Tooth extraction is the process that involves removal of a tooth from the mouth. Nowadays, the incidence of tooth extraction has been reduced due to the modern methods of saving and restoring teeth such as fillings, root canal treatments and periodontal treatments.
Despite all the modern treatments teeth still need removal, if they are grossly destroyed with decay extending into the roots, loose or fractured teeth and the teeth that require removal due to orthodontic alignment of teeth.
The tooth extraction initiates a series of reparative processes involving both hard tissue (bone) and soft tissues (tooth-supporting fibres and gums).
In general, extraction socket takes one to six months for your gums and bone to heal completely after the extraction.
It is important to know that hard and soft tissues regenerate at different rates. However, you can get back to the normal routine within 3- 5 days when the pain and swelling subsides.
Now let’s get into the details of what happens at the site of surgery at the cellular level vs what you see in the mouth.
Stages of tooth extraction healing
Tooth extraction healing takes place in three stages,
• An inflammatory phase
• A proliferative phase
• A maturation phase
The early or inflammatory stage (First 3 days post-extraction)
The inflammatory phase is characterised by constriction of the injured blood vessels and the collection of circulating platelets that adhere or stick to each other to form a clot at the site of injury.
Once the bleeding stops, vascular permeability increases allowing blood plasma (containing white blood cells and other cellular mediators of healing) to pass through the vessel walls into the area of surgery.
The platelets also produce growth factors and mediators involved in the formation of new blood vessels (capillaries) and the attraction of more white cells.
What do you see during the first 3 days after tooth extraction?
The changes during the first 3 days brings redness, pain, swelling and an increase in the temperature of the wound .
The intermediate or proliferative stage (4th- 14th days postoperatively)
This stage is characterised by the formation of new blood vessels in the cells and fibre rich mesh called granulation tissue. The entire clot is replaced by a pink granulation tissue within a week.
The platelets also activate fibroblasts – the cells that produce collagen fibres. Collagen fibres are rich in protein and function to bind tissues together and provide them strength.
This phase also activates the epithelial cells to start migrating towards the wound edges in an attempt to close it.
What do you notice during the second stage after tooth extraction?
During this stage, gums grow to close the socket opening, the pink colour of the tissue returns and scar tissue forms to fill the socket cavity.
Last phase or Remodelling stage (3rd-20th weeks postoperatively)
During this stage, the randomly placed collagen fibres begin to organise into a dense network that provides strength to the tissue. The small capillaries aggregate into larger vessels.
Finally, bone mineralization begins with the deposition of calcium and phosphate ions. The initial immature bone appears as fingerlike projections within the matrix.
The fingerlike calcified projection joins with the neighbouring projections and transforms into the mature bone. The bone formation takes 24 weeks or more to complete after extraction.
What do you see during the last stage after tooth extraction?
The features noticed during this period are smooth, pink and intact gums and the obliteration of the socket hole.
Factors affecting the healing of extraction Socket
Everyone doesn’t share the same rate of healing. Healing of extraction socket varies with the complexity of the surgical procedure, the type of tooth and the patient’s health status.
• Surgical extractions involve cutting the bone and soft tissues to remove the whole tooth.
Simple extractions, on the other hand, involve luxating the tooth with hand instruments without much damage to bone and soft tissues.
Due the increased tissue damage, surgical extractions take longer to heal than the simple or uncomplicated extractions.
• Back teeth or molars are large teeth with multiple bulbous roots than the incisors and premolars. Therefore, molars take much longer to heal than any other tooth in the mouth.
• The presence of medical conditions like uncontrolled diabetes impairs the normal healing process. Therefore, special care is needed in such patients to allow the healing to occur.
When to call a dentist?
A tooth extraction normally takes 7-10 days to heal. Older patients and smokers take longer to heal. Proper care after the extraction is important to prevent any complications.
If you experience the following symptoms call your dentist.
• Persistent or worsening pain (during first 3 days could be a dry socket).
• Nausea or vomiting
• Persistent bleeding
• Discharge from the extraction site