nothing to worry about. If you get a very large piece that doesn’t seem to be moving, then you can always pop back to your dentist to get it checked or removed if you are worried or if it is rubbing your gum or tongue.

• Dry socket

• Infection

How Long will Recovery Take? Do I need Time Off?

This depends on the difficulty of the extraction and on you.

A standard simple extraction might knock you around for a day or so; therefore you might want to plan it on a Friday so you have the weekend to recover. If you have four, heavily impacted wisdom teeth removed under general anaesthetic, I would imagine you are going to want at least a week to let the swelling and bruising go down, perhaps two.

I meet people with immensely high pain thresholds and those at the other end of the scale. There is so much variation. Some patients are good to go the same day; others take considerably longer to recover from a similar procedure.

The key is getting a good clot to form by following the extraction instructions carefully.

The initial healing period- to fully cover the socket generally takes a few weeks. The bone and gum however will continue to remodel over the next 6 months, after which point it will be pretty stable.

It is important to take this into consideration when planning to replace the missing tooth since the appearance of a bridge or implant may be affected, if it is placed too soon.

Can I Exercise?

Not on the day of the extraction- the rise in blood pressure will start you bleeding. One day off training isn’t going to set you back too much. You can exercise the next day if you feel up to it, again this will vary from person to person and on the type and difficulty of the extraction.

What can I Eat?

Eat whatever your feel like, but be careful of temperature while you are still numb. A soft diet for a couple of days is sensible because your jaw has often been pulled around a bit during the extraction, so chewing itself can be a bit sore. I recommend mashed potato, eggs, soups… all the food your mum cooks, or used to cook when you were ill- that sort of thing!

Should I use Mouthwash?

The warm salt rinses are very good for keeping your mouth clean and helping gently swill out food particles. I certainly wouldn’t go using anything like Listerine- ouch, that would sting like crazy and do you little good.

A gentle rinse with a chlorhexidine mouthwash (Savacol) a couple of times a day certainly won’t do you any harm and is what we would recommend when patients have had oral surgery and it is too painful to brush.