Emergency dental symptoms

Pain after a tooth extraction: normal healing or dry socket?

Some soreness after a tooth is taken out is expected. Pain that eases for two days and then comes back worse is not, and it has a name. Here is how to tell the two apart and what to do.

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Clinically reviewed by Dr Ibraheem Ijaz, Principal Dentist · GDC 301711 · Last reviewed April 2026

Normal healing versus something going wrong

Within minutes of a tooth coming out, the socket fills with a blood clot. That clot is the scaffold for everything that follows: over the first week it is gradually replaced by new tissue, and over the following months by bone. Until then it is also the only thing covering the bare bone and nerve endings of the socket walls. Normal healing follows a fairly fixed pattern:

Day one.

The worst of the pain, usually the evening after as the anaesthetic wears off. Some oozing of blood-stained saliva.

Days two and three.

Sore, with swelling and sometimes bruising that peak around 48 to 72 hours, then start to ease.

The first week.

A mild ache when eating, improving daily. The socket develops a whitish or yellowish coating, which is healing tissue, not pus.

Not normal: pain that gets worse from day two or three onwards rather than better. Pain radiating to the ear or along the jaw. A bad taste or smell. A socket that looks empty with bone visible. Swelling that is growing after day three. A fever. Bleeding that restarts after the first day. Numbness of the lip or tongue that is not fading.

Dry socket: why it starts on day three, not day one

Dry socket happens when the blood clot breaks down or washes out before the new tissue has grown in to replace it. The bone of the socket is left open to the mouth, and bone has plenty of nerve endings and no covering, which is why the pain is deep, gnawing and often worse than the toothache that led to the extraction. It usually radiates to the ear and comes with a foul taste.

The timing is the clue. It almost always starts between day two and day five, because that is the window when the clot is most vulnerable: the body’s own clot-dissolving enzymes are at their busiest and the replacement tissue has not yet arrived. Those enzymes are boosted by bacteria, by oestrogen and by smoking, which is why dry socket is more common after lower wisdom teeth, in smokers, and in women taking the contraceptive pill. Vigorous rinsing or spitting in the first day can also lift the clot out. It is not an infection, so antibiotics do not treat it.

Other causes of pain after an extraction

A sharp edge of bone.

A small splinter of socket bone works its way through the gum a week or two later and catches your tongue. Usually smoothed in a minute or works its way out on its own.

Socket infection.

Less common than dry socket. Swelling that increases after day three, pus from the socket, a fever, and sometimes the neighbouring teeth becoming tender.

An aching jaw joint.

After a long extraction with the mouth held wide, the joint in front of the ear and the chewing muscles can ache for a week, worst in the morning. See our jaw pain guide.

Nerve bruising or a retained root.

Tingling of the lip, chin or tongue after a lower wisdom tooth usually recovers over weeks. A retained fragment of root shows on the X-ray and is removed only if it causes trouble.

When to ring the practice

Call today.

Pain not improving by day three. A bad taste. A sharp edge you can feel with your tongue. Numbness that is not fading.

Same day.

Pain that is worse than yesterday from day two onwards. Pain shooting to the ear. An empty-looking socket. Swelling that is growing after day three. Pus. A fever. If we took the tooth out, ring and we will see you; if it was done elsewhere, you are still welcome, and around eight in ten emergency patients are treated on the day they call.

A&E.

Bleeding that has not stopped after two 30-minute rounds of firm pressure, especially if you take blood thinners. Swelling that affects swallowing or breathing or closes the eye. A high fever with feeling very unwell. The Northern General Hospital has the nearest maxillofacial unit.

Easing the pain at home

01
Ibuprofen and paracetamol as directed on the packet, together if you can take both. On the first day, take the first dose before the anaesthetic wears off, and keep taking them regularly for two or three days rather than waiting for the pain to build.
02
For the first 24 hours: no rinsing, no spitting, no straws, no smoking, no alcohol, no hot drinks and no exercise. Every one of those can lift the clot. Sleep with your head raised.
03
From day two: warm salt water held gently over the socket after meals and allowed to fall out, three or four times a day for a week. No hard swishing.
04
Soft food, chewed on the other side. Keep brushing the other teeth.
05
A cold pack on the cheek, ten minutes on and ten off, in the first day or two for swelling. Never a hot water bottle.
06
If it bleeds: sit upright, bite firmly on a damp piece of gauze or a clean folded handkerchief for 20 to 30 minutes without checking. Repeat once. If it is still bleeding, ring us.
07
Do not poke the socket with your tongue or a finger, and if you smoke, hold off as long as you possibly can; 72 hours makes a real difference.

How we treat a painful socket

The emergency examination is £30 including X-rays. We look at the socket, gently flush it with warm saline to clear any food debris, check whether bone is exposed, and take a digital X-ray to rule out a retained root, a loose fragment of bone or infection spreading into the jaw.

Dry socket. The socket is washed out and packed with a soothing medicated dressing (Alvogyl or similar), which usually brings relief within the hour. The dressing may be repeated every two or three days until the socket is comfortable. Details are on our dry socket management page.
Infected socket. Drained and irrigated, with a medicated dressing. Antibiotics are added only if the infection is spreading or you have a fever.
Sharp bone. Smoothed or lifted out under local anaesthetic in a few minutes.
Bleeding. Local anaesthetic to constrict the vessels, a dissolving sponge packed into the socket, and a stitch or two.

Fees are agreed in writing before treatment. Evening and weekend visits carry an additional out-of-hours charge. Our page on extractions and wisdom teeth explains the aftercare we give in full.

Treatment	Fee (from)
Emergency examination including X-rays	£30
Socket irrigation and medicated dressing	priced at the visit
Removal of a retained root	priced at the visit
Extraction (if a neighbouring tooth is the cause)	£120–£260

What happens if dry socket is left

Dry socket is not dangerous, and a socket left alone eventually heals from the bottom up. But it takes a week or two longer than normal, and those are weeks of severe pain that painkillers barely touch. Exposed bone can also pick up an infection, which is a much slower problem to treat. A dressing takes ten minutes and usually turns the worst night into a manageable one. An infected socket left untreated does what any dental infection does: it spreads.

Questions, answered

Common questions

How long should pain last after a tooth extraction?

The worst is the first evening. It should ease steadily from day two or three, with mild aching on eating for up to a week. A lower wisdom tooth can take a little longer. Pain that gets worse after day two is not normal healing.

Is dry socket dangerous?

No, but it is very painful and slows healing by a week or two. It is treated with a medicated dressing, not antibiotics. The rare danger is exposed bone becoming infected, which is one reason to have it dressed rather than wait it out.

Do I need antibiotics for dry socket?

No. Dry socket is a lost blood clot, not an infection, so antibiotics do nothing for it. The treatment is washing out the socket and packing it with a soothing dressing, which usually eases the pain within the hour.

What does a dry socket look like?

An empty-looking hole, sometimes with greyish or whitish bone visible at the bottom, instead of a dark red clot. There is usually a bad taste or smell. A pale creamy coating over a clot, on the other hand, is normal healing tissue.

Can I smoke after a tooth extraction?

Ideally not for at least 72 hours. The sucking action can pull the clot out, and nicotine cuts the blood supply the socket needs to heal. Smokers get dry socket far more often than non-smokers.

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