Swelling is common after certain dental procedures, particularly tooth extractions and periodontal surgery. Holding an ice pack—or better yet, a plastic bag of frozen peas or corn (which adapts to facial contours)—to the cheek can prevent much of the swelling. Ice therapy can be used for the first 18 hours. Cold should be held on the cheek for 25-minute periods and then removed for 5-minute periods. If swelling persists or increases after 3 days or if pain is severe, an infection may have developed, and the person should contact the dentist.

Dry Socket: A dry socket (exposure of the bone in the socket, causing delayed healing) may develop after a lower back tooth has been removed and the normal blood clot in the socket is lost. Typically, discomfort lessens for 2 or 3 days after the extraction and then suddenly worsens, sometimes accompanied by an earache. Although the condition goes away by itself after 1 to 2 weeks, a dentist can place a dressing soaked with an anesthetic in the socket to eliminate the pain. The dentist replaces the dressing every day or two for about a week.

Bleeding: Bleeding after oral surgery is common. Bleeding in the mouth may appear worse than it is because a small amount of blood may mix with saliva. Usually, the bleeding can be stopped by keeping steady pressure on the surgical site for the first hour, normally by having the person bite down on a piece of gauze. If bleeding continues, the area can be wiped clean, and another piece of gauze or a moistened tea bag can be held against the area with steady biting pressure. Keeping the gauze or tea bag steadily in place for at least an hour is important. Most problems with bleeding occur because the person frequently removes the pack to see if the bleeding has stopped. If bleeding continues for more than a few hours, the dentist should be notified.

People who regularly take an anticoagulant (a drug that prevents clots) or aspirin (even if they only take one aspirin every few days) should mention it to the dentist a week before surgery because these drugs increase the tendency to bleed. The dentist and the person's doctor may adjust the drug dosage or temporarily stop the drug.

Osteonecrosis of the Jaw: In this disorder (see Osteonecrosis: Osteonecrosis of the Jaw), prolonged exposure of bone through the gum tissue usually causes pain, but osteonecrosis of the jaw may also be accompanied by loose teeth, infection, or a discharge of pus. The disorder may occur after

• Tooth extraction
• An injury
• Radiation therapy to the head and neck (osteoradionecrosis)

Or osteonecrosis of the jaw may occur spontaneously. This disorder has developed in some people who were given high intravenous doses of bisphosphonates (certain drugs used to treat osteoporosis), particularly people requiring oral surgery while receiving the drugs.

Last full review/revision October 2008 by David F. Murchison, DDS, MMS