Infection After Wisdom Tooth Removal: What You Need to Know

Wisdom teeth are commonly removed because they often don’t have enough space to come in properly.

While removing them can help prevent problems like gum disease, cavities, and infections, the procedure itself doesn't always come without risks.

Wisdom teeth that are fully erupted are usually straightforward to extract. However, removing impacted wisdom teeth (which are deeply embedded in the bone) can be more difficult and carries a higher risk of post-operative complications, including infection.

In this article, we’ll discuss the different infections that can occur after wisdom tooth removal and how to tell them apart from normal healing.

Types of Infections That Can Occur After Wisdom Teeth Removal

All surgeries carry some risks, and wisdom tooth extraction is no exception.

Your risk of developing post-operative complications depends on many factors, including your age, the complexity of the procedure, your overall health, and whether or not you follow your dentist’s instructions.

Infections are one of the possible complications that can develop immediately, days, or even weeks after surgery. They often cause a throbbing pain and pus discharge, along with other signs of inflammation such as redness, swelling, and a feeling of warmth.

However, don’t confuse infections with the normal healing process. Some signs, like swelling, mild discomfort, and light bleeding, are completely normal and expected during recovery. These are your body’s natural and temporary reactions to help the healing process.

Here are the most common infections that can occur after a tooth extraction:

1. Dry Socket

Alveolar osteitis, commonly known as dry socket, is one of the most common and painful complications after a tooth extraction. It’s not a "true" infection but rather an inflammation of the bony socket that can interfere with and delay healing.

Dry socket occurs in about 2% of all extractions, but the risk is much higher for lower wisdom teeth, up to 30%!

Lower wisdom teeth are more prone to dry socket for several reasons:

• The lower jaw naturally has less blood supply.
• Removing lower wisdom teeth is often more complex.
• The blood clot in this area is more likely to break down prematurely.

When a wisdom tooth is removed, the socket is immediately filled with a blood clot. This clot helps stop bleeding and protects the exposed bone from infection.

Dry socket happens when the blood clot doesn’t form properly or becomes dislodged too soon.

Symptoms usually appear 3 to 4 days after the procedure and often start suddenly, with constant, severe pain that even over-the-counter painkillers can’t relieve. The pain may also spread to your ear and jaw.

Other signs can include bad breath, an unpleasant taste in the mouth, and swollen gums.

To prevent dry socket, the first few days after extraction are the most crucial. During this time, you should avoid disturbing the blood clot and carefully follow your dentist’s instructions.

2. Socket infection

Unlike dry socket, a socket infection is a true infection caused by bacterial overgrowth.

Bacteria can thrive if any debris or residues are left in the socket after the extraction. An infection is also more likely if the tooth was already infected before surgery.

Symptoms of a socket infection usually appear sooner — sometimes just a few hours after the procedure — and the pain is often less intense than with dry socket.

You may notice that the wound is filled with a white or gray material, along with pus leakage and an unpleasant taste in your mouth. Your gums may also be swollen, tender, and inflamed.

An infection can also cause systemic signs like fatigue and swollen lymph nodes under the lower jaw.

If you think you have a socket infection, see your dentist or surgeon as soon as possible. Untreated infections can spread and become more serious over time.

If left untreated, the infection may progress to the underlying jawbone, leading to a condition called osteomyelitis.

3. Cellulitis

Infections are more likely to spread to the soft facial tissues than to the underlying bone. Why? Because bacteria always follow the path of least resistance.

It’s easier and more common for bacteria to move into soft facial tissues than hard bone. When the infection reaches facial areas like your cheek, chin, lips, or under your lower jaw, it's called cellulitis.

Symptoms may appear a few days after the procedure and can include diffuse swelling, redness, and warmth in the area.

Over time, you may also experience other signs like fever, fatigue, and swollen lymph nodes in the neck.

Facial cellulitis, or any other infection, should never be ignored. Once it starts, bacteria are free to spread further, and in rare cases, they may reach vital spaces and block the airways, creating a life-threatening situation.

4. Sinusitis

This complication occurs only with upper tooth extractions.

The roots of upper wisdom teeth can sometimes be very close to — or even in direct contact with — the overlying sinuses. The sinuses are bony cavities located on each side of your cheeks, just above the upper molars.

Removing these teeth can sometimes accidentally damage the sinus, leading to an infection called sinusitis.

Symptoms may include pain and pressure around the eyes, cheeks, and nose, nasal congestion, and pus leaking from the extraction site.

A key sign of sinusitis after extraction is that these symptoms appear only on the same side of your face where the tooth was removed.

Can an Infection Occur Weeks After the Procedure?

When infections develop, they usually appear during the first week after surgery, when damage to the wound or blood clot is more likely.

If the first week goes well, you’re unlikely to have problems later.

However, a rare and unusual complication called delayed-onset infection (DOI) can occur weeks later. Studies suggest DOI happens in about 0.7% to 5.8% of cases, mostly involving lower impacted wisdom teeth.

DOI usually occurs 3 to 4 weeks after the procedure and can have similar symptoms to facial cellulitis. These include swelling, pain, difficulty opening the mouth, pus discharge, and fever.

Several factors can increase the risk of delayed infections, including poor oral hygiene, trapped food debris, smoking, and certain medical conditions.

How to Tell Infection from Normal Healing?

Some reactions are completely normal after wisdom tooth extraction. These signs are usually mild, temporary, and improve gradually during the first one to two weeks.

Common normal signs include discomfort, swelling, bleeding, bruising, and difficulty opening your mouth.

What sets normal healing apart from infection is that these symptoms start very early and fade over time as you recover.

Infections, on the other hand, tend to begin suddenly (not necessarily from day 1) and get worse instead of better.

For example, if the first three days went well but on the fourth day you notice unusual symptoms, that’s a warning sign you should get checked.

Increasing swelling and throbbing pain, pus leakage, fever, and swollen lymph nodes are also red flags for infection.

Here's what's normal after wisdom teeth removal:

Swelling or edema

This is a natural inflammatory process that initiates healing. It occurs after any surgical procedure. The swelling may be noticeable on your lips, cheeks, and even neck.
Typically, this peaks after 72 hours, then gradually subsides and disappears after a week.

Redness and heat sensation

They are also related to the inflammatory process. After surgery, blood vessels expand to supply the surgical site with cells and nutrients needed for healing. Again, these reactions are normal and fade gradually over the first week.

Pain

Discomfort and pain after a wisdom tooth extraction may occur in the next few hours as the numbness wears off. This pain is expected to reach its max around 6 hours post-procedure. The pain should subside as you heal. If it does not, contact your surgeon as it may be a postoperative complication.

Bruising

Swollen blue, green, or yellow patches may appear after the procedure. This fades on its own within 10-15 days.

Factors That Increase the Risk of Infection After Wisdom Tooth Extraction

Here are some factors that can increase your risk of infection after wisdom tooth removal:

Poor Oral Hygiene

Poor oral hygiene can cause food and plaque to build up around the wound. This can damage the blood clot, allowing bacteria to grow and trigger an infection.

Smoking

Smoking is one of the main causes of dry socket. Tobacco contains toxic substances that slow down healing by narrowing the blood vessels. It’s important to avoid smoking for at least the first 3 to 4 days after surgery.

General Health Conditions

Certain illnesses that weaken the immune system—such as diabetes, some blood disorders, and HIV—increase the risk of infections after extraction.
If you have any systemic disease, make sure to tell your surgeon. You may need antibiotics before and after the procedure to help prevent infection.

Not Following Your Dentist’s Instructions

Not carefully following your surgeon’s advice can disrupt healing and raise your risk of infection. Your surgeon will guide you on oral hygiene, diet, and may prescribe antibiotics if needed.

Age

Overall, the risk of post-operative infections increases with age. As we age, blood flow decreases, the immune system weakens, and healing takes longer.

Treatment of Infection After Wisdom Teeth Removal

The treatment for an infection after wisdom tooth extraction depends on the type and severity of the infection.

Options can range from a simple course of antibiotics to minor procedures performed by your dentist.

• If your tooth socket is infected, your dentist will clean and flush the area to remove debris or residue. You will likely be prescribed antibiotics and painkillers to control the infection and manage discomfort.


• For facial cellulitis, antibiotics are the main treatment. If pus has accumulated, your dentist may need to perform a minor surgery to drain the area. This will relieve pressure and help with healing.


• Sinusitis treatment typically involves antiseptics, anti-inflammatory medications, and antibiotics.


• If a hole (oroantral communication) forms between the sinus and the mouth after removing an upper wisdom tooth, it may heal on its own within a few days. If it doesn’t, surgery might be necessary to close the opening.

Other Complications of Wisdom Teeth Removal

Other potential complications after wisdom tooth extraction include:

Loss of Sensitivity

Surgery can injure nearby nerves, causing a long-lasting numbness or tingling in parts of your mouth—a condition called paresthesia. This usually lasts from a few days to a few months. In rare cases, paresthesia can be permanent.

Temporomandibular Joint (TMJ) Pain

Jaw muscle and joint pain after extraction is common due to the strain placed on your jaw during the procedure. This pain is usually temporary.

Limited Mouth Opening

After removing a lower wisdom tooth, you might find it harder to open your mouth fully. This typically lasts only a few days. However, if the limited opening persists or comes with other symptoms, see your dentist promptly, as it may indicate a more severe complication.

Bleeding

Some bleeding after surgery is normal and may continue for several hours. However, if you are on blood thinners or have a bleeding disorder, the bleeding can become heavy and difficult to control. If this happens, don't wait to contact your dentist.

How to Prevent Infection After Wisdom Teeth Removal

Following your dentist’s instructions carefully is key to avoiding complications after any tooth extraction, including wisdom teeth. Here are some important tips:

Oral Hygiene

Keeping your mouth clean after wisdom tooth removal helps reduce bacteria and prevents infection at the surgical site.

• For the first 24 hours: Avoid brushing your teeth, rinsing vigorously, using alcohol-based mouthwash, or disturbing the extraction site. These actions can damage the blood clot and delay healing. Instead, rinse gently by moving your head slowly without swishing.


• After the first day: You can gently brush your teeth with a soft-bristled toothbrush and floss carefully (staying away from the surgical site).


• Rinse with saltwater: Rinsing your mouth several times a day with warm saltwater (½ teaspoon of salt in 8 ounces of water) can soothe pain and promote healing.

Avoid Smoking

Smoking increases the risk of dry socket by disrupting the blood clot due to suction and pressure. It also reduces blood flow, slowing healing. Avoid smoking for at least the first 3 to 4 days, or even better, consider quitting altogether.

Rest

Take it easy and avoid physical activity for the first two to three days after surgery to help your body heal.

Diet

During the first 24 hours, stick to cold or lukewarm soft or liquid foods. Avoid sucking through straws or eating hot, spicy foods to prevent burns and damage to the extraction site.
After 72 hours, eat soft foods that require little chewing. Avoid hard, sticky foods that can get stuck in the wound.
After about two weeks, you can return to your normal diet.

Control Bleeding

Some bleeding is normal for a few hours after extraction. To control it:

• Bite gently on the gauze pad your dentist has provided for about 20 minutes to help the blood clot form.


• Avoid touching or poking the blood clot with your tongue or fingers.


• Do not rinse vigorously, spit forcefully, or do any strenuous activities that increase blood pressure, as these can cause more bleeding and delay healing.