06/20/2026
Postoperative (Delayed) Complications of Tooth Extraction:
These complications appear hours to days after the extraction procedure is completed.
🔹 Delayed Bleeding
Occurs within 24 to 48 hours post-extraction. It usually happens when the vasoconstrictor (epinephrine) from the local anesthesia wears off, causing reflex vasodilation, or if the patient's blood pressure rises.
Secondary bleeding: Occurs 7 to 14 days post-extraction. This is almost always caused by infection that breaks down the blood clot or causes sloughing of blood vessels.
🔹 Pain
Persistent/Severe Pain: Normal post-extraction pain peaks at 12 hours and gradually subsides over 2 days. Pain that is severe, throbbing, radiates, or begins to increase after 48 hours strongly indicates an underlying issue like a dry socket or infection.
🔹 Healing Deficit
Dry Socket : A focal osteomyelitis caused by the premature lysis/disintegration of the blood clot.
High-Yield: Presents 2 to 3 days post-op with severe, throbbing pain radiating to the ear, an "empty" looking socket with exposed bone, and a foul odor/taste.
Note: No pus is present. Most common in mandibular third molars, smokers, and patients on oral contraceptives.
🔹 Tissue Reaction
Postoperative Edema / Swelling: A normal inflammatory response to tissue trauma.
Timeline: Peaks at 48 to 72 hours and typically resolves within 5 to 7 days.
Management: Ice packs for the first 24 hours (to minimize), followed by warm, moist heat.
🔹 Vascular Pooling
Bruising
High-Yield: Gravity often pulls the bruising downward toward the neck or chest. It typically resolves completely on its own within 7 to 14 days. Reassurance is the primary management. Hematomas can sometimes risk secondary infection.
🔹 Infection
Secondary Infection: Occurs when bacteria colonize the surgical site.
Signs: Presents with localized swelling, pus, fever, and lymphadenopathy. Unlike normal edema which subsides after 3 days, swelling from infection continues to worsen.
🔹 Muscular Complication
Trismus: A protective spasm of the muscles of mastication (chewing muscles)
Etiology: Usually caused by surgical trauma, prolonged mouth opening, or inflammation from an IAN block injection passing through the muscle.
Management: Warm compresses, NSAIDs, soft diet, and gentle jaw-opening exercises.