Mild residual discomfort 7 days after a tooth extraction is normal but severe pain is abnormal and it is an indication of a potential complication.
Whether it is a post surgical complication would depend on the severity and intensity of the pain that you're feeling.
How long does pain last after an extraction?
If you're experiencing toothache 7 days after your extraction, it is a tell tale sign that something has gone wrong. It is abnormal because that is not a part of the healing process.
During the normal progression of pain after a tooth extraction, the discomfort should peak 48-72 hours after the procedure. However after that point in time you should experience a decrease in pain with each passing day. Basically, there should be a positive trend towards recovering from that point forward.
If you're still having tooth pain by the 7th day, it means that you've gone off track 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 7th day
Increasing pain
Swelling
Bleeding
Purulence
Non-healing socket
Note: We would like to emphasize that it is normal if you're having worsening pain within the first 3 days. As a reminder, pain typically peaks within the first 2-3 days so you can't tell if something has gone wrong at that point. However if you're having excruciating discomfort after that time period, it may indicate that a complication has occurred.
Other sign that something is wrong
Your dentist will prescribe you enough pain medication for what they think you would need. Most commonly you'll get enough pain killers for about one week because that's what you would need.
Therefore the expectation is that you shouldn't have anymore pain and that you don't need anymore pain alleviating after the 7th day. If you're still in pain after a week it is a clear indication that there is a complication!
Potential complications
There can be many dental conditions which can cause residual pain after having your tooth taken out. Although the prime suspect for your pain would be a dry socket.
Painful dental conditions:
Dry socket (alveolar osteitis)
Recurrent infection
Gum infection
Osteonecrosis of the jaw (ONJ)
Dry socket
A dry socket is a painful dental condition in which a blood clot fails to develop, thus leaving sensitive exposed bone. Studies have shown that symptoms for alveolar osteitis typically appear 24-96 hours after an extraction.
The reason why this condition is extremely painful is because there is no blood clot covering and protecting your jaw bone. The exposed jaw bone is simply left open to all of the stimuli in your mouth. Whenever you drink something cold, hot, spicy, sour, and sweet it will directly stimulate the exposed bone.
Signs of a dry socket:
Throbbing pain. It can throb and radiate across your head.
Missing blood clot. The socket 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 extraction hole will close very slowly.
Recurrent infection
If you've had an abscess before the tooth was extracted, there is a possibility that it may have returned. Sometimes the bacteria cells can escape elimination from your dentist and they can re-proliferate. If that happens you will swell back up and the pain will return.
However, this situation is unlikely to happen if you're taking the prescribed antibiotics as directed. The caveat is that you don't always get prescribed antibiotics after your extraction. It is not standard protocol to give antibiotics after every tooth removal.
When antibiotics are given:
An abscess with swelling.
Surgical extraction that requires drilling away bone.
Gum infection
It's not unusual to get a gum infection while the socket is healing. After all there is a big gaping open wound where the extracted tooth used to be. In other words, the risk for infection is increased. It is quite easy for bacteria, food, and debris to get lodged into the hole and cause an infection.
Osteonecrosis
Albeit rare, it is possible to get osteonecrosis of the jaw after a tooth removal. 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 still in pain 7 days after the surgical 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 in-office treatment.
Dental abscesses will need an incision and drainage. After that the socket will need to get flushed out with an antibiotic solution. You'll still be prescribed antibiotics to take afterwards just in case the infection tries to return once again.
There is no cure for a dry socket but palliative treatment is available to help alleviate the pain. Unfortunately you'll just have to bear through the slower than normal healing if you get this condition. There is simply no way around it. Smoking seems to be a risk factor for getting a dry socket.
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 tooth removed but only up to a certain point. Typically the post-operative pain will peak around 48-72 hours but should decline after that. If you're still having severe throbbing pain by the end of the first week, it means that something has gone wrong.
Depending on what the exact condition is the treatment will vary. Regardless of what you have, you will need to see a dentist because none of the conditions can be self-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 extraction aftercare instructions so that you can speed up your recovery and minimize the complications.
