Browse categories and answer follow-up questions to refine your symptom profile.
History
Presenting concern
Post extraction course
Tooth and extraction date
Day post procedure
Routine extraction
Surgical extraction
Bone removal
Sectioning
Sutures placed
Immediate post procedure pain control response
OPQRST
Onset
Pain start time relative to extraction
Sudden worsening after initial improvement
Persistent from day of extraction
Provocation and palliation
Worse with swallowing
Worse with chewing
Worse with mouth opening
Worse with cold liquids
Relief with ibuprofen
Relief with acetaminophen
Quality
Throbbing
Dull ache
Sharp
Pressure
Bad taste
Halitosis
Region and radiation
Localized to socket
Radiates to ear
Radiates to jaw
Radiates to temple
Facial pain distribution
Severity
Pain score pattern
Waking from sleep
Analgesic breakthrough frequency
Timing
Constant
Intermittent
Worse at night
Progression day by day
Associated symptoms
Local and systemic symptoms
Fever
Chills
Facial swelling
Trismus
Dysphagia
Odynophagia
Drooling
Voice change
Dyspnea
Pus drainage
Bleeding
Numbness
Sinus symptoms
Bleeding and wound care
Hemostasis and aftercare
Time to stop bleeding post extraction
Rebleeding episodes
Gauze use pattern
Spitting or vigorous rinsing early
Straw use
Smoking or vaping
Oral hygiene since extraction
Alarm Features
Airway and deep space infection red flags
Immediate escalation triggers
Dyspnea
Stridor
Drooling
Inability to handle secretions
Voice change
Floor of mouth elevation
Rapidly progressive swelling
Neck swelling
Trismus severe
Sepsis and toxicity
High risk systemic findings
Fever with rigors
Hypotension
Tachycardia out of proportion
Altered mental status
Immunocompromised host with facial infection
Hemorrhage risk
Concerning bleeding patterns
Persistent bleeding despite pressure
Large clot burden
Lightheadedness
Known coagulopathy
Anticoagulant or antiplatelet use
Neurovascular and anatomic complication red flags
High risk focal deficits
New facial numbness
Tongue numbness
Weakness of facial muscles
Visual changes
Severe headache with facial infection
Oroantral communication red flags
Maxillary sinus involvement
Fluid from nose with drinking
Air passage from socket
Unilateral nasal congestion
Unilateral purulent nasal drainage
Medications
Analgesics and recent antibiotics
Current pain regimen
Acetaminophen dose and timing
NSAID dose and timing
Opioid exposure
Last dose timing
Effectiveness trend
Antibiotic exposure
Agent
Start date relative to extraction
Missed doses
Allergy history
Bleeding related medications
Antithrombotics
Warfarin
Direct oral anticoagulant
Aspirin
Clopidogrel
Recent INR result if applicable
Medication contraindication screen
Contraindication risks
NSAID risk
Chronic kidney disease
Peptic ulcer disease
Anticoagulation
Heart failure
Third trimester pregnancy
Acetaminophen risk
Chronic liver disease
Heavy alcohol use
Opioid risk
Sleep apnea
Concomitant sedatives
Diet
Hydration and intake
Oral intake pattern
Reduced intake due to pain
Ability to swallow liquids
Dehydration symptoms
Exposures affecting healing
Healing modifiers
Tobacco exposure
Alcohol exposure
Very hot foods early
Hard particulate foods
Nausea and constipation contributors
Medication related intake issues
Nausea with analgesics
Constipation with opioids
Review of Systems
Infectious and constitutional
Systemic symptoms
Fever
Chills
Malaise
Poor oral intake
Head and neck
Local symptoms
Facial swelling
Neck swelling
Trismus
Odynophagia
Dysphonia
Otalgia
Sinus pressure
Respiratory and cardiovascular
Airway and perfusion symptoms
Dyspnea
Chest pain
Presyncope
Neurologic
Cranial nerve and sensory symptoms
Lip numbness
Tongue numbness
Facial weakness
Severe headache
Collateral History and Family History
Collateral sources and reliability
Context and reliability
Dentist or oral surgeon contact details available
Operative note availability
Caregiver observations
Family history relevant to complications
Bleeding and clotting disorders
Hemophilia
von Willebrand disease
Early thrombosis
Household exposures
Infection exposure context
Sick contacts
Shared smoking exposure
Risk Factors
Procedure related risk
Extraction risk factors
Mandibular third molar extraction
Difficult or prolonged procedure
Traumatic extraction
Poor oral hygiene baseline
Patient related infection risk
Host risk factors
Diabetes mellitus (E11.9)
Immunosuppression
Chemotherapy
Chronic kidney disease (N18.9)
Malnutrition
Dry socket risk
Alveolar osteitis risk factors
Smoking
Oral contraceptive use
Prior dry socket
Early vigorous rinsing
Straw use
Bleeding risk
Hemorrhage predisposition
Anticoagulants
Antiplatelets
Liver disease (K76.9)
Known coagulopathy
Special populations
Pregnancy and pediatrics
Pregnancy trimester
Pediatric age and weight based dosing needs
Differential Diagnosis
Life threatening
Deep neck space infection
Ludwig angina
Submandibular space abscess
Parapharyngeal abscess
Retropharyngeal abscess
Clues
Trismus
Dysphagia
Drooling
Floor of mouth elevation
Toxic appearance
Airway compromise
Clues
Stridor
Voice change
Respiratory distress
Sepsis (A41.9)
Clues
Hypotension
Altered mental status
Persistent fever
Necrotizing soft tissue infection (M72.6)
Clues
Pain out of proportion
Rapid progression
Crepitus
Common
Alveolar osteitis
Clues
Pain peak day 2 to 4
Severe socket pain with radiation
Empty socket appearance
Halitosis
No prominent facial swelling
Postoperative inflammatory pain
Clues
Expected peak first 24 to 72 hours
Gradual improvement
Minimal systemic symptoms
Localized odontogenic infection
Periapical abscess (K04.7)
Post extraction socket infection
Clues
Purulence
Increasing swelling
Fever possible
Hemorrhage from socket
Clues
Oozing with clot disruption
Antithrombotic use
Less common
Retained root fragment or foreign body
Clues
Persistent focal pain
Poor healing
Osteomyelitis of jaw (M27.2)
Clues
Persistent pain
Fever
Exposed bone
Oroantral communication
Clues
Fluid regurgitation into nose
Unilateral sinus symptoms
Temporomandibular disorder (M26.60)
Clues
Jaw pain with opening
Joint tenderness
Mimics and pitfalls
Trigeminal neuralgia (G50.0)
Clues
Electric shock pains
Triggered by light touch
Otitis media (H66.90)
Clues
Ear symptoms predominate
Tympanic membrane findings
Giant cell arteritis (M31.6)
Clues
Age over 50
New headache
Visual symptoms
Past Medical History
Medical conditions
Comorbidities affecting management
Diabetes mellitus (E11.9)
Chronic kidney disease (N18.9)
Liver disease (K76.9)
Immunocompromise
Valvular heart disease
Prior oral and dental history
Prior relevant history
Prior dry socket
Recurrent dental infections
Prior jaw surgery
Prior bleeding or anesthesia issues
Procedure history
Prior bleeding complications
Prior difficult airway
Prior sedation complications
Baseline function
Baseline status
Baseline swallowing ability
Baseline mouth opening
Physical Exam
Vitals and general appearance
Initial clinical status
Temperature
Heart rate
Blood pressure
Respiratory rate
Oxygen saturation
Toxic appearance
Hydration status
Airway and oropharynx
Airway and oropharyngeal exam
Voice quality
Drooling
Stridor
Uvular deviation
Posterior pharyngeal bulge
Floor of mouth elevation
Tongue displacement
Oral cavity and socket
Local oral findings
Extraction socket appearance
Visible clot
Exposed bone appearance
Purulence
Foul odor
Active bleeding
Gingival erythema and fluctuance
Face and neck
Face and neck exam
Facial swelling distribution
Induration
Crepitus
Neck range of motion
Cervical lymphadenopathy
Trismus measurement estimate
Neurologic
Cranial nerve screening
Facial sensation distribution
Tongue sensation
Facial motor function
Cardiopulmonary
Systemic impact exam
Work of breathing
Lung auscultation
Perfusion
Mental status
Lab Studies
When labs are useful
Indications for labs
Systemic toxicity
Suspected deep space infection
Immunocompromised host
Significant swelling with fever
Persistent bleeding with concern for coagulopathy
Suggested labs by scenario
Infection evaluation
CBC
CRP
Basic metabolic panel
Blood cultures if febrile and toxic
Bleeding evaluation
INR if warfarin
Platelet count
PT and aPTT if coagulopathy suspected
Interpretation pearls and pitfalls
Limitations
Normal WBC does not exclude deep space infection early
CRP supportive but nonspecific
INR target ranges are local protocol dependent for hemostasis decisions
Imaging
Scoring Systems
Severity and escalation frameworks
Airway risk stratification
Drooling
Stridor
Voice change
Floor of mouth elevation
Sepsis screening
Hypotension
Tachypnea
Altered mental status
MRI
When MRI can help
Suspected osteomyelitis with nondiagnostic CT
Soft tissue extension assessment when CT contraindicated
Limitations
Limited availability in emergent airway risk
Motion artifact with severe pain and trismus
CT
CT neck with IV contrast
Indications
Suspected deep neck space infection
Trismus with systemic symptoms
Rapidly progressive swelling
Interpretation pearls
Abscess
Gas in soft tissues
Airway narrowing
Contraindications and cautions
Contrast allergy
Chronic kidney disease
CT maxillofacial
Indications
Suspected retained root fragment
Suspected fracture
Suspected osteomyelitis
Ultrasound
Point of care ultrasound
Superficial facial abscess assessment
Guidance for superficial drainage when appropriate
Limitations
Poor evaluation of deep neck spaces
Limited by gas and bony structures
Special Tests
Bedside dental and ENT focused checks
Focused bedside assessments
Gentle socket inspection for clot and exposed bone
Palpation for fluctuance adjacent to socket
Bimanual floor of mouth palpation
Trismus functional assessment
Bleeding source confirmation
Hemostasis assessment
Identification of oozing versus arterial bleeding
Assessment for clot disruption behaviors
Oroantral communication screen
Sinus communication clues
Nasal regurgitation with fluids
Unilateral nasal symptoms after maxillary extraction
ECG
When ECG is relevant
ECG triggers in dental presentations
Chest pain
Syncope or presyncope
Significant tachycardia with fever
Key findings to note
High risk patterns
ST elevation
New ischemic changes
Wide complex tachycardia
Serial ECG logic
Repeat ECG scenarios
Ongoing chest pain
Evolving symptoms during ED stay
Assessment
Working diagnosis framework
Likely category
Alveolar osteitis
Pain worsening day 2 to 4
Minimal swelling
Halitosis
Localized infection
Purulence
Increasing swelling
Fever possible
Deep space infection concern
Trismus
Dysphagia
Neck swelling
Toxic appearance
Bleeding complication
Persistent oozing
Antithrombotic exposure
Severity and risk stratification
High risk features present
Airway threat signs
Sepsis physiology
Rapid progression
Immunocompromised status
Complications to rule out
Cannot miss complications
Ludwig angina
Deep neck abscess
Necrotizing infection
Significant hemorrhage
Oroantral communication
Plan
First 5 minutes
Time critical priorities
Airway risk screen
Drooling
Stridor
Voice change
Floor of mouth elevation
Monitoring
Continuous pulse oximetry if swelling or respiratory symptoms
Cardiac monitor if toxicity
IV access criteria
Toxic appearance
Concern for deep space infection
Ongoing significant bleeding
Immediate consult activation
ENT or OMFS for airway threat signs
Anesthesia for anticipated difficult airway
Analgesia and symptom control
Adult analgesic options
Acetaminophen 1000 mg PO
Maximum 3000 mg per day if liver risk
Maximum 4000 mg per day if no liver risk
Ibuprofen 400 mg PO
Every 6 to 8 hours as needed
Avoid in high bleeding risk or renal disease
Naproxen 500 mg PO
Then 250 mg PO every 8 to 12 hours as needed
Avoid in pregnancy third trimester
Oxycodone 5 mg PO
Every 6 hours as needed for severe pain
Avoid with other sedatives
Nonpharmacologic adjuncts
Ice packs for swelling first 24 hours
Warm compresses after 24 hours if swelling persists
Local socket management
Suspected alveolar osteitis management
Dental or OMFS follow up for socket irrigation and medicated dressing
Avoid empiric antibiotics if no infection signs
Suspected localized infection management
Antibiotics when signs of spreading infection
Amoxicillin 500 mg PO every 8 hours
Duration 5 days
Local protocol dependent
Penicillin allergy option
Clindamycin 300 mg PO every 6 hours
Duration 5 days
C difficile risk
Hemorrhage control
Initial measures
Direct pressure with gauze bite
Duration at least 20 to 30 minutes without checking
Escalation measures
Tranexamic acid topical
Soaked gauze application
Local protocol dependent
Local anesthetic with vasoconstrictor for focal bleeder
Suture consideration
OMFS consultation for refractory bleeding
Deep space infection pathway
If deep space infection concern
CT neck with IV contrast if stable airway
Broad spectrum IV antibiotics
Ampicillin sulbactam 3 g IV every 6 hours
Penicillin allergy option
Clindamycin 600 mg IV every 8 hours
Add levofloxacin 750 mg IV daily if severe and gram negative concern
Local protocol dependent
Early airway planning
Awake technique consideration
Surgical airway readiness if obstruction risk
Reassessment loop
Reassessment timing
Pain response within 30 to 60 minutes of therapy
Airway and swelling reassessment every 30 to 60 minutes if concern
Triggers to change plan
Increasing trismus
New dysphagia
Worsening swelling
New fever or instability
Disposition
ICU and step down criteria
ICU level care indicators
Airway threat signs
Need for intubation planning
Sepsis with hypotension
Rapidly progressive deep space infection
Inpatient admission indicators
CT proven abscess
Failed outpatient antibiotics
Immunocompromised with facial infection
Inability to tolerate oral intake
Uncontrolled pain despite ED regimen
Observation pathway
Short stay considerations
Moderate swelling without airway signs
Pain control requiring serial reassessment
Bleeding controlled but high rebleed risk
Discharge criteria
Safe discharge features
No airway symptoms
No rapidly progressive swelling
Afebrile or improving
Oral intake adequate
Pain controlled with oral regimen
Reliable follow up
Follow up timing
Recommended follow up
Dentist or OMFS within 24 to 48 hours for suspected dry socket
Earlier same day follow up if persistent bleeding
ENT or OMFS urgent follow up if swelling progression risk
Discharge Instructions
Copy discharge instructions
You have pain after a tooth extraction that can be normal in the first few days, but it should steadily improve
If your pain suddenly gets worse after initially improving, this can be a dry socket
If you develop swelling, fever, trouble opening your mouth, trouble swallowing, drooling, a muffled voice, or any breathing trouble, go to the emergency department right away
Pain control
Acetaminophen as directed on the label or as prescribed
Ibuprofen or naproxen only if you have no kidney disease, stomach ulcer history, pregnancy third trimester, or blood thinner use unless your clinician said it is ok
If you were given an opioid, do not drive, do not drink alcohol, and do not take other sedating medicines
Bleeding care
If bleeding starts again, bite firmly on gauze for 20 to 30 minutes without checking
Avoid spitting and avoid vigorous rinsing for the first day
Healing care
Avoid smoking or vaping because it increases the risk of dry socket and infection
Avoid using straws for several days
Soft foods until chewing is comfortable
Follow up
Contact your dentist or oral surgeon within 24 to 48 hours if pain is not improving or if you suspect dry socket
If you were started on antibiotics, take them exactly as prescribed
Return now or call emergency services
Trouble breathing
Drooling or trouble swallowing saliva
Rapidly increasing swelling of the face or neck
Fever with feeling very unwell
Uncontrolled bleeding
References
Guidelines and evidence
American Association of Oral and Maxillofacial Surgeons clinical guidance on odontogenic infections and management
Local protocol dependent variability
Emphasis on airway risk and early surgical consultation
Scottish Dental Clinical Effectiveness Programme guidance on acute dental problems and dental abscess management
Antibiotic stewardship emphasis
Criteria for urgent referral
American Dental Association guideline on antibiotic use for dental pain and swelling
Avoid antibiotics when localized and no systemic signs
Use antibiotics when systemic involvement or spreading infection
NICE antimicrobial prescribing guidance relevant to dental infections
Antibiotic choice and duration principles
Stewardship framework
Cochrane reviews on interventions for alveolar osteitis
Dressing and irrigation symptom relief focus
Limited role for antibiotics without infection
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.