The short answer
Healing after a tooth extraction (Zahnentfernung) happens on two clocks at once. The soft tissue clock is fast: the worst is over in two to three days, stitches come out after about seven to ten days, and the gum has usually closed over the socket within one to two weeks. The bone clock is slow: the socket fills in gradually over roughly three to six months, and the shape of the jaw carries on remodelling for a year. You feel almost nothing of the second clock — but it is the one that decides when an implant (Implantat) or a bridge (Brücke) can follow. For everyday planning, count on one to three quiet days, a careful first week, and normal life from about week two.
the most important protection
Week by week: what is actually happening
Hours 0–24: the clot forms. Blood fills the socket and clots within minutes. That clot (Blutgerinnsel) seals the bone, keeps bacteria out and is the scaffold everything else grows on. Protecting it is the entire job of day one — no rinsing, spitting, straws, smoking or anything hot.
Days 1–3: the peak, then the turn. Swelling builds and usually peaks between 24 and 72 hours before receding, and discomfort is highest on day one or two. Bruising may appear on the cheek by day three. This is the phase people misread: swelling still increasing on day two is normal, not a sign of infection.
Days 3–7: soft tissue takes over. The clot is replaced by granulation tissue — new, pinkish, fragile tissue rich in blood vessels — and a whitish-yellow coating appears over the wound. Patients regularly mistake it for pus; it is healing tissue and must not be brushed or picked at. Pain should now be clearly declining every day.
Days 7–10: stitches out. After a surgical extraction the sutures (Nähte) come out at this appointment — a couple of minutes, and most people find it causes little or no discomfort. Dissolving sutures disappear on their own within one to three weeks.
Weeks 2–3: the gum closes. For most people the socket is covered over by now and eating is comfortable again. You may still feel a dip where the tooth was, and occasionally a sharp bone edge with the tongue; most smooth over by themselves, and a persistent one is tidied up in a very short appointment.
Months 1–6: the socket fills with bone. Invisible from outside. New bone gradually replaces the soft tissue inside the socket, and by around three to six months it is generally solid enough to build on — the standard waiting window before an implant is placed in a healed site.
Months 6–12: the ridge settles. The jaw ridge carries on reshaping and narrows somewhat, because bone that no longer carries a tooth is gradually reduced. Normal biology — and precisely why the decision about replacing the tooth should not be postponed indefinitely.
What changes the timetable
The same procedure heals at different speeds in different people:
| Factor | Effect on healing |
|---|---|
| Simple vs surgical extraction | A surgical extraction with an incision means more swelling and roughly twice as long for the soft tissue to settle |
| Which tooth | Lower back teeth and wisdom teeth are the slowest and cause the most jaw stiffness; upper front teeth are usually the quickest |
| Smoking | The single biggest modifiable risk factor — impairs blood supply and markedly raises the risk of dry socket |
| Diabetes | Well-controlled: little difference. Poorly controlled: measurably slower healing and higher infection risk |
| Age | Older patients heal somewhat more slowly, but reliably |
| Existing infection | An extraction on an already infected tooth takes longer to settle |
| Blood thinners | Longer bleeding time; the healing timetable itself is largely unchanged |
| Immunosuppressants, chemotherapy, bone medication | Need individual planning — tell us before, not after |
Planning real life around it
Work. After a simple extraction, many people work the same afternoon or the next day, particularly in a desk job. After a surgical extraction, plan on one to three quieter days. Physical work, heavy lifting and anything in heat or dust warrant longer.
The sick note. In Germany a dentist can issue a certificate of incapacity for work (Arbeitsunfähigkeitsbescheinigung, AU — colloquially a Krankschreibung) where the treatment warrants it. Ask for it during the appointment rather than the next morning, and check your contract: many employers require the certificate from the first day of absence rather than the fourth.
Sport. Nothing on the day, walking from day two, and proper training, swimming and gym work from about day three to five after a simple extraction or around a week after a surgical one. Contact sport and diving: wait longer and ask us.
Flying. Short flights are usually fine after two to three days if healing is uneventful; after a surgical extraction, especially an upper back tooth near the sinus, allow about a week. The real problem with flying early is not cabin pressure — it is being at 10,000 metres if bleeding restarts. Tell us about a fixed flight date before we schedule the extraction.
Sauna, hot baths, sunbathing. Off the list for two to three days. Heat dilates blood vessels and is a classic trigger for the wound bleeding again.
Alcohol. Two to three days at minimum, and not at all on days you take painkillers.
Driving. Fine after local anaesthetic alone. Not on the day of sedation or laughing gas (Lachgas) — arrange a lift.
Food. Cool and soft on day one, warm and soft for the rest of the week, close to normal from week two. The detailed version, including a German supermarket list, is in What can you eat after a tooth extraction? (EN).
When healing takes longer than it should
Dry socket (trockene Alveole). The most common cause of a healing course that goes backwards: the clot is lost or breaks down, leaving bare bone exposed. The signature is unmistakable once you know it — things were improving, then from day two to four a deep, throbbing ache sets in that radiates to the ear, temple or neck, often with a foul taste, and ordinary painkillers barely touch it. It is not dangerous and not your fault, but it does not resolve well alone; treatment in the practice usually brings relief quickly. Smokers and patients after a difficult lower extraction are most affected.
Wound infection. Less common: swelling that increases again after day three, becomes firm and hot, with fever and general malaise. Needs to be seen.
Bone fragments (Sequester). Small splinters occasionally work their way to the surface weeks later, felt as a sharp point with the tongue. Usually harmless and easily removed.
An opening to the sinus. After an upper back tooth whose roots reached into the maxillary sinus, a small communication can remain. The signs: liquid coming through the nose when you drink, or air whistling into the mouth when you blow your nose. Treated early it is straightforward.
Delayed healing generally. A socket that still looks and feels raw after three weeks is worth an appointment rather than more patience.
What's normal — and when to contact us
Seek emergency care immediately if swelling spreads rapidly with difficulty breathing or swallowing.
Outside our opening hours the dental out-of-hours service (zahnärztlicher Notdienst) covers Wuppertal and the surrounding NRW region at night, at weekends and on public holidays; the rota is published by the regional dental association and reached by phone. Our own hours are Monday to Friday 07:30–19:30 and Saturday 08:00–18:00 — worth knowing, because dry socket has an inconvenient habit of announcing itself on a Saturday morning.
What the bone clock means for replacing the tooth
Because healing is slow underneath, the plan for the gap is a timing decision as much as a clinical one:
- Immediate implant placement — the implant goes in at the same appointment as the extraction. Only possible in favourable conditions: no acute infection, sufficient bone, good primary stability.
- Early placement, roughly 6–12 weeks — the soft tissue has healed, the bone is partly filled. A common compromise.
- Late placement, from about 3–6 months — the standard route into a fully healed site.
- Socket preservation — filling the socket with bone graft material at the time of the extraction to limit ridge shrinkage. Worth considering when an implant is already the likely plan, and a private service in the statutory system.
Which route suits you depends on the tooth, the bone and your own timetable. In our practice the surgical part of an implant starts from 999 € and a 3D X-ray (DVT) is 178 €; anything else appears in writing beforehand. As general market background — not our prices — an implant with crown in Germany typically costs around 2,100–4,000 €, and studies report implant survival of around 95 % and above. See When do you need an implant after a tooth extraction? (EN).
Special situations
If you smoke. Every day without cigarettes in the first week counts. This is not a moral point: the effect on blood supply to the socket is direct, and dry socket is substantially more common in smokers.
If you have diabetes. Keep blood sugar as steady as you can through the first week, and do not skip meals because chewing is awkward. Soft protein — quark, skyr, egg, puréed pulses — beats living on white carbohydrates.
If you are older or take several medications. Healing is usually reliable but slower; allow a longer margin before a holiday or a busy work period.
If you have just arrived in Germany. A dentist here can sign you off work, so you need no separate GP appointment for that. And if the reason you have been putting off dental appointments is the thought of describing symptoms in German, that is a solvable problem: English-Speaking Dentist in NRW. From Düsseldorf, Cologne, Bonn or Dortmund, 20–30 minutes to a practice that works in your language is a distance our patients consider entirely normal.
The gum usually closes over the socket within one to two weeks, though you may see and feel a dip for several weeks. The bone underneath takes around three to six months to fill in properly. Visible healing and structural healing run on very different clocks.
Often none after a simple extraction in a desk job, and one to three days after a surgical one. Physical work or work in heat and dust usually needs longer. Your dentist can issue the sick note (Arbeitsunfähigkeitsbescheinigung) — ask during the appointment.
Nothing on the day, walking from day two, proper training from roughly day three to five after a simple extraction or about a week after a surgical one. Raising your blood pressure early is the main way people restart bleeding.
No — that is the pattern that warrants a phone call. Pain should decline a little each day, so a deep ache setting in from day two to four that radiates to the ear and resists painkillers points towards dry socket. It is treatable, usually in one short appointment, and there is no reason to endure it over a weekend.
Short flights are usually fine two to three days after an uneventful simple extraction; allow about a week after a surgical one, particularly in the upper jaw. Tell us about a fixed flight date beforehand so the appointment can be timed around it.
Typically three to six months, once the socket has filled with bone. Earlier placement is possible in favourable cases — sometimes at the same appointment as the extraction — decided on the imaging and the condition of the site.
The visible part of healing is quick and the invisible part is slow, and both are normal. Expect the worst on days one and two, clear improvement from day three, stitches out at seven to ten days, normal life from week two. Underneath, the bone works quietly for months — which is why the conversation about replacing the tooth belongs in the first weeks rather than a year later. The rule for spotting trouble is simple: healing should feel a little better every day. When it starts going the other way, that is information, and a reason to call us.
Zahnarztpraxis Tsypin · Wuppertal. This article was medically reviewed and is provided for information; it does not replace an examination. Updated August 2026.
