One of the most common problems faced by patients after a tooth extraction is swelling of soft tissues near the tooth hole. Such oedema can occur during the extraction of any tooth, but often, the most prominent is in the removal of chewing teeth (molars), including wisdom teeth. We will also talk about this problem in more detail and discuss the most exciting questions:
· Whether it is worth worrying about if the gums, even the whole cheek, are very swollen near the hole after a tooth is removed;
· How to prevent the development of severe oedema without additional intervention;
· Accompanying symptoms should be considered very worrying to seek medical attention quickly from your doctor;
· How long the swelling usually lasts after the tooth is extracted and how exactly your situation fits the norm;
· If you misjudge the situation and bring the problem to coincidence, which complications may occur;
· And we'll also look at what exercises will help a difficult opening of a mouth (usually observed after the forced removal of the lower wisdom teeth).
In order to understand how you can eliminate swelling after the tooth is extracted, first, it is important to understand the nature of oedema. Interestingly, many people who come to see a dentist surely forget that they came to the doctor with oedema, they wait for oedema to disappear first day after removal of a tooth. After all, the dental problem seemed to have disappeared, so why didn’t oedema disappear, it also seemed to have increased even more?
A swollen cheek or lip (even before tooth removal) may result from the development of periodontitis (acute stage), periostitis, or odontogenic osteomyelitis. Very few people come to the doctor with the neglected form of the tooth, manifested by the so-called "flux". By its nature, flux is an inflammation process that is almost always localized in the root region of a neglected tooth located below the alveolar process or infectious origin jaw body.
When a tooth completely destroyed by tooth decay is left untreated for many years, it continues to slowly decay and inflammatory processes occur in the roots.
The body prevents the attack of infection for a while and limits the spread of the capsule-capsule - surrounding granuloma or cyst.
The following photo shows the extracted tooth with cysts in the roots:
However, the sources of immunity are not limitless and the balance of power may deteriorate under various conditions: overload on the tooth, concomitant disease (eg, ARVI), stress - all of which can trigger the spread of infection in the jaw tissue with the accumulation of purulent. And because of such oedema, the asymmetry of the face can be very pronounced.
Although the main problem during the removal of a tooth is eliminated, infectious focus and oedema can be felt for a long time.
In the meantime, it is noteworthy that the relief immediately takes place immediately after removal of a tooth: the sensation of explosion disappears, the swelling decreases, the pain stops. Once extracted with cysts on the diseased tooth roots, the person begins to live normally again (as the patients say).
A number of dentists sometimes work without an incision to reduce the marrow in the wound after an extraction. In this case, the symmetry of the swelling-induced face is restored onto a sterile gauze ball by removing liquids out of the gums. Yes, sometimes it is painful, but it is possible to reduce the swelling very quickly, the patient can see in the mirror how good everything is. Swollen face (cheek, lip) decreases 2-3 times by volume in about 5 minutes.
After removal of the roots of a tooth without granulomas, cysts and even without them, not every human being has an organism, but also copes rapidly with the infection that remains in the hole. No tweezers can remove millions of bacteria, both harmless and pathogenic, from the wound.
Once the tooth is removed, the wound is filled with a blood clot that should allow immune factors to deal with infection factors and initiate the safe healing mechanism of the hole. For many, this mechanism is triggered by a series of inflammatory reactions – as a result, often tooth extraction, pain, swelling, fever and other unpleasant symptoms are not often relieved on day 2, may even intensify to some extent and cause anxiety in the patient. Often this can be observed after the removal of the lower wisdom teeth: difficulty in their eruption, exacerbation of chronic periodontitis, periostitis, etc. In the mandibular teeth area, there are large volumes of loose tissues that are well-fed and innervated. Therefore, the inflammatory reaction herein is often accompanied by severe oedema, fever and pain, especially when swallowed. A completely plausible question arises: can a face swell if a calm tooth is removed? Indeed, not only is there a dental surgeon for decayed teeth, but it is also very strong when there is no infection of the roots.
For example, you can consider the following reasons:
· Due to violation of biting or injury to the cheek mucosa;
· Due to intervention in orthodontic treatment (eg, braces);
· Depending on the interaction with a successful prosthesis (for example, when an unnecessary root of a tooth or a mobile tooth needs to be removed);
· Or, in principle, at the personal request of patients who refuse to treat a tooth, this can also be saved.
In such cases, the swelling also occurs after the tooth is extracted, but is usually less pronounced compared to removing the teeth against the background of purulent exacerbation. However, even in this case, the wound may be infected by significant oedema, pain and fading of the mouth later, especially if the patient is mistaken to care for the hole. Below we will talk about these alarming symptoms. In the meantime, let's see how you can prevent the development of severe oedema after tooth extraction and thus make the postoperative period more comfortable. And what mistakes should not be allowed?
There are many techniques that do not allow you to swell your face after the tooth is extracted, the resulting edema will be small and will only affect the gums in the hole.
Attention should be paid to three main points that have a good effect on the complex:
· Hot, hard and spicy food as well as strong physical activity and warming (bath, sauna, steam room, solarium, hot bath);
· Medications to take (nonsteroidal anti-inflammatory drugs, antihistamines, sometimes - hemostatic)
To prevent severe swelling after tooth extraction, most dentists recommend cold application to the cheek area on the side where the hole is located. However, not all dentists recommend this method because they are aware that patients can perform the same instruction in very different ways.
As a result, in winter, snow can provide that cold effect: best, 1-2 minutes, one or more at the worst hour. For a limited time, not every dentist can tell the patient that it is a cold compress. That is, it is not necessary to freeze the face until it is whitened, but it is important that the skin has a mild effect. If there is a pack of frozen dumplings, if the towel is thin - wrap it in towel in several layers. Cold water bottle is the best option. Again, if the water is frozen, you must wrap it with a towel and remove the towel or change the water when the water becomes hot. Retention time - 15-20 minutes every 2 hours.
Cold as a local decongestant, it is certainly effective, but only with common sense and detailed instruction.
The use of cold is effective only on the first day after tooth extraction. The use of cold will be less effective on the second day.
The cold vessels narrow and reduce blood flow in the wound area, everything about warming the body contributes to the development of strong edema (hot food and drinks, physical activity, bathing, etc.)
It is quite possible to take a shower and wash your hair, but you should set the water to a temperature of about 36-37 ° C.
What else can prevent the appearance of edema after tooth extraction?
Patients suffering from cardiovascular system diseases should closely monitor blood pressure and reduce the medication recommended by your doctor. As a result, edema and hematoma occurring after tooth extraction in such cases are largely the result of alveolar hemorrhage against the background of suspended pressure. Stable blood pressure is a guarantee of comfort in the postoperative period.
As for drugs, there are many drugs that prevent significant edema and even reduce them, even if they have already occurred. They contain antihistamines. People know them first of all as antiallergic drugs, but they can also be called anti-edema.
When choosing a drug, when using it with other drugs, consider the contraindications to the use of the drug as well as its use (eg pregnancy, breastfeeding, childhood, various diseases, etc.). Consider how this antihistaminic drug in your condition will be effective and safe, consult your doctor.
The same applies to nonsteroidal anti-inflammatory drugs, hemostatic agents, glucocorticoids and other drugs that depend on how comfortable postoperative time is. These drugs should be taken under the supervision of a physician.
Despite efforts to reduce the severity of edema, it may still appear and cause discomfort. In particular, this occurs after removal of the affected wisdom teeth in the lower jaw. The post-traumatic inflammatory process, despite the efforts of the doctor and the patient, often leads to the appearance of quite pronounced edema, in connection with the anatomy and features of the location of the teeth of wisdom.
The following picture shows a polyurethane wisdom tooth:
Don't panic now. Usually, swelling reaches a maximum level within 2-3 days after removal of a wisdom tooth, and here it is important to monitor the situation as a whole, not just a symptom. If you have a serious deterioration in your health (elevated values, even temperature increase for unbearable pain that does not respond to analgesics, suppuration or bleeding through the hole), you should immediately consult your doctor.
Now let's give some information about the appearance after removing a bruise on the cheek, neck or chin.
Don't panic when such a bruise appears, even if it looks bad. This is common after swelling of a common hematoma (especially in patients with arterial hypertension) after removal of the lower molars. First hematoma may have a bluish colour, after 3-5 days it becomes yellow and disappears completely without a trace. The emergence of a hematoma after tooth extraction does not indicate any complication or error of the dental surgeon, a common phenomenon.
Hematoma can also occur due to needles that puncture the gums during anaesthesia injection. To prevent unwanted wounds after anaesthesia, several dentists ask you to press the injection site with your hand for 1-2 minutes before removing the teeth. Some doctors believe that this is the remnant of the past: modern techniques working with imported anaesthetics do not run the risk of developing a large hematoma when vessels are injured. However, if there is a risk of hematoma due to the individual characteristics of the patient, the technique of “pressing the injection site” may be considered appropriate in our time.
Although the abovementioned methods can significantly remove the oedema after the tooth is extracted, this is not yet a complete guarantee of a safe postoperative period.
The most common symptoms associated with oedema are:
· Pain (especially when swallowed, chewed, and even during speech);
Increased body temperature often occurs on the first day after tooth extraction. This is a normal reaction of the body in response to surgery, but only in this context: as high as possible in the evening (up to 38.5 ° C), and 36.6 or slightly higher in the morning (not more than 37.5 ° C). In this case, we can say that the body fights the inflammatory process and fights in normal mode. If more than one tooth is pulled at the same time, the body may respond more strongly.
In the photo below - fresh holes after removing two teeth at the same time:
Therefore, high fever for 1-2 days after removal should not be considered pathology, but should also be monitored twice a day (for example at 8 am and then at 8 pm). If the temperature is above 38.5 ° C or lasts more than 2 days and has high morning rates, this is a reason to consult a doctor.
The degree of health deterioration after tooth extraction depends largely on the individual characteristics of each individual organism. If the body is weakened against the background of other diseases, there are immune pathologies or older age, then the state of health may deteriorate significantly, and the help of a doctor will be required. After the examination, the doctor can only assess the situation and, if necessary, prepare a report for the patient to gain strength at home.
Some people are very “eager to fight” (to return to work as soon as possible because they do not want to spend a few days in the household). Lower the swelling quickly, if the hole hurts, swallow some anaesthetic pills and go! However, it is important to understand that the postoperative body needs time to heal. Failure to do so may result in a series of progressive serious complications.
The occurrence of severe pain in the background of advanced oedema is a frequent and perhaps the most unpleasant phenomenon, especially when the pain is not relieved by analgesics.
Physicians almost always give painkillers as a recommendation to cope with the painful period in the first days after tooth extraction. However, with the development of tissue edema, both loosening and painful pains may occur, which are not loosening and pain-relieving and are not able to cope on their own. 2-3 days after the development of acute pain and reception of the tooth against fever, severe swelling, bad breath and other alarming symptoms, you should immediately contact your doctor for help.
Oedema may be accompanied by difficulty in opening the mouth (usually observed when removing the lower wisdom tooth). Sometimes opening your mouth a few centimetres can hurt you. When swallowed as in the throat and on the one hand there is a strange sensation of pain. This is due to the anatomical location of the eighth teeth: the spread of oedema captures the chewing muscles of the jaw.
Improvement usually takes place within 3-4 days - opening the mouth decreases pain and other symptoms (if any) slowly disappear, meaning positive dynamics are determined. If this does not happen and you are still having difficulty opening your mouth or getting worse, you should consult a doctor.
Rarely, neurological problems occur - in particular, paresthesia, ie, loss of sensation in the area of the extracted tooth, as well as in the lip, cheek, and jaw area. This is most commonly the case for the removal of the lower wisdom teeth (octets), less frequently the lower sixth and seventh teeth.
The cause may be overly invasive at the site of intervention that damages the mandibular nerve. In the last case, loss of sensitivity is automatically eliminated as oedema (hematoma) in the area of the extracted tooth decreases.
The conditions for restoring the damaged nerve trunk can take quite a long time: 2-3 weeks to 1-2 years, depending on the severity of the violation. However, it is possible to speed up this process a little bit - it is important to consult a doctor over time, determine the cause of paresthesia and start initiating procedures (physiotherapy) on time.
If the doctor has not paid enough attention to the patient after the tooth has been extracted, and has not informed him about the basic recommendations for looking at the hole (this is usually the case in polyclinics), even if minor problems occur, patients often have a fear of panic. This is especially true for the appearance of oedema and severe pain: because of the stress experienced after severe tooth removal, the patient is afraid to go back to the doctor, does not know whether the current situation is dangerous and what to do.
Therefore, in this case, it is useful to know how long the swelling of the tooth extraction area lasts on average and how long other unpleasant symptoms reveal themselves. According to research, oedema can be up to a maximum of 2-3 days, and this deviation from the norm, as well as a slight increase in body temperature, some deterioration in the general situation, such as the emergence of pain appeared to occur. These are all natural and regular manifestations of the post-traumatic inflammatory process. So what to do - should something go uncomfortable after the tooth is removed, should you go to the doctor immediately or wait? Answer: never intervene in reinsurance, you should not expect the swelling to spread around the neck or take half the face (sometimes the eyes do not even open due to swelling). If there is anything uncomfortable, at least it makes sense to call the doctor and ask for advice or make an appointment for an examination.
However, when there is a clear positive tendency (oedema is insignificant and if it starts to occur for 3-4 days, almost no temperature, severe pain, painless mouth opening, paresthesia, bad breath) it is understandable that you do not go regularly every two days.
The average postoperative period is 3 to 10 days. Main symptoms (oedema, pain) can be pronounced severely for 3-4 days. Usually, all unpleasant phenomena pass in one week and in difficult situations - in two weeks. And the main rule here is not self-treatment without advice and control from the dentist.
Now, let's look at the cases where oedema is associated with possible complications after extraction. In such cases, oedema does not diminish until the underlying disease disappears.
Let's start with the most common complication, alveolitis. Alveolitis is a result of good infection, ie simply well-inflamed. The degree of oedema may be greater. Often, during alveolitis, gingival pulping occurs around the hole of the extracted tooth, sometimes develops under reinforcing pressure.
It is not worth treating alveolitis independently, you need to consult a doctor. It is important to understand the main causes of this pathology:
· The so-called “dry hole” (ie, without a blood clotting that protects it);
· A major violation of doctor's recommendations (drilling a hole with toothpicks, warming, etc.)
A more serious version of the complication is limited osteomyelitis of the tooth cavity. In rare cases, when alveolitis is neglected or treatment fails, purulent-necrotic inflammation of the bone walls of the hole develops – osteomyelitis. Symptoms are strongly pronounced: a swinging pain may occur in the hole, may extend to adjacent teeth, the person cannot normally sleep, cannot eat. The temperature reaches high values, develops strong oedema, moves on the gums surrounding adjacent teeth, and also on the soft tissues of the face. The fetus smell coming from the mouth starts to disturb the person, there is an increase in lymph nodes.
In such cases, as a rule, special assistance is required for jaw surgery. Possible complications after removal of the tooth include an abscess and phlegmon.
An abscess is a limited inflammation and phlegmon is common (and may even threaten the patient's life). Often, with such serious complications, children go to surgical surgeons.
In a child (especially weak), a few days may develop from oedema to abscess and phlegmon. Unlike adults, children do not always create protection factors against fulmine infection. Therefore, parents should remember that the occurrence of strong pronounced oedema after removal of a tooth (or even primary teeth) is a reason to ring the alarm and seek medical attention immediately.
After removing a molar tooth (usually in the lower jaw, especially the mental tooth), many people are seriously concerned about the fact that it is impossible to open their mouths normally. Problems with opening the mouth (trism) can be observed both in the background of apparent oedema and without it. Sometimes the mouth fails to open even 1-2 centimetres, which creates big problems not only with speech but above all with food intake.
What can you do to quickly approach your normal state? First of all, you should not guarantee that the removal of oedema will provide a successful solution to the problem of opening the mouth. If the trism is “fresh,, the jaw should be developed, otherwise surgical intervention may be required. The conditions for disappearance of trismus are entirely individual - from one week to 1-2 months (depending on how difficult tooth extraction is).
From the first days after tooth extraction, frequent and small chewing movements with the bubble gum accelerate the development of a joint, even against the background of the inflammation process in the chewing muscles. For more complex exercises, you should consult a dentist who is interested in TMJ diseases. Physical therapy for the maxillofacial region - you will get therapeutic physical culture.
A few examples of exercises to improve mouth opening:
1. Slowly opening the mouth (as far as possible) at a slow pace in a a position where the head is thrown back, without muscle tension;
2. With a little effort by lowering the jaw and pushing it forward;
3. With an open mouth (as far as possible), raise the sound by pronouncing the letter "a" aloud;
4. Gently pulling the lower jaw down with both hands is done using the jaw of the head by throwing the head backwards.
The change in tension and relaxation of the muscles of the maxillofacial region has a significant therapeutic effect with the correct and systematic performance of each exercise. In severe cases, especially when trisism persists for several months or more, mechanotherapy is required - a series of exercises using special devices. Often, mechanotherapy is performed in conjunction with physiotherapy procedures (electrophoresis, ultraviolet radiation, thermal mouth baths, paraffin treatment and others).