The First Night After a Tooth Extraction: What to Do and What to Avoid

Bleeding and the gauze pad

Most of the first night's advice is about not disturbing the clot that forms in the socket. A little oozing that stains your saliva pink is common; bleeding that keeps filling your mouth is not.

If the socket keeps bleeding, Scottish dental guidance (SDCEP) advises biting firmly on rolled gauze or a clean cotton pad moistened with water, for 20 minutes¹ before checking. If you do not take blood thinners and it has not stopped, press once more; if it still does not stop, you need urgent care. If you do, see the next section. The NHS page on wisdom tooth removal gives a shorter time: press for at least 10 minutes² with a clean cloth or cotton wool.

These times come from guidance, not from trials. A Cochrane review looked for trials of how to treat bleeding after an extraction and, in searches up to January 2018, found none that it could include³. So there is no single proven pressure time; firm, steady pressure is the common thread.

If you take blood thinners

People who take anticoagulant or antiplatelet medicines have their own, stricter UK leaflet:

• Pressure for longer. The leaflet advises pressing on the bleeding area for 30 minutes⁴, and contacting your dentist if that does not stop it.
• No second round. SDCEP's guidance for clinicians says that if bleeding in someone on these medicines fails to stop or restarts¹, they should get emergency care, rather than trying pressure again.
• Pain relief. The same leaflet advises paracetamol and says to avoid anti-inflammatory painkillers such as aspirin, ibuprofen or diclofenac.
• Food. The leaflet advises avoiding hot liquids and hard foods for the rest of the day, and not chewing on the affected side.
• Rinsing. Avoid rinsing until the next day; from then on, the leaflet advises gentle warm salt-water rinses 3 or 4 times a day for 5 days.

Do not stop or change your blood thinner on your own. SDCEP's patient information says: do not alter your medication⁵ for dental treatment unless your doctor, specialist or dentist tells you to.

Protecting the clot: rinsing, smoking, straws and alcohol

Do not rinse on the first day. You may have read that you should rinse with salt water on the first night. UK guidance says the opposite: avoid rinsing on the day of the extraction⁶. From the next day, the NHS advises keeping the wound clean by rinsing gently with mouthwash or warm salt water². Brush your other teeth, but keep away from the socket.

The first 24 hours. Once the bleeding has stopped, SDCEP advises people to avoid alcohol, smoking and exercise for 24 hours¹, to keep their head raised if possible and not to disturb the clot.

Smoking. Smoking is linked to dry socket, a painful condition in which the clot is lost. Dry socket is most common after a molar⁶ has been taken out. A review of 11 observational studies with over 10,000 patients found dry socket in about 13 in 100 smokers and about 4 in 100 non-smokers⁷. These studies show a link, not proof of cause, and no study has worked out a safe time to start again or a safe number of cigarettes.

Straws. The only study we found, a small one of 60 patients after wisdom tooth removal, saw the same dry socket rate⁸ with and without straws; it does not say how patients were allocated. That is thin evidence either way. Hard sucking can pull on the clot, so drinking from a glass on the first night is a reasonable precaution.

Pain, swelling and sleep

Some pain and swelling is expected. After wisdom tooth removal, the NHS says these can last for up to 2 weeks² and should start to improve after 1 or 2 days. These figures describe wisdom tooth removal; the sources we found do not give a separate course for other extractions.

Painkillers. The NHS advises paracetamol or ibuprofen. In a Cochrane overview of pain-relief trials, mostly after wisdom tooth removal, ibuprofen combined with paracetamol⁹ relieved at least half the pain over 4 to 6 hours in almost 70 in 100 people. Follow the pack or your pharmacist on doses, and check with your dentist or doctor first if you take blood thinners or have been told to avoid anti-inflammatories. If you are pregnant, the NHS says to avoid ibuprofen¹⁰ unless a doctor or pharmacist advises it. Ask a pharmacist if you have a long-term condition or take other medicines, and do not take two products that both contain paracetamol¹¹.

Cold packs. A cold pack on the cheek may help a little. A review of 6 trials after wisdom tooth surgery found a small reduction in pain on the third day¹², no clear effect on swelling, and low-certainty evidence. There is no agreed schedule; wrap it in a cloth.

Sleep. We found no source on the best side to sleep on or how many pillows to use. The only related advice is SDCEP's: keep your head raised if you can. An extra pillow may help.

After sedation or a general anaesthetic. The NHS advises not driving for 24 hours² after a sedative injection, or for 48 hours after a general anaesthetic.

Eating and drinking on the first night

Wait until the numbness wears off before you eat, so that you do not bite your cheek. Then:

• Soft or liquid food, such as cooled soup, yoghurt or mashed potato. The NHS advises soft or liquid food² and avoiding hard or crunchy food and food that could get stuck in the wound, such as nuts or seeds.
• Nothing very hot. Very hot drinks are on the NHS list to avoid.
• No alcohol on the first day.

Dairy is often on the list of things to avoid, but two randomised trials in Germany did not detect harm from it after mouth surgery. In one, of healthy young non-smokers having wisdom teeth removed, 3 of 77 people who ate dairy¹³ and 8 of 80 who avoided it had a complication. A second, broader trial did not detect a difference in wound healing¹⁴ either way. Neither trial shows that dairy is safe for everyone.

When to see a dentist

Contact a dentist urgently if:

• The bleeding does not stop after the pressure steps above.
• Pain is severe or getting worse and painkillers are not helping.
• You have pain with a bad taste in your mouth, a high temperature, or you feel unwell. Any one of these is enough. The NHS lists them as signs to get urgent help² after wisdom tooth removal. We found no source that says a mild fever is normal after an extraction, so do not wait it out.
• Pain starts or gets much worse 1 to 2 days later, with a bad taste or smell and a socket that looks empty. This is the typical pattern of dry socket, and SDCEP advises urgent dental care⁶.
• Bleeding starts again days later. SDCEP notes that bleeding within a week of an extraction can be a sign of infection.

Emergencies. Call 112 or go to the nearest emergency department if swelling makes it hard to breathe, swallow or speak, or if the area around your eye or your neck swells. The NHS lists these as reasons to go to an emergency department¹⁵.

Frequently asked questions