After Wisdom Tooth Removal

The removal of impacted wisdom teeth is a serious 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 should be kept in place for a half hour. After this time, the gauze pad should be removed and replaced with a new pad as instructed by the surgical assistant for three to four (3-4) sessions.
  • 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 as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
  • Restrict your activities on the day of surgery. You may resume normal activity approximately three to four (3-4) days after the surgical procedure.
  • 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 thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. To minimize further bleeding, sit upright and avoid exercise. If bleeding does not subside, call for further instructions.

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 bodys normal reaction to surgery and eventual repair. The swelling may not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be applied while you are awake. After 36 hours, ice has less 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. Thirty-six 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, two tablets of Tylenol or Extra Strength Tylenol may be taken every six (6) hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets; 2-3 tablets may be taken every six (6) hours as needed for pain.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine may make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Surgical discomfort should subside. If pain persists or worsens, you should call the office.

Pain medications (codeine derivatives) can cause nausea and/or vomiting. Therefore, it is reasonable to start with Ibuprofen or over-the-counter medications. Take the prescription pain medications only if needed. If nausea or vomiting occur, discontinue the medications immediately.

Diet

You may want to start out with clear liquid immediately following your surgery, especially if IV sedation was utilized. Do not use straws. Drink from a glass. Advance to a soft diet using teeth remote from the surgical site. Refer to the section on suggested diet instructions on your post-op insruction sheet. Nourishment should be taken regularly. You should prevent dehydration by taking 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.

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

Rinsing should be limited the day of surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing gently at least 5-6 times a day. Be sure to rinse after eating with a cup of warm water mixed with a teaspoon of salt.

Bruising

In some cases, discoloration of the skin will occur. 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. The degree of discoloration increases with age.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics may be given to prevent or treat infection. Take the antibiotics until they are gone. 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 clear liquids (water, tea or ginger ale). You should sip slowly over a fifteen-minute period. When the nausea subsides you can proceed to full liquids and then begin taking soft, solid foods and the prescribed medicine.

Dry Sockets

Dry socket is the term used to describe blood clot loss from the tooth socket. Symptoms of pain at the surgical site and even pain radiating up to the ear may occur 2-3 days following surgery. If the pain does not resolve after 3-4 days or does not improve, please contact our office at that time. If a dry socket does occur, we may need to pack a medicated dressing in the socket. This will help to relieve the pain.

Other Complications

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, 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 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 may feel dizzy following surgery. Move slowly when going from the lying down position to standing. Taking pain medications can also make you dizzy. Before standing up, you should sit for one minute then get up.
  • Patients may feel hard or sharp projections in the mouth. They are not roots; they may be bony projections. These projections usually smooth out or fall out spontaneously. If not, they can be removed by the oral surgeon.
  • 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 which will resolve in time.

Sutures may have been placed in the area of surgery to help healing. Sometimes they become dislodged; this is no cause for alarm. Just remove the suture from your mouth and discard it. Most often, the oral surgeon uses self-dissolving sutures. You will not have to come back to the office to have them removed; they dissolve on their own in about 10 days following the surgery.

Pain and swelling should resolve over 5-10 days following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions.

There will be a cavity where the tooth was removed. The cavity will fill in gradually over the next month. In the mean time, the area should be kept clean, especially after meals, with salt water rinses.

Brushing your teeth is okay but avoid the surgical sites for several days.