When should i stop feeling pain after wisdom teeth removal

Tips for FAST Recovery After Wisdom Teeth Removal

Written by on December 1, 2012 (Updated: August 8, 2020)

Table of Contents[Hide][Show]

• Day of Surgery: What to Expect+−
  • Waking Up
  • Going Home
• Wisdom Teeth Home Care: Do’s and Don’ts
• Tips for Fast Wisdom Teeth Removal Recovery+−
  • 1. Prevent dry socket
  • 2. Keep your head elevated for the first 3 days
  • 3. Ice your cheek(s) for the first 36 hours
  • 4. Rinse with warm salt water
  • 5. Reduce inflammation
  • 6. Don't let your mouth dry out
  • 7. Massage your jaw
  • 8. Try photobiomodulation
  • 9. Drink coconut water
  • 10. Rest as much as you can
  • 11. Don’t overuse medications
• How long does it take to recover from wisdom teeth removal?
• When to Call Your Dentist
• What to Eat After Wisdom Teeth Removal
• How to Manage Pain During Recovery
• How to Sleep After Wisdom Teeth Removal
• Complications that Extend Recovery Time
• FAQs
• Long-Term Outlook

Wisdom teeth, or third molars, are the final adult teeth that erupt in the mouth. They typically come in between the ages of 17-21. Many people don’t have enough room for wisdom teeth, which is why they must be removed.

Most people recover in 3-4 days from wisdom teeth removal surgery, but full recovery may take a week or more. Complex extraction of impacted wisdom teeth that were already causing symptoms may require longer healing time, closer to 2 weeks.

Every year, about 5 million people in the United States have their wisdom teeth removed. Over 85% of people undergo wisdom tooth removal during their lifetimes.

How painful is wisdom teeth removal? Most people have some discomfort, mild pain, and swelling for about 3 days after wisdom teeth removal. Unless you develop a dry socket, you should feel better within 3-7 days.

How long should you take off work? Generally, your dentist will advise you to request 1-2 days off to recover from wisdom teeth removal.

It’s important to not only follow your dentist’s and surgeon’s instructions but also to support fast healing by following a few easy tips.

Day of Surgery: What to Expect

Wisdom tooth oral surgery is an outpatient procedure that usually takes 45 minutes or less. 

You won’t be required to stay anywhere overnight. If you’re only receiving local anesthesia (for non-impacted wisdom teeth), you can drive to and from the appointment. For surgical extractions with moderate to deep sedation, you will need a ride to and from your oral surgeon’s office. 

Depending on which anesthesia optionsyou choose, your first day of recovery might be slightly different. Local anesthetic and conscious sedation are less taxing on your body than deep sedation.

Waking Up

For simple wisdom tooth extraction, a local numbing agent and light sedation may be used. You probably won’t be fully aware during the procedure, but can typically leave soon after the extraction is complete.

Extraction of impacted wisdom teeth is required if your wisdom teeth have not erupted through your gums and may be embedded in your jawbone. During this procedure, the patient will typically receive some form of general anesthesia on top of local anesthesia near the extraction site. 

After an impacted wisdom tooth surgery, it may take longer for you to wake up from general anesthesia. You probably won’t remember anything about the procedure, being moved to a recovery room, or the few minutes before the procedure began.

Going Home

When you first wake up, you’ll notice that your mouth is numb. Your feeling will come back over the course of the next several hours.

There may be blood in your mouth during the first 24 hours of recovery. 

Plan to rest for the evening of your surgery and cancel any strenuous activity. 

For impacted wisdom teeth surgery, you’ll have a few additional things to do the day of your surgery:

• Your surgeon will give you a gauze pad to keep over the site of the extraction for anywhere between 30 minutes to 4 hours. You may also receive additional gauze pads to use over the next few hours. Change gauze pads every hour for the length of time recommended by your dentist.
• Your surgeon may instruct you to fill prescriptions for painkillers or antibiotics on your way home so you can take them as soon as possible.
• If over-the-counter painkillers are suggested in lieu of prescriptions, you will probably be told to take them as soon as you get home.
• You should begin using an ice pack soon after surgery on the side(s) of your jaw where teeth were extracted. 

Nausea and vomiting may occur during the first 10 hours after your surgery as a result of swallowed blood, sedation, or general anesthesia. If you continue to vomit after this time, call your surgeon.

Wisdom Teeth Home Care: Do’s and Don’ts

Once the wisdom teeth extraction is complete, your dentist or oral surgeon will provide information on how to care for your mouth while you recover. 

For the shortest recovery time, follow these simple rules.

Do…

• Take the pain medications your surgeon prescribes as soon as you can after surgery
• Change your gauze once every hour
• Remove your gauze pad(s) 2-3 hours after surgery ends (or whenever your surgeon instructs you to do so)
• Use an ice pack for the first 24-36 hours after surgery
• Use moist heat as needed to reduce jaw soreness after the first 36 hours
• Eat only soft foods 
• Drink plenty of fluids, including water
• Use a wedge pillow to elevate your head
• Start brushing your teeth, but not the extraction site(s), beginning on day 2

Don’t… 

• Brush your teeth, floss, or use mouthwash for the first 24 hours
• Touch the area around the extraction site(s)
• Remove your gauze to look at the infection site except to replace it
• Rinse your mouth vigorously for any reason
• Drink from a straw for the first 3 days
• Spit
• Smoke(for at least 5-7 days)
• Perform strenuous activities for at least 3-4 days (exercise, housework, hiking, etc.)
• Drink alcohol
• Drive a vehicle or operate heavy machinery for 48 hours
• Eat a lot of sugar, which can slow healing
• Eat hard, sticky, or crunchy foods
• Use more pain medication than you need (use a pill cutter to reduce dosage size)

To speed up wisdom teeth recovery, it’s important to follow your surgeon’s instructions. 

It is normal to experience some pain, swelling, and discomfort after your wisdom teeth are extracted. For fast healing, try these tips:

1. Prevent dry socket
2. Keep your head elevated for the first 3 days
3. Ice your cheek(s) for the first 36 hours
4. Rinse with warm salt water
5. Reduce inflammation
6. Don’t let your mouth dry out
7. Massage your jaw
8. Try photobiomodulation
9. Drink coconut water
10. Rest as much as you can
11. Eat healthy soft foods 
12. Don’t overuse medications

1. Prevent dry socket

The most important way to speed up wisdom teeth recovery is to do everything you can to prevent a dry socket. 

Dry socket happens when the blood clot that forms over your extraction site is dislodged. It happens after up to 25-30% of impacted wisdom teeth removals.

Losing this blood cot can cause tremendous pain by revealing the underlying bone. It’s most common during days 2-3 after tooth extractions.

Your dentist or oral/maxillofacial surgeon should provide you with a list of instructions for home care after surgery. Following these instructions is the most effective way to prevent dry socket. 

The best ways to prevent dry socket include:

• Not soaking new gauze pads in water before placing them on the extraction site
• Avoiding drinking through a straw, smoking, or any sucking action
• No vigorous rinsing
• Not removing the gauze until you’re ready to replace it
• Resorbable sutures
• Light coconut oil pulling each evening for the week after surgery
• Eating soft and/or liquid foods (nothing hard, spicy, or very hot)
• Antibiotics before and/or after surgery (as prescribed)
• Avoiding passionate kissing

Taking estrogen-based birth control may increase your risk of dry socket. It’s recommended that you have wisdom teeth extracted during days 23-28 of your cycle to reduce this risk.

Dry socket may increase your risk of infection, so it’s important to stay in close contact with your dentist if this happens. Post-operative infections can happen several weeks after surgery.

Your dentist’s protocols will impact this, too. I have done thousands of extractions in 33+ years and only two of my patients, early on, developed a dry socket. 

Talk to your dentist before your wisdom teeth extraction about how they extract wisdom teeth to reduce your risk.

2. Keep your head elevated for the first 3 days

When you sleep, keep your head elevated with pillows (or a wedge pillow) so your upper body is at a 45-degree angle. 

This can help you recover faster from wisdom tooth surgery because blood vessel tone and blood volume near the wound increase when you’re lying flat, which can make the wound throb. Additionally, keeping your head elevated above your feet can help reduce swelling.

Using a travel pillow is an easy and effective way to keep your head comfortably elevated when you’re in an upright position.

3. Ice your cheek(s) for the first 36 hours

After wisdom tooth extraction, apply an ice pack to your cheeks on the side(s) where your wisdom teeth were removed. Ice for 20 minutes on, 20 minutes off, as much as you can during the first 36 hours after surgery.

Cold compresses can help reduce swelling and inflammation even before you see outward signs of swelling. By icing consistently for the first day and a half, you may reduce pain and swelling for the rest of your recovery time.

You can also purchase a head wrap ice pack for a hands-free way to ice your jaw. These are particularly useful if you had extractions on both sides of your mouth.

A word of caution, though: Don’t apply heat to this area until around day 3. Heat can increase blood flow to the area which, as mentioned, will increase pain and swelling.

4. Rinse with warm salt water

To keep your wound clean, very gently rinse your mouth with warm salt water a few times each day. 

I recommend super-saturated salt water rinses for the best results. This may even help cut down on gum inflammation in addition to keeping your surgical site free of debris and a buildup of bacteria.

To make a super-saturated salt water rinse for your healing extraction site:

1. Pour an 8-ounce glass of warm water (not hot/boiling)
2. Stir in Celtic sea salt or pink Himalayan salt one tablespoon at a time until it stops dissolving
3. Very gently swish it around in your mouth
4. Do not spit; hold your head over the sink and let the water fall out
5. Repeat 2-3 times per day

5. Reduce inflammation

From Dr. Yasmin Chebbi: “Controlling inflammation after a wisdom tooth extraction is the key to controlling pain. Inflammation is highest after 48 hours, so it is important to continue taking anti-inflammatories through day 2, even if you feel fine immediately after the extraction. 

“Ibuprofen and acetaminophen can be used synchronously, as they both act on inflammation using two different pathways. BCQ [bromelain, curcumin, and quercetin] supplements are also great adjuncts to reduce inflammation.”

Yasmin Chebbi, DMD is a Massachusetts dentist and graduate of Harvard School of Dental Medicine.

6. Don’t let your mouth dry out

Your mouth will probably feel quite sore after wisdom tooth surgery. Depending on how tender you are, you may be tempted to breathe through your mouth. Avoid it if possible, though, as this can dry your mouth out. 

Dryness can disrupt the pH balance of your mouth, which can allow cavity-causing bacteria to proliferate, increasing the chance of infection.

If you must breathe through your mouth, use an oral cavity moisturizer like Biotene gel to help keep your mouth healthy while you recover.

7. Massage your jaw

During wisdom tooth surgery, your mouth is held wide open for an extended period of time, which can contribute to myofascial pain and cramped or sore muscles. This is a condition called temporary trismus, or “lockjaw”.

The masseter, one of the muscles in your jaw that helps you chew, is particularly prone to soreness.

Massaging this area post-surgery will help you recover faster because it releases some of the unnecessary tension that your jaw may be holding onto. 

To massage your masseter muscle:

1. Place your first 2 fingers just before the opening of each ear
2. Gently massage with your first 2 fingers in circular motions
3. Do not over-massage 

Jaw stiffness after wisdom tooth extraction should decrease significantly after 7 days and is typically gone by about 11 days after surgery.

8. Try photobiomodulation

Photobiomodulation may greatly reduce pain, swelling, and trismus (jaw pain) after wisdom tooth surgery. Your dentist/surgeon needs to use this light therapy right after your teeth are extracted for it to be effective.

In a 2015 study, oral/maxillofacial surgeons applied red light and near-infrared light immediately after wisdom teeth were extracted to 10 areas around the surgical sites. They compared the results from these patients to a group of “control” patients who did not receive the therapy.

The patients who received photobiomodulation therapy “showed significant reductions in pain, swelling, and trismus at 48h and 7 days postoperatively.”

There is some evidence that using the light therapy on the outside of the jaw, rather than the inside, might help reduce trismus even more.

This technique is also known as red light therapy, near-infrared therapy, or low light laser therapy (LLLT).

9. Drink coconut water

Coconut water can hydrate and nourish your body and soothe inflammation of your gums as they heal from surgery.

Coconut water helps to keep blood sugar stable and replenish electrolytes while you’re unable to eat solid foods. Having these elements in balance allows your body to focus more of its attention on healing from wisdom teeth surgery.

There is also evidence that coconut water reduces inflammation. This can be great for speeding the healing process. It’s also why I suggest patients drink it ice cold. 

If you want to reap the benefits of coconut water but don’t want to drink it straight, try whipping up a smoothie with lots of greens and healthy fats, and use coconut water as the liquid. I’d also recommend adding a dash or two of turmeric to further fight inflammation and speed recovery.

10. Rest as much as you can

Discomfort from healing extraction sites can make it difficult to rest or get into deep sleep. However, the more you can rest, the better chance your body has at healing fast.

11. Don’t overuse medications

Medications like hydrocodone (Vicodin) and sedatives used during wisdom tooth surgery frequently lead to side effects like nausea and vomiting. Vomiting, in particular, may increase your risk of infection, which can slow the healing process.

In addition, opioid abuse often starts with prescriptions from a dentist.

To reduce your risk of vomiting after your surgery, drink water, coconut water, and perhaps unsweetened green tea. 

After 10 hours or so have passed since your surgery, you should no longer feel nausea caused by swallowing blood or from surgical anesthetics. This is most common for people who have a little to eat or drink when they’re NPO (nothing by mouth) before surgery.

Ultimately, it’s best to use as little pain medication as you can stand. Use a pill cutter to reduce the size of your pills. 

Be sure to properly dispose of your remaining medication and don’t leave it around the house after you don’t need it.

How long does it take to recover from wisdom teeth removal?

Most people recover from wisdom teeth removal in 3-4 days. If your wisdom teeth were impacted, wisdom teeth recovery time may take up to 1 week. Swelling and bruising may linger for up to 2 weeks.

Here’s a timeline of the standard healing process after impacted wisdom teeth extraction:

1. First 24 hours: Blood clots form. Numbing agents wear off and pain and swelling begin. Lethargy and nausea are common.
2. Days 2-3: Swelling goes down. Pain usually begins to subside. Risk of dry socket is highest.
3. Days 4-7: Severe pain should be gone. Jaw stiffness may occur. Swelling should go down. Bruises form. Risk of dry socket drops dramatically. You can resume normal activities and return to work around day 4. Stitches, if required, can be removed around day 7. 
4. Days 8-10: Soreness and stiffness in the jaw should go away.
5. Days 11-14: Brushing should fade.
6. Weeks 3-4: Wisdom tooth sockets close.
7. Months 3-6: The surgical site and surrounding areas should completely heal.

The time it takes you to recover may differ, particularly if you develop a dry socket or your wound is infected.

When to Call Your Dentist

If you experience any of the following after wisdom teeth surgery, contact your dentist/surgeon immediately:

• Excessive bleeding that doesn’t subside within 4 hours post-extraction
• Throbbing pain that doesn’t subside with medication
• Oozing pus
• Increased swelling over time
• Fever and chills
• Pain that spikes 48 hours after the extraction
• Nausea or vomiting, particularly over 10 hours after surgery 
• Vomiting significant amounts of blood
• Coughing
• Chest pain
• Shortness of breath
• Difficulty swallowing or breathing
• Blood or pus from your nose

What to Eat After Wisdom Teeth Removal

For the first 24 hours after your surgery, you should have only liquids and very soft foods like applesauce or mashed potatoes. Avoid very hot, spicy, crunchy, hard-edged foods (like sourdough bread).

During days 2-3, you can start to eat a larger variety of foods. It’s important to get plenty of calories and nutrients, but you may not have much of an appetite. Prepare ahead of time for an easy-to-fix menu.

How long after wisdom teeth removal can you eat normally? 4 days after wisdom tooth extraction, you should be able to eat normally, unless you have complications like dry socket or infection.

Check out my free guide for how to eat after oral surgery for a complete shopping list and the best foods to encourage fast healing.

I recommend plenty of vitamin K2 and D3 foods after a wisdom tooth extraction. These nutrients, together with vitamin A and calcium, encourage bone growth.

If you can’t — or don’t — eat foods rich in K2 and/or D3, you may also supplement both vitamins.

How to Manage Pain During Recovery

Medications typically prescribed after wisdom tooth extraction recovery include:

• Hydrocodone (Vicodin) — prescription only
• Tylenol with codeine (Tylenol 3) — prescription only 
• Ibuprofen (Advil) — over-the-counter
• Acetaminophen (Tylenol/Paracetamol) — over-the-counter

Hydrocodone and ibuprofen are the best pain relief medications to ease the pain of wisdom teeth removal. Tylenol seems to be less effective for tooth pain relief.

How long should you take painkillers after wisdom tooth extraction? Most people can discontinue prescription painkillers 2-3 days after extraction without complications. You may need to take over-the-counter painkillers to reduce pain for an additional 3-4 days.

Never take medications prescribed to anyone else.

How to Sleep After Wisdom Teeth Removal

Sleeping after wisdom teeth removal is most difficult for the first 2-3 nights. For the most restful sleep:

• Keep your head elevated with a wedge pillow for the first 5 nights; do not lay flat
• Ice your cheeks right before bed for the first 36 hours
• Do not leave gauze on the surgical site when you go to sleep
• Avoid laying on your side, as this can lead to more swelling on the side of your face on the pillow

Complications that Extend Recovery Time

If you experience complications of wisdom teeth removal, healing time will get longer. Your body will need to work to not only heal your open tooth socket but also to correct the follow-up issues.

The most common complications of wisdom teeth removal are:

• Paresthesia: If your surgeon nicks a nerve, you may suffer temporary or permanent nerve damage that causes numbness (pins and needles) in the tongue, lips, and/or cheeks. This damage, called paresthesia, affects anywhere between 0.7% and 22% of patients, depending on the study. Most of the time, it resolves itself without treatment. Permanent paresthesia may happen in around 1.1% of wisdom teeth extraction patients.
• Dry socket: A dry socket, or the loss of the blood clot in the tooth socket, exposes the bone and can lead to severe pain. Up to 30% of wisdom teeth removals may result in a dry socket. It takes about 7-10 days for a dry socket to heal.
• Infection: Secondary infections can lead to multiple visits back to the dentist. Some infections occur several weeks after surgery. In very rare cases, they can be life-threatening. The risk for infection is higher in lower (mandible) wisdom teeth, with inexperienced surgeons, with a dry socket, after food impaction, or with a very deep tooth socket. 

FAQs

Q

How long is wisdom teeth surgery?

A

Wisdom teeth surgery lasts around 45 minutes. It depends on your dentist and your particular case, but typically it should take no more than an hour and a half.

Q

What is a bone graft, and do I need to have one after extraction?

A

A bone graft is a procedure typically done after extraction to rebuild the bone that is left behind after a tooth is removed. When dental implants are planned, a bone graft will provide the foundation for the implant to be screwed into.

When a wisdom tooth is removed, it is not usually replaced by an implant. However, I still often recommend a bone graft to provide support for the tooth right next to the extraction site. Talk to your dentist about a bone graft before your extraction to determine if this is right for you.

Q

How long does the bleeding last after surgery?

A

You can expect to bleed significantly for up to 3 hours after your surgery — that’s why your surgeon has you bite down on gauze and change it every hour.

For 24-48 hours after surgery, you may ooze small amounts of blood (mixed with a lot of saliva).

Thick, clotted blood warrants a call to your surgeon.

Q

How long does the pain after wisdom tooth extraction last?

A

Acute pain and swelling should subside within 2-3 days.

Jaw stiffness and soreness should subside within a week or so of surgery, and any bruising should be gone within about two weeks.

Typically, bone pain after surgery peaks at the 72-hour mark and then begins to subside.

Q

How long does it take for wisdom teeth sockets (holes) to close?

A

Your tooth sockets are mostly closed by about week 3 after your surgery, and they should be fully closed by the end of week 4.

Long-Term Outlook

Wisdom teeth surgery is a common and relatively safe procedure. If you follow your dentist or surgeon’s detailed advice and consider some of the above tips, you’ll be well on your way to healing in no time.

Good oral hygiene, nose breathing, and a healthy diet — the pillars to optimal oral health — also support fast recovery. 

References

1. Friedman, J. W. (2007). The prophylactic extraction of third molars: a public health hazard. American journal of public health, 97(9), 1554-1559. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1963310/
2. Ramos, E., Santamaría, J., Santamaría, G., Barbier, L., & Arteagoitia, I. (2016). Do systemic antibiotics prevent dry socket and infection after third molar extraction? A systematic review and meta-analysis. Oral surgery, oral medicine, oral pathology and oral radiology, 122(4), 403-425. Abstract: https://pubmed.ncbi.nlm.nih.gov/27499028/
3. Catellani, J. E., Harvey, S., Erickson, S. H., & Cherkin, D. (1980). Effect of oral contraceptive cycle on dry socket (localized alveolar osteitis). Journal of the American Dental Association (1939), 101(5), 777. Abstract: https://pubmed.ncbi.nlm.nih.gov/6935267/
4. Blum, I. R. (2002). Contemporary views on dry socket (alveolar osteitis): a clinical appraisal of standardization, aetiopathogenesis and management: a critical review. International journal of oral and maxillofacial surgery, 31(3), 309-317. Ful text: https://www.researchgate.net/profile/Igor_Blum2/publication/11197833_Contemporary_views_on_dry_socket_alveolar_osteitis_A_clinical_appraisal_of_standardization_aetiopathogenesis_and_management_A_critical_review/links/59bedd67458515e9cfd22997/Contemporary-views-on-dry-socket-alveolar-osteitis-A-clinical-appraisal-of-standardization-aetiopathogenesis-and-management-A-critical-review.pdf
5. Sortino, F., & Cicciù, M. (2011). Strategies used to inhibit postoperative swelling following removal of impacted lower third molar. Dental research journal, 8(4), 162. Abstract: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221082/
6. Landucci, A., Wosny, A. C., Uetanabaro, L. C., Moro, A., & Araujo, M. R. (2016). Efficacy of a single dose of low-level laser therapy in reducing pain, swelling, and trismus following third molar extraction surgery. International journal of oral and maxillofacial surgery, 45(3), 392-398. Abstract: https://pubmed.ncbi.nlm.nih.gov/26691932/
7. Aras, M. H., & Güngörmüş, M. (2010). Placebo-controlled randomized clinical trial of the effect two different low-level laser therapies (LLLT)—intraoral and extraoral—on trismus and facial swelling following surgical extraction of the lower third molar. Lasers in medical science, 25(5), 641-645. Abstract: https://pubmed.ncbi.nlm.nih.gov/19484402/
8. Rao, S. S., & Najam, R. (2016). Coconut water of different maturity stages ameliorates inflammatory processes in model of inflammation. Journal of intercultural ethnopharmacology, 5(3), 244. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927129/
9. Richardson, S., Patrick, K., Daniels, S., Royall, S., Schachtel, E., Zhang, B., … & Schachtel, B. (2016). (436) Opioid-induced nausea and vomiting (OINV) in post-operative patients: a comparison of CL-108 to hydrocodone 7.5 mg/acetaminophen 325 mg. The Journal of Pain, 17(4), S83. Abstract: https://www.jpain.org/article/S1526-5900(16)00443-0/abstract
10. Harbaugh, C. M., Nalliah, R. P., Hu, H. M., Englesbe, M. J., Waljee, J. F., & Brummett, C. M. (2018). Persistent opioid use after wisdom tooth extraction. Jama, 320(5), 504-506. Abstract: https://pubmed.ncbi.nlm.nih.gov/30088000/
11. Blondeau, F. (1994). Paresthesia: incidence following the extraction of 455 mandibular impacted third molars. Journal (Canadian Dental Association), 60(11), 991. Abstract: https://pubmed.ncbi.nlm.nih.gov/8000949/
12. Lata, J., & Tiwari, A. K. (2011). Incidence of lingual nerve paraesthesia following mandibular third molar surgery. National journal of maxillofacial surgery, 2(2), 137. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343412/
13. de Oliveira Neto, P. J., de Souza Maliska, M. C., Sawazaki, R., Asprino, L., de Moraes, M., & Moreira, R. W. F. (2012). Temporal abscess after third molar extraction in the mandible. Oral and maxillofacial surgery, 16(1), 107-110. Abstract: https://pubmed.ncbi.nlm.nih.gov/21318264/
14. Sukegawa, S., Yokota, K., Kanno, T., Manabe, Y., Sukegawa-Takahashi, Y., Masui, M., & Furuki, Y. (2019). What are the risk factors for postoperative infections of third molar extraction surgery: A retrospective clinical study-?. Medicina Oral, Patología Oral y Cirugía Bucal, 24(1), e123. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344007/