What does a healthy tooth extraction site look like

Tooth extraction healing timeline. – Appearance changes and stages of extraction site healing. (The first-24 hours post-op to 4 weeks and beyond.)

– What’s normal? What will you notice? | How long does it take … for gum tissue to heal … and bone to fill in? | What will your extraction site look like during the process? – Pictures of tooth extraction healing stages.

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X-ray of an empty tooth socket.

How long does it take for a tooth extraction site to heal?

Once your tooth’s extraction procedure has been completed, you’ll no doubt want to know how long it will take for its socket to heal and what it should look like as it does.

So to provide an answer to these questions, we’ve broken this page’s discussion into the following time frames and stages:

• A) What you’ll notice during the initial 24 hours following your surgery.
• B) Healing progress during weeks 1 & 2.
• C) Healing progress during weeks 3 & 4.
• D) Bone tissue healing timeline (Details about how long it will take the hole in your jaw to fill in and close.)

Additional issues associated with the extraction healing process.

Since they’re closely related subjects, we also address the following questions on our website:

►  How much time will you need to take off after your extraction?

It only makes sense that you’ll need to know how long you may need to take time off or limit your activities after having your tooth pulled. Jump to page.

And while it is your dentist who is really in the best position to know, our page explains what factors can affect what you’ll end up needing to do.

►  When can future dental work be started?

In the case where a tooth that’s been pulled will need to be replaced, we explain how extraction site healing will affect the timing of this future dental work. Jump to section.

Things you’ll need to keep in mind while reading this page.

Wound size matters.

While the type of healing events that have taken place at any point in time will be similar for all extractions, it’s important to keep in mind that more involved (larger, deeper, wider) wounds simply take longer to heal over and fill in than comparatively smaller ones.

So, for example, that means if you’ve had a major procedure performed, like having a wisdom tooth surgically removed, you’ll need to expect that the total amount of healing time it requires will be greater than that needed for less involved extractions, like having a lower incisor or a baby tooth pulled.

Personal factors come into play too.

It’s important to keep in mind that the healing capacity of individuals varies. This is in part due to their differing genetic characteristics but also includes factors associated with the person’s current status, such as age, medical condition, and personal habits (e.g. smoking).

The preoperatory status of a tooth will also influence its extraction site’s healing timeline. For example, pathology associated with a tooth at the time of its removal, like the presence of infection due to gum disease, pericoronitis (infection around an impacted tooth), or endodontic status (teeth having infected nerve tissue) can prolong or complicate the healing process.

▲ Section references – Cohen

The stages of extraction site healing –

A) The initial 24 hours following your tooth extraction.

What tooth sockets look like immediately following the extraction process.

Blood clots have begun to form and fill in the sockets.

What will you notice? / What will your extraction site look like?

The amount of healing progress that you’ll be able to visualize during the first 24 hours after your surgery won’t look like much. But what has taken place is vitally important.

a) During the first 24 hours following your extraction, you should notice that …

• A blood clot has filled the tooth’s empty socket. (It’s the clot’s formation that actually triggers the healing process.)
• And the bleeding from your wound has stopped.  If not …, in cases where bleeding persists, it interferes with the formation of tissues that are needed for the healing process to progress.

b) Also during the first 24 hours …

• You’ll hopefully notice that the level of any discomfort associated with your extraction site has begun to slowly subside.
• You’ll probably find that the region immediately adjacent to the empty socket is tender when touched.
• Traumatized gum tissue immediately surrounding your socket may have a whitish appearance.
• It’s possible (especially in the case of a relatively involved or difficult extraction) that you’ll find some degree of swelling has already started to form, both in the tissues that surround your extraction site and possibly your face too.

  If so, this swelling should peak within the first 48 to 72 hours and then start to subside. What to expect. / Management.

What’s taking place with the gum tissue around your extraction site at this stage?

While you won’t really be able to notice anything, the creation of new gum tissue around the edges of your wound has already begun. This starts as early as 12 hours post-extraction.

What’s going on inside your tooth’s socket?

Immediately following your tooth’s extraction its socket will fill with blood and the formation of a clot will begin. The blood clot typically fills the socket up to the level of the gum tissue surrounding it.

The clot itself is composed of platelets (sticky cell fragments that initiated the clot’s formation) and red and white blood cells, all embedded together in a fibrin gel. (It’s the fibrin gel that gives the clot its semi-solid consistency.)

Starting at this point, and continuing on during the days that follow, the platelets in the clot, along with other types of cells that have been attracted to it, begin to produce chemical compounds that initiate and advance the healing process.

▲ Section references – Farina, Politis, Cohen

How long does the blood clot last after a tooth extraction?

What happens to the blood clot that forms after a tooth is pulled? / When does it go away?

These aren’t such cut and dried questions to answer because during the healing process the clot isn’t specifically lost or discarded. Instead, over time, it’s infiltrated by other types of cells and newly forming tissues.

In essence, it becomes the scaffolding for all of the participants of the healing process to follow. So that means that the blood clot that fills in the tooth’s socket after an extraction isn’t so much “lost” as it is “transformed.”

On this page, in each healing period’s “What’s going on inside your tooth’s socket?” section, we describe the transformation that’s taking place at that point.

Restrictions on activities. / Taking time off.

During this initial 24-hour period following your extraction, you may start to wonder how much total time you should take off for rest and recovery.

What’s needed.

As anyone would probably anticipate, the specific circumstances associated with your procedure will be one determining factor.

• With routine extractions (“simple” extractions) … it’s common for a patient to take the rest of the day off.

  Although, with the easiest of these types of procedures (small teeth, unchallenging removal), just a few hours of recuperation followed by a light schedule may be sufficient.

• With difficult or involved extractions (impacted wisdom teeth or other “surgical” extractions) … you may need to take off a few days, once again, depending on the specifics of your procedure.

Of course, a patient’s personal factors (like their age or general health status) will need to be considered too.

Your best resource.

It is, of course, your dentist who’s in the best position to estimate what you’ll require. And it’s their obligation to advise you accordingly. So, if they don’t, just ask (or call back and ask).

If you’d like more information about this subject, we offer this page: How much time do you need to take off after a tooth extraction? Jump to page.

Tooth Extraction Healing pictures – The stages.

What a tooth extraction site looks like during healing, day 1 to 4 weeks.

B) Extraction site healing – Weeks 1 and 2.

What will you notice? / What will your extraction site look like?

During the first two weeks following your surgery, you should notice that the gum tissue that surrounds your extraction site has completed a significant amount of repair.

• As compared to the skin on the outside of your body, wounds located in the soft tissues of the mouth tend to heal more rapidly.
• As a point of reference for how much repair has taken place at this stage, it’s usually considered that enough gum tissue healing has taken place by days 7 through 10 that stitches can be removed. How that’s done.

  (Removing stitches means that the healing tissues are now strong enough and anchored to the underlying bone securely enough that the stabilizing effect that the stitches provided is no longer required.)

Especially towards the end of this time frame, your extraction area should look much improved. (Pink as opposed to reddish. Rounded tissue contours.) It shouldn’t pose any significant inconveniences (tenderness, bleeding, etc…) or concerns.

How much will the socket have closed?

The total amount of healing that’s been able to take place by this point in time (weeks 1 & 2) will be influenced by the initial size of your wound.

• The sockets of smaller diameter, single-rooted teeth (such as lower incisors) may appear mostly healed over by the end of two weeks. The same goes for baby teeth.
• Wider and deeper wounds left by comparatively larger teeth (canines, premolars) or multi-rooted ones (molars), or wounds resulting from surgical extractions (like needed to remove impacted wisdom teeth), will require a greater amount of time to heal over and show signs of filling in.

  So in these types of instances, the contours of the gum tissue in the region may still show quite an indentation or divot in the area of the tooth’s socket.

What’s going on inside your tooth’s socket during this time frame?

During the first week after your extraction, the blood clot that originally formed in your tooth’s socket will have become partially colonized (it’s in the process of being fully replaced) by granulation tissue. This is a primordial type of tissue that’s rich in collagen (an important tissue building-block protein) and developing blood vessels.

Toward the end of this time period, and as a next stage, mesenchymal cells (“adult” stem cells) will begin to form a dense network within this granulation tissue (and later on fully replace it). These cells will ultimately differentiate into more specialized types of cells, such as bone tissue.

▲ Section references – Cohen, Farina

Restrictions on activities.

Since the new tissues that form during this time frame are quite vascular in nature (they contain a large number of blood vessels), if you traumatize your extraction site it’s likely to bleed easily. So be careful when eating foods or brushing. You can also expect this new tissue to be tender if touched or prodded.

But other than that, and especially towards the end of this two-week period, you should find that your extraction area is of minimal concern and does not need to be a major consideration in regard to performing routine activities.

C) Extraction site healing – Weeks 3 and 4.

What will you notice? / What will your extraction site look like?

By the end of the 3rd to 4th weeks after your tooth extraction, most of the soft tissue healing will have taken place.

• You’ll probably still be able to see at least a slight indentation in your jawbone that corresponds with the tooth’s original socket (hole).
• Where a large tooth (molar) or several teeth in a row have been removed, or with cases where a significant amount of bone was removed during the extraction process (like with impacted wisdom teeth), a relatively significant indentation may still remain. It may persist, even for some months.

What’s going on inside your tooth’s socket at this point?

During this stage, mesenchymal cells will continue to proliferate into the socket’s granulation tissue and organize into a dense network. At this point, they’ll have replaced about half of the granulation tissue that originally formed.

Many of these mesenchymal cells will transform into bone cells, and they will begin to create the socket’s first new bone tissue. This new bone growth takes place adjacent to the existing walls of the socket, which means that it will fill in from the bottom and sides (as opposed to across the top). This explains why tooth sockets become narrower and more shallow as they heal.

▲ Section references – Pagni, Cohen

Restrictions on activities.

You may notice that the new gum tissue that has formed has some tenderness, like when jabbed by hard foods. But at this point, even this level of trauma probably won’t cause any significant amount of bleeding.

D) Bone healing – Filling in the socket.

How long does it take the hole to close after a tooth extraction?

After you’ve had a tooth pulled, it’s the healing of the hole in your jawbone (the tooth’s socket) that takes the greatest amount of time (as opposed to your gum tissue).

• New bone formation really doesn’t start to begin until the end of the first week post-op.
• After about 8 to 10 weeks, your tooth’s extraction socket (the hole) will have substantially filled in with newly formed bone. (Around 2/3rds of the way.)
• At around 4 months, the socket will be completely filled in with new bone.
• It then takes on the order of another 2 to 4 months (6 to 8 months post-op) of further healing for the extraction site to finally finish smoothing out evenly with the contours of the surrounding jawbone.
• During the whole process, the newly formed bone gradually matures and becomes denser. It finally reaches a density similar to that of the surrounding jawbone at around 4 months (as demonstrated by x-ray evaluation).

So in terms of the extracted tooth’s hole filling in to the point where your surgical site no longer shows much of an indentation where your tooth used to be, the amount of time required will be on the order of 4 months plus.

▲ Section references – Politis, Pagni, Cohen

What will you notice as the bone fills in?

Initially.

During the initial weeks following your extraction, it will be easy for you to see and feel the pronounced hole left in your jawbone.

In some cases, it may be deep enough that it traps food and debris. (Especially large or deep sockets may require “irrigation” (gentle flushing out) When. How to. to keep them clean during the early weeks of healing.)

As the healing process progresses.

The formation of new bone first starts adjacent to the bony walls of the tooth’s socket, which means that as the healing process progresses the socket will fill in from the bottom and sides first.

In terms of appearance, that means that over time the width and depth of the wound will become more narrow and shallow. What once was a hole will gradually transform into less of one, then just a divot, then a dimple, ultimately smoothing out and blending in with the contours of the surrounding bone.

A healed extraction site.

Note the sunken appearance of the bone (in both height and thickness) due to ridge resorption.

The shape of your jawbone will change.

While the contours of your tooth’s extraction site will ultimately fill in and smooth out, the shape of your jawbone in the immediate area will undergo permanent changes.

Jawbone height.

Some of the bone’s original height will be lost during the healing process. Resulting in a saddle shape where its lowest point is definitely lower than where it originally lay on the extracted tooth.

Jawbone width.

There will also be a reduction in the width of the jawbone in the area of the healed socket. Usually this loss is greater on the cheek or lip side, as opposed to the palate or tongue side.

Studies have shown that the dimensional changes associated with premolar and molar extraction healing can run as high as 50% of the bone’s width at 12 months post-op.

Together, these changes in bone dimensions give a healed extraction site a sunken-in look (see picture).

▲ Section references – Walker, Pagni

Ridge resorption.

The height and width changes mentioned above are collectively referred to as “resorption of the alveolar ridge” (the alveolar ridge is that portion of a jawbone that holds its teeth).

One long-term study (measurements were taken 2 to 3 years post-extraction) reported alveolar ridge shrinkage on the order of 40 to 60%. (Pagni – Linked above)

How long do these changes take?

The amount of time it ultimately takes for bone healing, and thus for the “final” shape of the ridge to form, will greatly depend on the size of the original wound. Larger wounds (i.e. multi-rooted teeth like molars, surgical sites from impacted wisdom tooth removal) will take longer to heal and will result in a greater degree of alveolar ridge changes.

• Overall, the rate of resorption (and therefore bone shape changes noticed) will be greatest during the first month post-op.
• At 3 months, two-thirds of the changes will have occurred. By 6 to 12 months out, the bulk of the transformation will have been completed.
• Beyond that, some level of continued resorption will continue throughout the patient’s lifetime, albeit at an ever reducing rate (estimated around 0.5 to 1.0% per year).

▲ Section references – Wan der Weijden, Schropp, Pagni

Immediately after an extraction, the outline of the socket is easily seen.

FYI: Bundle Bone

If your dentist would take an x-ray immediately after pulling your tooth, it would show a white line outlining the shape of your tooth’s socket (see our graphic).

This is termed “bundle bone” and it’s the layer of bone in which the fibers that anchored your tooth in place (its periodontal ligament) were embedded.

Since the tooth is now gone and this outline of bone no longer has a function, as the healing process progresses and new bone is formed, this layer will be gradually resorbed (be broken down and dispersed by your body).

After about 18 months or so, it will have totally disappeared and the outline of the socket will have been mostly lost.

Restrictions on activities.

As significant as the changes that take place are, it’s really a slow gradual process that during the 6 to 8 months that it takes, you really won’t notice anything going on at all.

Bits and fragments.

The exception might be the case where you discover a small piece of broken tooth or necrotic bone poking through the surface of your gums (your body’s attempt to eject the object).

In most cases, these fragments are only of minor concern and are easily removed. This link explains in greater detail: Managing bone and tooth fragments. What to do.

Treatment timing – Making plans to replace your missing tooth.

The fact that it takes as long as 6 to 12 months for the bulk of the jawbone’s healing process to take place doesn’t mean that you have to wait that long until your empty space can be filled in with a replacement tooth.

A healing period may be needed.

With some types of restorations (dental bridges, partial dentures, some kinds of dental implants) there is typically a healing ‘wait’ period that must be adhered to for best results. For many cases, this may be on the order of just 1 to a few months. With others, it may be 6 months or longer before the final prosthesis should be placed.

The general idea is that the dentist wants to wait for your socket’s healing process to have progressed to a point where the changes it creates in the shape of the jawbone (see discussion above) won’t substantially adversely affect the fit, function, or appearance of the replacement teeth.

But even if some sort of wait period is required, your dentist should have some type of temporary tooth or appliance that can be placed or worn until that point in time when your jawbone’s healing has advanced enough.

Our next page discusses post-extraction recovery and care the day after and beyond. ►

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 Page references sources: 

Cohen N, et al. Healing processes following tooth extraction in orthodontic cases.

Farina RT, et al. Wound healing of extraction sockets.

Pagni G, et al. Postextraction Alveolar Ridge Preservation: Biological Basis and Treatments.

Politis C, et al. Wound Healing Problems in the Mouth.

Schropp L, et al. Bone Healing and Soft Tissue Contour Changes Following Single-Tooth Extraction: A Clinical and Radiographic 12-Month Prospective Study.

Van der Weijden F, et al. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review.

Walker C, et al. Evaluation of Healing at Molar Extraction Sites With and Without Ridge Preservation: A Randomized Controlled Clinical Trial.

All reference sources for topic Tooth Extractions.

Comments.

This section contains comments submitted in previous years. Many have been edited so to limit their scope to subjects discussed on this page.

Comment –

Gum healing.

I had my wisdom teeth removed two weeks ago and everything it fine with their healing but the tooth in front of a socket on the bottom has a flap of gum on the outer side. Will it go back to normal on its own or will the dentist have to do something? It’s not infected as far as I can tell.

Anonymous

Reply –

You should call you dentist and describe your situation and let them make a decision.

In routine cases, over time (several weeks) the expectation would be that your body will just take care of the excess flap of tissue on its own. The tissue will slowly shrink down and ultimately smooth out.

In cases where the dentist feels that the excess is somewhat sizable, they may trim it for the patient, so to speed things along and to ensure an ideal final tissue contour (one that doesn’t trap debris or interfere with brushing and flossing).

Staff Dentist

Comment –

White areas in hole where tooth removed.

There is white/creamy areas in the center of the hole where both bottom molars were removed. Is this normal? Can I rinse with anything other than salt water to remove it?

Kerrie

Reply –

It would take evaluation by your dentist to know for sure but what you notice is probably just the normal appearance of the tissues as the healing process advances (new tissues forming, clot disintegrating).

You don’t say how many days ago you had your teeth removed as there are different rinsing instructions for the first day vs. the following ones (see buttons at top of this page).

The less you do, probably the better. The use of liquids other than just saltwater are likely to irritate the wound and typically make a poor choice.

Staff Dentist

Comment –

Clot

I had a molar pulled a week ago. The socket feels like it is full with I’m guessing is the blood clot. I have been careful not to dislodge it. Is the clot absorbed or will it come out or does it just dissolve? What about what feels like a skin flap that moves slightly with my tongue? Will it die off? Thanks

Marsha S.

Reply –

As discussed above, over time the clot is infiltrated and replaced by other types of cells that are an important part of the healing process and important in the formation of new tissues.

Smallish flaps of gum tissue should disappear (by a process termed apoptosis that eliminates unneeded tissues) in the weeks following your procedure. This is part of the the surgical area’s “remodeling” process. Large flaps may persist and may need to be removed surgically by your dentist.

Staff Dentist