Three Days After the Extraction, It Got Worse Instead of Better

Quick answer: After an extraction, day one is the worst and each day should be better than the last. Pain that increases from day three, especially with swelling, a bad taste or a fever, means something is wrong — usually dry socket or an infected socket, and they are treated differently.

The call

Nurit, 48, from Moshav Yishi, had a lower molar extracted elsewhere on a Sunday. Monday and Tuesday were sore but improving. On Wednesday it got worse, and by Thursday morning she had a swollen jaw, a foul taste and a temperature.

She phoned us because the original clinic could not see her until the following week.

What we found

The socket was not empty and dry. It was filled with soft, unhealthy granulation tissue, discharging pus, with red swollen gum around it and tenderness under the jaw. Temperature 37.9.

Then the finding that explained everything: a small radio-opaque fragment at the base of the socket on the x-ray. A retained root tip, about 3mm, left behind at the extraction.

The distinction between the two common post-extraction problems matters, because the treatments differ:

Dry socket (alveolar osteitis). Severe, deep, radiating pain starting day two to four. The socket looks empty, with visible grey-white bone and no clot. There is a bad taste and often bad breath, but usually no swelling and no fever. It is not primarily an infection — the clot has broken down and exposed bone. Treated by irrigating and dressing the socket, which relieves the pain within minutes.

Infected socket. Increasing pain with swelling, redness, pus, a fever and feeling generally unwell. The socket contains inflamed tissue rather than being empty. Treated by cleaning out the socket and, usually, antibiotics — and by finding the cause.

Hers was clearly the second, with a specific cause sitting at the bottom of it.

A retained root fragment is not automatically a mistake. Small fragments are sometimes deliberately left when removing them would risk damaging the nerve or the sinus, and many cause no trouble at all. What matters is that the patient is told, so that if the site does not settle, everyone knows where to look. That had not happened here.

What we did

Anaesthetised the area, opened the socket, removed the granulation tissue and lifted out the root fragment, which came away easily once visible. Irrigated thoroughly with saline, placed a dressing and prescribed an antibiotic, justified by the fever and swelling.

She was noticeably better by the following morning.

The outcome

Healed uneventfully over the following three weeks. We sent a courtesy note to the original clinic with the x-ray, which is the professional thing to do and helps nobody if it is left unsaid.

What to do if this happens to you

1. Track the trend, not the level. Day one sore is normal. Day four worse than day three is not.
2. Phone the clinic that did the extraction first. If they cannot see you promptly, go elsewhere — do not wait.
3. Note whether there is swelling and fever. That distinguishes infection from dry socket.
4. Do not rinse vigorously in the first 24 hours, and avoid smoking and straws, which dislodge the clot.
5. Ask for an x-ray if a socket is not healing. Retained fragments and bone sequestra show up clearly.
6. Go to hospital if the swelling spreads under the jaw or you have difficulty swallowing.

Extraction site not healing? Ramat Beit Shemesh Urgent Dental Care sees post-extraction problems the same day, wherever the tooth was taken out. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.