You should, however, notice that:

• The bleeding from your wound has stopped and a clot has filled in the empty socket.
• The level of discomfort associated with your wound has slowly started to subside.

Additionally...

• You'll probably find that the region immediately adjacent to the tooth's empty socket is tender when touched and feels irregular and different to your tongue.
• It's also possible (especially in the case of a relatively involved or difficult extraction) that you'll find some degree of swelling has formed, both in the tissues that surround your extraction site and possibly your face too.

  If so, this swelling should peak within the first 24 hours and then start to subside.

What's taking place with the gum tissue around your extraction site at this point?

While you'll notice nothing, the reattachment and new growth of gum tissue begins at the edges of your wound as early as 12 hours post-extraction.

What's going on inside your tooth's socket?

At just 24 hours after your extraction, the focus of the activity inside your socket revolves around the blood clot that's formed.

The clot itself is composed of platelets (sticky cell fragments that initiated the clot's formation) and red and white blood cells, all embedded together in a fibrin gel. (It's the fibrin gel that gives the clot its semi-solid consistency.)

Starting at this point and continuing on during the days that follow, platelets in the clot and other types of cells attracted to it begin to produce chemical factors and mediators that initiate and promote the healing process.

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Restrictions on activities. / How much time will you need to take off?

The amount of postoperative rest and recuperation you require will vary according to the circumstances of your extraction process.

a) With routine extractions.

Most patients are probably best served by just going on home after their tooth extraction and taking it easy.

• Doing so will give you some privacy and adjustment time during that awkward period while your anesthetic is wearing off and your site's bleeding is coming to an end.
• It will also give you an opportunity to familiarize yourself and get in sync with your dentist's all-important postoperative instructions.

Possible guidelines.

Returning to routine non-strenuous activities (going to an office job, attending class, shopping) the next day should present no problem. If you have more aggressive or involved activities in mind (including during the next several days) you should clear them with your dentist.

Generally speaking, for people who are healthy who have had the easiest, most routine kind of extraction:

• After a short period of recuperation, you may be able to return to non-strenuous activities even the same day of your surgery.
• With extractions involving small-sized wounds whose bleeding has been easily controlled (think small single-rooted tooth vs. large multi-rooted molar), returning to moderate physical activity the day following your extraction may be permissible too.

Ask your dentist for instructions. And of course, it always makes sense to error on the side of caution.

b) With difficult or involved extractions.

In the case of relatively involved or difficult extractions, or cases where some method of patient sedation has been used, your dentist may feel strongly that you must limit your activities during the initial 24 hour period following your surgery.

• In regard to strenuous physical activities, their concern may extend for some days after your surgery too, you'll need to ask.
• As far as participating in routine non-strenuous activities (school, desk work, running errands) the following day, even with your dentist's OK the way you feel (or look, if pronounced swelling has occurred) may factor into your decision about how active to become.

It's important to follow their recommendation, your safety may be involved. And remember, the way you take care (or don't take care) of your extraction site during this initial period will set the stage for the healing process that follows.

c) Taking time off / Sick leave - What research studies have found.

Here are some examples of what researchers have reported about the amount of time off patients typically require after having wisdom teeth taken out (a level of surgery that is frequently more involved than just a routine tooth extraction).

Lopes (1995)

This paper followed the healing outcomes of 522 patients that had 3rd molars removed (from the simplest to very involved surgeries). 81% of the patients took time off from work, for an average of 3 days (with a range of 0 to 10 days). 19% of the patients took no time off.

Hu (2001)

This study also evaluated patient healing outcomes associated with 3rd molar extractions (about 2000 of them). It found that on average patients missed 1.2 days of work, or were unable to perform normal daily activities.

40% of the teeth removed were erupted (had come through the gums into relatively normal position). Removing erupted teeth typically creates less surgical insult than impacted ones, thus possibly explaining the lower amount of recuperation time reported by this study.

B) Extraction site healing - Weeks 1 and 2.

What will you notice?

During the first two weeks following your surgery you should be able to notice that the gum tissue that surrounds your extraction site has completed a significant amount of repair.

• In comparison to skin on the outside of your body, oral soft tissue wounds generally heal more rapidly.
• As a point of reference, it's usually considered that enough gum tissue healing has taken place by days 7 through 10 that stitches can be removed.

Especially towards the end of this time frame, your extraction area should look much improved and shouldn't pose any significant problems.

How much will your socket have closed up?

The total amount of healing that's been able to take place by this point in time (weeks 1 & 2) will be influenced by the initial size of your wound.

• The sockets of smaller diameter, single-rooted teeth (such as lower incisors) may appear mostly healed over by the end of two weeks. The same goes for baby teeth.
• Wider and deeper wounds left by comparatively larger teeth (canines, premolars) or multi-rooted ones (molars), or wounds resulting from surgical extractions (like needed to remove impacted wisdom teeth), will require a greater amount of time to heal over and show signs of filling in.

  So in these types of instances, the contours of the gum tissue in the region may still show quite an indentation or divot in the area of the tooth's socket.

What's going on inside your tooth's socket during this time frame?

During the first week after your extraction, the blood clot that originally formed will be colonized and ultimately replaced by granulation tissue (a kind of primordial highly-vascularized collagen-rich tissue).

Then as a next stage, mesenchymal cells ("adult" stem cells) will begin to organize within this granulation tissue. They will ultimately differentiate into more specialized types of cells such as bone tissue.

Restrictions on activities.

Since the new tissues that form during this time frame are quite vascular (contain a large number of blood vessels), if you inadvertently traumatize your extraction site it's likely to bleed easily. So be careful when eating foods or brushing.

You can also expect this newly formed tissue to be tender if accidentally touched or prodded. But other than that, at this point you'll probably find your extraction area to be of minimal concern and does not need to be a major consideration in regard to performing routine activities.

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C) Extraction site healing - Weeks 3 and 4.

What will you notice?

By the end of the 3rd to 4th weeks after your tooth extraction, most of the soft tissue healing will have taken place.

You'll probably still be able to see at least a slight indentation in your jawbone that corresponds with the tooth's original socket (hole).

Where large teeth have been removed (or a lot of bone was removed during the extraction process like with impacted wisdom teeth), a relatively significant indentation may still remain. It may persist, even for some months.

What's going on inside your tooth's socket at this point?

During this phase mesenchymal cells will continue to proliferate and organize within the socket's granulation tissue. Many of these cells will transform into bone cells, with the first bone tissue formation occurring along side the bony walls of the tooth's socket.

Restrictions on activities.

You may notice that the new gum tissue that has formed has some tenderness, like when jabbed by hard foods. But even this type of trauma shouldn't result in significant amounts of bleeding.

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When you have a tooth 'pulled,' it's the healing of your jaw's bone tissue (as opposed to your gums) that takes the greatest amount of time.

Despite the fact that new bone formation begins as early as one week post-op, it may take on the order of 6 to 8 months for this process to have substantially filled in your tooth's empty socket.

What will you notice?

During the initial weeks of the healing process that follows your extraction it will be easy for you to see and feel the pronounced 'hole' left in your jawbone.

In some cases it may be deep enough that it traps food and debris. (Especially large or deep sockets may require "irrigation" to keep them clean during the early weeks of healing.)

A healed extraction site.

Note the sunken appearance of the bone (in both height and thickness) due to ridge resorption.

The shape of your jawbone will change.

Your tooth's socket will ultimately fill in and smooth over but the shape of the bone in the immediate area of your extraction site will change.

• Some of the bone's original height will be lost during the healing process and as a result never again lie at a level as high as where it originally abutted the tooth. (The contours of the bone in the region of the extraction space will look somewhat sunken.) (Pagni 2012)
• There will also be a reduction in the width of the jawbone. Usually this is more pronounced on the cheek or lip side, as opposed to the palate or tongue side.

  Studies have shown that the dimensional changes associated with premolar and molar extraction healing can run as high as 50% of the bone's width at 12 months post-op. (Walker 2017)

Collectively these changes are referred to as "resorption of the alveolar ridge" (the alveolar ridge is that portion of the jawbone intended to hold teeth). And overall the effect of this resorption process is one that results in a narrower and shorter ridge.

One long-term study (measurements were taken 2 to 3 years post-extraction) reported alveolar ridge shrinkage on the order of 40 to 60%. (Pagni 2012)

How long do these changes take?

Ultimately the amount of time it takes for healing, and thus for the "final" shape of the ridge to form, will greatly depend on the size of the original wound. Larger wounds (i.e. multi-rooted teeth like molars, surgical sites from impacted wisdom tooth removal) will take longer to heal and will result in a greater degree of alveolar ridge changes.

• Overall, the rate of resorption (and therefore bone shape changes noticed) will be greatest during the first month post-op.
• At 3 months, two-thirds of the changes will have occurred. By 6 to 12 months out, the bulk of the transformation will have completed.
• Beyond that, some level of continued resorption will continue throughout the patient's lifetime, albeit at an ever reducing rate (estimated around 0.5 to 1.0% per year).

(Schropp 2003, Van der Weijden 2009, Pagni 2012)

Immediately after an extraction, the outline of the socket is easily seen.

FYI: Bundle Bone

If your dentist takes an x-ray right after you've had your tooth pulled, it will show a whitish outline surrounding your tooth's socket (see our graphic).

This is called "bundle bone" and it is that layer in which the fibers that anchored your tooth in place (its periodontal ligament) were embedded.

Over time as healing takes place and new bone is formed in the socket, this layer will slowly resorb (be broken down and dispersed by your body) since the tooth is now gone and it no longer has a function.

After about 18 months or so it will have totally disappeared and the outline of the socket will have been mostly lost.

Restrictions on activities.

Don't expect to be incapacitated, or even inconvenienced, during the 6 to 8 month time period required for bone healing. It's a slow gradual process during which you really shouldn't notice anything going on at all.

Bits and fragments.

The exception might be the case where you discover a small piece of broken tooth or necrotic bone poking through the surface of your gums (your body's attempt to eject the object).

In most cases these fragments are only of minor concern and are easily removed. This link: Bone and tooth fragments explains this issue in greater detail.

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Treatment timing - Making plans to replace your missing tooth.

The fact that it takes as long as 6 to 12 months for the bulk of the jawbone's healing process to take place doesn't mean that you have to wait that long until your empty space can be filled in with a replacement tooth.

A healing period may be needed.

With some types of restorations (dental bridges, partial dentures, some kinds of dental implants) there is typically a healing 'wait' period that must be adhered to for best results. For many cases this may be on the order of just 1 to a few months. With others, it may be 6 months or longer before the final prosthesis should be placed.

The general idea is that the dentist wants to wait for your socket's healing process to have progressed to a point where the changes it creates in the shape of the jawbone (see discussion above) won't substantially adversely affect the fit, function or appearance of the replacement teeth.

But even if some sort of wait period is required, your dentist should have some type of temporary tooth or appliance that can be placed or worn until that point in time when your jawbone's healing has advanced enough.

Source: https://www.animated-teeth.com/tooth_extractions/a-tooth-extraction-healing-times.htm?