After Wisdom Tooth Removal

The removal of impacted teeth is an invasive surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.

Immediately Following Surgery:

The gauze pad placed over the surgical area is designed to enable you to keep pressure on the surgical site to prevent bleeding. If you are not actively bleeding the gauze is not necessary. If bleeding is still present, the gauze should be kept in place for 45 minutes with biting pressure on the extraction sites. If you are sleeping, while the gauze will still absorb oozing, the lack of pressure will likely not assist much with control of oozing. . After use, the gauze pad should be removed and discarded, if you are still bleeding, new gauze should be placed and pressure held again for 45 minutes.

Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.

Take the prescribed pain medications before you begin to feel discomfort. This will usually coincide with the return of sensation in your mouth, as the local anesthetic wears off. In the lower jaw, the return of sensation may not occur for many hours after your surgery.

Restrict your activities the day of surgery regardless of how you feel and resume normal activity when you feel comfortable.

You may have been instructed to place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for 45 minutes. Repeat if necessary.

If bleeding continues, bite on a moistened tea bag for 45 minutes. The tannic acid in the tea bag may help to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, please call to discuss how to proceed.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to inflammation and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days after the surgery. Therefore it is normal and expected to be more swollen the second postoperative day than the first. You may have been instructed to use ice packs following your surgery. There is some debate about the effectiveness for swelling following wisdom tooth surgery. In any case, ice may help provide comfort and certainly will not hurt things. The ice packs should be placed 20 – 30 minutes on followed by 20 minutes off for the first 24 hours following your surgery. After 24 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. 48 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

For moderate pain, 1or 2 tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two to four 200 mg tablets may be taken every 4-6 hours.

For more severe pain, take the tablets prescribed as directed. If you have been prescribed a narcotic pain medication, it likely also contains Tylenol and thus should not be mixed with additional Tylenol doses. With rare exceptions, Advil may be taken along with your prescribed medication. If you have been prescribed an anti-inflammatory medication along with your narcotic, you should not add further such medications (i.e. Advil, Motrin, Ibuprofen, etc.) The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion of a straw can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment should be taken regularly. You should prevent dehydration by drinking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.

Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been prescribed antibiotics, take the tablets or liquid as directed. Antibiotics may be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. If this is not successful please call the office for assistance.

Other Complications

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. This is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call your Doctor if you have any questions. Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
• You should be careful going from the lying down position to standing. Remember you were not able to eat or drink prior to surgery so you may become dizzy if you stand up too quickly. Taking pain medications can make you dizzy. If you are lying down, you should sit up for one minute prior to standing up.

• Occasionally, patients may feel hard projections in the mouth with their tongue and mistake them as being roots. They are actually the bony walls that supported the tooth. These projections usually smooth out spontaneously. If the do not, they can be smoothed by your Doctor.
• If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.
• Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
• Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event that will resolve in time.

Further General Comments

• Sutures are sometimes placed the area of surgery to minimize post-operative bleeding and to help healing. They are resorbable and will become dislodged; this is no cause for alarm. Just remove the suture from your mouth and discard it.
• The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or any unusual symptoms occur call our office for instructions.

• There may be a cavity or space where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with saltwater rinses or a toothbrush.
• Every case is individual and no two mouths are alike. Therefore, do not accept advice from friends. Discuss your problem with your doctor or your family dentist.
• Brushing your teeth is okay - just be gentle at the surgical sites.
• A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. Call the office if this occurs. We can help.
• If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.