After Wisdom Tooth Removal

The removal of impacted 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

Gauze should be placed over the surgical area for at least 1 hour. Change gauze at least every 30 minutes.
Vigorous mouth rinsing or touching the wound 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 the day of surgery and avoid strenuous activities for approximately 1 week.
Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
DO NOT SMOKE

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon for 24 to 48 hours. Placing a gauze pad over the area and biting firmly for thirty minutes may control excessive bleeding. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. If excessive bleeding (e.g. blood pooling in your mouth) does not subside, call for further instructions.

Swelling

The swelling that occurs is proportional to the type and extent of surgery involved. Swelling around the mouth, jaws, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and it’s repair mechanism. The swelling will not become apparent until 1-2 days following surgery and will not reach its maximum until 2-3 days post-operatively. The swelling may be minimized by the immediate use of ice packs. Baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 48 hours, ice has no significant effect. Jaw stiffness may persist for several days. This is a normal reaction to surgery. 72 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling and loosening the stiff jaw muscles.

Pain

For mild to moderate pain, one or two tablets of acetaminophen (Tylenol or Extra Strength Tylenol) may be taken every 4 to 6 hours. Two to three (200 mg) tablets of Ibuprofen (Motrin or Advil) may be taken every 6 to 8 hours.

For severe pain, take the tablets prescribed as directed. 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. Surgical pain and discomfort will generally start to subside 3 to 5 days from your surgery.

Diet

Clear liquids should be initially taken after general anesthesia or I.V. (intravenous) sedation. 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 will 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. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.

Keep the mouth and wounds 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 6 to 8 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt or diluted mouthwash.

Discoloration

In some cases, discoloration or bruising of the skin occurs following surgery. The development of black, blue, green, or yellow discoloration is due to blood 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

Antibiotics are not routinely prescribed following oral surgery. If you have been placed on antibiotics take the tablets or liquid as directed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

Nausea and Vomiting

Nausea and/or a small amount of vomiting are not uncommon following general anesthesia or intravenous sedation. In the event of nausea and/or vomiting following surgery start with sips of clear liquids, coke, or ginger ale. Avoid ibuprofen and the narcotic pain medication until it has resolved. Acetaminophen (Tylenol) can be taken. When the nausea subsides you can begin taking solid foods and the prescribed medicine.

Other Complications

If numbness of the lip, chin, or tongue is present for more than 48 hours following your surgery, contact our office for a follow-up appointment. As discussed 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. Call our office 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. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing, you should sit for one minute, then get up.
Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls that supported the tooth. These projections usually smooth spontaneously. These bony edges can be removed or smoothed by your 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 become swollen and stiff. The normal act of swallowing can then become painful. This will subside within a few days.
Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for several days following surgery. This is a normal post-operative complaint, which will resolve in time.

Finally

Sutures may have been placed in the area of surgery to minimize post-operative bleeding and to help with healing. They often become dislodged. Just remove the suture form your mouth and discard it. The sutures will dissolve approximately 5-7 days after surgery.

Your pain and swelling should begin to subside on the 3rd day following surgery. If your post-operative pain or swelling first improves and then worsens call our office for instructions. Any unusual symptoms or concerns should be reported immediately.

There will be an empty “socket” where the tooth was removed. This hole or socket will fill in over the next month with new tissue. In the mean time, the area should be kept clean, especially after meals, with mouth rinses and a toothbrush.

Your case is individual; no two surgeries or are alike. Do not accept well-intended advice from friends. Discuss your questions with our office.

Good oral hygiene is very important. Brush your teeth following surgery and rinse on a regular basis.

A dry socket is when the blood clot dissolves and/or gets dislodged prematurely from the tooth socket. Symptoms of severe pain at the surgical site, which may feel like an earache, 5-7 days following surgery, may be dry socket. Call the office if this occurs. We will generally place a medicated dressing in the “dry” socket. This will give you almost immediate relief. This medicated dressing is usually removed after 3-4 days.