Some discomfort and pain after wisdom teeth removal is to be expected. No one goes into the procedure expecting to come out unscathed but throbbing pain 5 days later is NOT a normal part of the process.
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Throbbing pain 5 days later is abnormal
If you're experiencing throbbing pain 5 days after your wisdom tooth extraction, it is a tell tale sign that a complication has occurred. Something went awry during the healing process.
During the normal progression of pain after an extraction, the discomfort should peak after 48-72 hours. However after that you should experience a marked decrease in pain with each successive day. There should be a trend towards improvement from that point forward.
If you're having a throbbing toothache on the 5th day, it means that you've a departure from the normal course of pain progression. Something is not right and it means that you have a complication.
Signs of a complication:
Pain after the 5th day
Worsening pain
Swelling
Bleeding
Presence of pus
Although we would like to emphasize that if you're having severe pain within the first 3 days, it doesn't mean that something is wrong. Once again, pain peaks within the first 2-3 days so it can still be considered normal. However if you're having excruciating discomfort after that time period, it may indicate that something is not quite right.
Potential complications
There can be many dental conditions which can cause throbbing pain after an extraction. The prime suspect would be a dry socket.
Complications:
Dry socket
Recurrent infection
Gum infection
Osteonecrosis of the jaw
Dry socket
A dry socket is a painful dental condition in which a blood clot fails to form, thus leaving sensitive exposed bone. Studies have shown that symptoms for this condition typically appear 24-96 hours after an extraction. The time frame seems to match up perfectly with throbbing pain 5 days after taking out your wisdom tooth.
The reason why it is extremely painful is because there is no blood clot covering and protecting your jaw bone. The exposed bone is simply left open to experience all of the external stimuli in your mouth.
Signs & symptoms:
Throbbing pain. It can throb and radiate across your face.
Missing blood clot. The wisdom tooth hole is missing a clot and it looks empty.
Exposed bone. Since there is no blood clot, you can visually see the jaw bone.
Bad breath. Food getting stuck in the socket can ferment and cause bad breath.
Unpleasant taste. Lodged food that is many days old can cause a bad taste.
Lack of blood. As its name implies, a dry socket is "dry" so it will not have blood.
Delayed healing. The wisdom tooth hole will close very slowly.
Recurrent infection
If you've had an abscess before the wisdom tooth was extracted, there is a possibility that it may have returned. Sometimes a couple of the bacteria cells could've escaped elimination from your dentist and they can re-proliferate. If that happens you will swell back up and re-experience pain.
This situation is unlikely to happen if you're taking your antibiotics properly. Although we do understand that you're not always prescribed antibiotics after wisdom teeth removal. Usually fully erupted teeth that don't need to be surgically extracted will not require antibiotics. The impacted ones on the other hand often do tend to need it. The decision is still your dentist's to make.
Gum infection
It's not unusual to get a gum infection during the healing process of an extraction. You do have a big gaping wound where the tooth used to be and it hasn't closed yet. That means it is quite easy for bacteria or food to get lodged in there and cause an infection.
Osteonecrosis
Albeit rare, it is possible to get osteonecrosis of the jaw after a wisdom tooth extraction. This condition is very painful and is characterized by a non-healing socket. What you'll see is exposed jaw bone that refuses to heal.
This condition is more common for those who have pre-existing problems with their bone health such as osteoporosis. Patients with that condition are especially at risk if they have been taking bisphosphonates which is medication that interferes with bone remodeling. Unfortunately the wisdom tooth hole needs to remodel the bone during the healing process.
Do I need help?
Yes, if you're having throbbing pain 5 days after the procedure you will need to see a dentist. In other words you do need professional help because treatment for all four of the conditions above require it. There is no home remedy that will make any of them go away.
Infections will most likely need to be drained along with cleaning out the tooth socket. You'll be prescribed antibiotics to take afterwards to prevent it from coming back.
There is no cure for a dry socket but palliative treatment is available to help you lessen the pain. Unfortunately you'll just have to bear through the slower than normal healing if you get this condition.
For osteonecrosis of the jaw, you will be referred to a specialist such as an oral surgeon. You may even get sent to the hospital for special treatment as well. Most of the care involves antibiotics, rinses, and analgesic gels.
Takeaway
It is normal to experience pain after having your third molar extraction but only up to a certain point. Typically post-surgical pain will peak around the 2nd to 3rd day but should decline from that point onward. If you're still having severe throbbing pain by the 5th day, it means that you've a complication.
Depending on what the exact condition is that you have, treatment may vary. Regardless of what you have, you will need to see a dentist because none of them can be treated at home. You don't even know what it is in the first place so you need to get a diagnosis first!
After that you can have a plan put in place for your recovery. Don't forget to review all of the aftercare instructions so that you can maximize your recovery and minimize the complications.
