Concerns About Persistent Swelling After Wisdom Tooth Extraction

The swelling after wisdom tooth extraction has not gone down, and I am a bit worried?

Hello, Director.
I had my lower right wisdom tooth extracted at the clinic on February 22.
After the extraction, my cheek was significantly swollen.
By March 18, the swelling had decreased, but it was still quite noticeable (the pain only occurs when I open my mouth wide).
During this time, I did not experience any fever, headache, or other symptoms.
On the same day, I received a referral to a medical center for drainage (but no drainage tube was placed; the doctor said the extraction was very well done, which made me wonder why I was still so swollen).
By March 31, the swelling had noticeably reduced to a hard lump about the size of a one-dollar coin (it is very hard, and the skin still shows a faint red mark).
It does not hurt when I open my mouth wide or press on it.
Although it is not painful and does not interfere with my daily life (I just pretend it doesn't exist), I am still a bit worried because it has been 23 days since March 31, and it seems like it is not going away.
It feels like it has only slightly decreased in size, but not significantly (it even seems like it might just be a psychological effect that it has shrunk, but in reality, it hasn't).
Therefore, I would like to ask you: 1) What should I do next? Should I return to the medical center for drainage again? Can medication help speed up the disappearance of the lump? 2) Are there any methods I can try at home (such as warm compresses or massage) to help the lump dissolve faster? 3) Can you tell me what the lump might be? (pus, blood, or something similar) 4) My biggest concern is whether that lump will ever go away completely.
Thank you, Director.

Zhong, 20~29 year old female. Ask Date: 2024/04/23

Dr. Zeng Guanghui reply Dentistry

Dear Mr.
Zhong,
1.
If the process of tooth extraction involves grinding down the alveolar bone, there is usually a higher risk of postoperative swelling and pain due to the larger wound area, which increases the likelihood of infection.
If an X-ray is taken postoperatively to confirm that there are no remaining roots and drainage has been performed, as long as the wound is kept clean, the swelling will typically subside gradually.
2.
You only need to apply cold compresses on the day of the tooth extraction.
3.
The hard lump is a blood clot in the extraction site.
4.
As long as you maintain cleanliness at the wound site, the hard lump will gradually disappear.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital

Reply Date: 2024/04/23

More Info

After wisdom tooth extraction, it is not uncommon to experience swelling and discomfort. However, persistent swelling, especially lasting several weeks, can be concerning and warrants further evaluation. Based on your description, it seems you are experiencing a hard lump that has not significantly changed in size over the past few weeks. Here are some insights and recommendations regarding your situation:
1. Next Steps: Given that the swelling has persisted for an extended period, it is advisable to return to the medical center for a follow-up evaluation. The healthcare provider may want to perform imaging studies, such as an X-ray or a CT scan, to assess the area more thoroughly. This will help determine if there is any underlying issue, such as an infection or a hematoma (a localized collection of blood outside of blood vessels). If there is evidence of infection, drainage may be necessary, even if a drain was not placed initially.

2. Medication and Home Remedies: While there is no specific medication that can guarantee the rapid resolution of a hard lump, anti-inflammatory medications (like ibuprofen) can help reduce swelling and discomfort. However, you should consult your healthcare provider before taking any medication. As for home remedies, gentle warm compresses may help promote blood flow and potentially assist in the healing process. However, avoid any aggressive massage or manipulation of the area, as this could exacerbate inflammation or introduce bacteria.

3. Nature of the Hard Lump: The hard lump you are feeling could be several things. It might be a residual hematoma, which can feel firm as it organizes and heals. Alternatively, it could be a seroma (a pocket of clear fluid) or even a localized area of inflammation. In some cases, if there was an infection, it could be a collection of pus (abscess). The absence of pain and other systemic symptoms (like fever) is a positive sign, but it does not rule out the possibility of an underlying issue.

4. Long-term Concerns: It is understandable to be worried about whether the hard lump will resolve. In many cases, such lumps do diminish over time as the body heals. However, if the lump does not decrease in size or if you develop new symptoms (like pain, fever, or drainage), it is crucial to seek medical attention. Persistent lumps that do not resolve may require further investigation to rule out complications.

In summary, while it is common to experience swelling after wisdom tooth extraction, persistent hard lumps should be evaluated by a healthcare professional. Regular follow-ups and imaging studies can help clarify the situation. In the meantime, managing discomfort with appropriate medications and gentle home care may provide some relief. Always prioritize communication with your healthcare provider regarding any changes or concerns you may have.

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