Updated: Oct 14
We can give you a million reasons as to why you shouldn't smoke after a tooth extraction, but we only need to give you one, dry socket. Have you heard of it because it is more dreadful than death itself.
The purpose of this article is to give you a compelling reason to not smoke after having your tooth removed. Just in case you were wondering, there IS a difference between having a regular tooth taken out vs a wisdom tooth and we'll cover that as well.
Are you ready?
Table of Contents:
Why shouldn't you smoke after having a tooth extraction?
The primary reason you should not smoke after a tooth extraction is because it increases the probability of getting a dry socket while you're healing.
That particular study showed that the incidence of dry socket from smoking was 12% when compared to 4% for non-smokers.
Therefore smokers are three times as likely to end up with a dry socket vs non-smokers.
What is dry socket?
A dry socket is when the blood clot fails to develop at the extraction socket, thus resulting in exposed bone. This bone is extremely sensitive to everything that touches it, which includes food and drinks. Normally, the exposed bone is covered by a blood clot but since the clot failed to form, it is left exposed to all of the elements within the oral cavity.
This is important because all patients who've had this condition report that it is extremely painful. It often results in an unbearable toothache that feels worse than the infection that necessitated the tooth extraction in the first place.
Symptoms of a dry socket:
Missing blood clot
Foul odor or bad breath
Lack of blood in the socket
How does smoking cause dry socket
Unfortunately, it is not really understood how a dry socket even forms. There have been a lot of theories as to the cause of a dry socket but researchers don't really know for sure.
The only thing that is certain is that there appears to be a decrease in blood flow to the extraction site and also a lot of fibrinolytic activity which dissolves blood clots. Since smoking causes vasoconstriction, which is narrowing of the blood vessels, it appears to increase the chances of getting it.
Aside from that, here are the risk factors that increases the chance of getting a dry socket:
Previous history of dry socket
Other reasons to not smoke
Aside from potentially getting a dry socket, there is a plethora of other reasons as to why you shouldn't smoke after having a tooth removed.
Delays healing. Smoking will constrict blood vessels and that constricts the amount of nutrients that can go to the extraction site. This delays healing because the socket is not receiving the proper supply of nutrients to repair the hole in your mouth after the tooth was removed.
Blood clot loss. The mechanical action of drawing in smoke when you puff the cigarette can potentially cause the blood clot to come out. If the clot comes out of the socket, you will experience continual bleeding. You want the bleeding to stop within a few hours of completing the procedure.
Carcinogenic. Cigarettes can cause lung cancer and tongue cancer. Most people don't think about the later and only recognize the former. Just so that you know, tongue cancer is incredibly disfiguring and also not very pleasant if you need to have your tongue removed.
Gum disease. Smoking is a risk factor for the start, extent and severity of periodontal disease such as gingivitis and periodontitis. Studies have shown that former smokers experience less attachment loss than current smokers but more than those who've never smoked. Attachment loss is correlated to tooth loss.
Stains teeth. The tar from smoking will stain your teeth. In fact it can cause them to look very unsightly especially if the tartar picks up the stain. It can become what is known as black tartar.
When can you smoke after tooth extraction
The general recommendation is to wait at least 72 hours after your tooth extraction before you start smoking again. That means no cigarettes for the next three days minimum but your dentist would actually prefer it if you quit smoking altogether after those 72 hours have passed.
The primary reason for not smoking within that time frame is because the wound from the extraction socket is fresh and actively bleeding. This means that it needs as much nutrients as possible going to the area in order for it to stop bleeding and to begin healing. Since nicotine acts as a vasoconstrictor, it will delay healing if you try to smoke.
This means that the actual act of smoking is not the main factor in slow healing because it is the nicotine within the cigarettes that is the culprit. In case you were wondering, this means that the nicotine patches are almost as destructive as smoking itself. You should not use nicotine patches for the next 72 hours after smoking since it will give you a similar effect of delayed wound healing.
Although the cigarettes are just a little bit worse than the patches because the sucking action from drawing in the smoke can dislodge the blood clot within the first 24 hours. After the clot has stabilized, the cigarettes are equal to the patches in destructiveness.
CAN you smoke after getting a tooth pulled if you don't care about dry socket?
Of course you can smoke after a tooth extraction because no one is stopping you from doing so. The procedure itself does not physically prevent you from smoking so it is up to you whether or not you want to do it. You won't definitively get dry socket if you do smoke but it does triple your chances of getting it if you do.
You may think that you'd rather take the chance but we would advise against it. The only reason you're thinking of giving it a try is because you've never experience dry socket. It is excruciatingly painful, more so than whatever the infection was that was causing you enough pain to have a tooth removed. If you don't believe us, you should ask around to see if there is a friend who ended up with this condition after the surgical procedure.
Smoking after tooth extraction with gauze
Even after our warnings and you can't stop yourself from smoking because of nicotine dependence, we would advise you to at least smoke with gauze covering the extraction socket. The gauze won't prevent dry socket but it can at least help prevent the blood clot from coming out from the sucking motion of drawing in smoke.
You may need to do this for the next 72 hours until the blood clot stabilizes so that it doesn't risk dislodging it. Its not a perfect prevention but it is better than nothing!
Smoking weed after tooth extraction
Smoking weed after a tooth extraction will increase bleeding. Studies have shown that marijuana use after surgery will increase the risk for bleeding as well as for stroke but it will decrease the chance for kidney injuries.
Cannabis appears to interfere with the coagulation cascade by preventing clot formation and platelet aggregation. Aside from that, the act of smoking weed can also mechanically dislodge the blood clot and that will result in bleeding as well.
Therefore, you should not smoke weed nor cigarettes after a tooth extraction.
Smoking with stitches
Smoking does not interfere with stitches directly but you still shouldn't do it because it can cause dry socket and potential increased bleeding. The reason why it doesn't interfere is because the stitches are tied with a surgeon's knot and will not come loose that easily. The only way to loosen it is by mechanically means, either with eating or cutting them with a scissor.
How to smoke without getting dry a socket
Unfortunately it is not possible to smoke without getting a dry socket if you've had a tooth removed. Even utilizing gauze or getting stitches won't prevent you nor decrease the chances of getting a dry socket.
However, studies have shown that taking antibiotics prophylactically can significantly reduce the chances for getting a dry socket. This means that if you are unable to stop yourself from smoking, you may want to request that your dentist prescribe you antibiotics.
Even though antibiotics can reduce the chances of getting it, a lot of researchers and clinicians pondered whether it was worth it to give antibiotics to the entire population just to prevent a few individuals from getting it. The conclusion was that it was not worth it because the percentage of people who get it are low.
Another major reason is possibly exposing the entire population to antibiotic resistant bacteria just to prevent dry socket. Due to these two reasons, the conclusion was that it was not worth it to do it just to prevent it.
What about smoking after wisdom teeth removal?
The incidence of dry socket is inherently greater in wisdom teeth removal when compared to a routine extraction and smoking only makes it worse. Since the risk for the condition is already higher for wisdom teeth, the smoking will only exacerbate getting dry socket after the wisdom teeth procedure.
Incidence of dry socket from extractions:
Routine extractions were 1-4%.
Mandibular third molars were as high as 45%.
Aside from the wisdom teeth being at a higher risk for developing the painful condition, all principles that apply for a routine extraction also apply for the third molars.
Smoking will dislodge blood cot in the first 72 hours but especially in the first 24.
Marijuana may increase bleeding.
Caffeine may increase bleeding.
Smoking with gauze is better than without gauze.
Nicotine patches are just as dangerous as cigarettes.
Stitches don't prevent dry socket.
Can cause cancer.
Can contribute to gum disease.
Therefore, the side effects from smoking are largely the same for extracting wisdom teeth but with the only difference being that you are at a higher risk for dry socket.
When can i smoke after wisdom tooth extraction?
The same principles for smoking after tooth extraction applies for wisdom teeth removal. Therefore, you should not smoke within the first 72 hours after the procedure. If you do so, you run the risk of dislodging the blood clot which can contribute to persistent bleeding and also increase the chances of you getting a dry socket.
If you must smoke, at least try to cover the socket with some gauze before you do it!
When can you smoke weed after tooth extraction?
There is no difference in recommendation for when to smoke weed vs when to smoke cigarettes. Therefore you should wait at least 72 hours before you smoke marijuana because that is when the blood clot is stabilized enough to not bleed. An unfortunate effect of marijuana is an increased chance of bleeding and stroke.
Smoking after a wisdom teeth extraction won't kill you but it can cause you a dry socket, which may make you feel like you are dying. Nicotine patches and marijuana also do not circumvent any of the rules, they're still bad for the healing process after having a tooth removed. There is also a difference between a routine extraction vs a wisdom tooth extraction because the chances for getting a dry socket are actually higher for wisdom teeth removal!
Therefore, you should be extra cautious of the third molars are bothering you! Although interestingly enough, taking antibiotics can help reduce the incidence of dry socket so if you are a smoker, you may want to request it even if you may not need it tooth infection wise.
Author: Written by Dr David Chen, a long island city dentist.
This article is for information purposes only.
You should consult your own dentist since they are your primary care provider.
99.99% of dental symptoms require intervention by a dentist, that's just the unfortunate nature of dentistry. (Hint: its the reason why you can't get rid of us.)