Swelling after having a tooth removed is common, and lower wisdom teeth usually cause more of it than upper ones, because the surgery involves more trauma to the bone. Swelling that has not gone down after five days is worth asking about rather than waiting.
Why some people swell up badly
The degree of swelling depends on how the tooth came out, how long the procedure took, and how difficult it was. A straightforward extraction of a fully erupted tooth causes little swelling. An impacted lower wisdom tooth, which has to be cut out of the bone, causes considerably more.
The general rule is that the more complex the extraction, the more tissue is disturbed, and the more the mouth reacts. That reaction can include swelling, pain, and sometimes a raised temperature.
None of that means something has gone wrong. It means the surgery was a real procedure.
How to reduce swelling and pain
Extraction is not finished when the tooth is out. What happens over the following two days matters as much as the extraction itself.
Medication. If there was an infection that was not fully settled beforehand, or the procedure was long and involved, the dentist may prescribe antibiotics as well as painkillers and something to reduce swelling. In some complex cases, antibiotics may be given intravenously rather than orally, but this is not routine.
Cold compress. An ice pack genuinely helps, with both swelling and pain. There is one way to get it wrong: applying ice directly to the skin, which can cause a cold burn. Wrap the pack in a cloth, and apply it for ten minutes at a time with ten minutes off in between. Alternating keeps the area cool without leaving the tissue cold long enough to injure it.
Cleaning. After a complex extraction, avoid brushing and rinsing for the first 24 hours. This is not a licence to neglect cleaning generally. Eat soft or liquid foods, avoid chewing on that side, and keep food from collecting in the socket.
After 24 hours you should be brushing gently again and rinsing. Good oral hygiene is what keeps infection at bay and helps swelling and pain settle sooner.
When to see the dentist again
Pain is a more important signal than swelling. If you are in the kind of pain you cannot manage, go back.
The specific thing to watch for is a socket that keeps hurting despite painkillers and starts to smell. That combination points to a dry socket, where the blood clot is lost, the bone surface becomes exposed, and infection may develop. It most often appears two to three days after removal, particularly after an impacted lower wisdom tooth.
Medication alone rarely settles a dry socket. It needs the socket cleaned out under local anaesthetic, which is unpleasant but gives the wound a chance to heal properly.
Practical note if you are travelling
If you have a tooth extracted while abroad, plan the appointment away from your flight. It is usually best not to fly within 24 to 48 hours after a simple extraction, and longer after more complex surgery, especially lower wisdom tooth removal. Follow your dentist’s advice. Swelling in the face can make pressure on the ear uncomfortable, and in rare cases changes in cabin pressure can worsen swelling or bruising.
Leave a few days of margin in your itinerary, and know how to reach a dentist in case the socket needs cleaning. The second point is the one people forget, and it is the one that matters.