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

  • 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 discarded.
  • Vigorous mouth rinsing or touching the wound area following surgery should be avoided the day of surgery. This may initiate bleeding
  • Begin over-the-counter pain medications (Ibuprofen and Tylenol) as soon as you can.  For severe pain that does not respond to OTC medications, the prescribed pain medication may be taken. Take the prescribed pain medications only when the ibuprofen and/or Tylenol are not working.  Use the prescribed pain medication with extreme caution.  They are sedating and addictive.  Keep these drugs away from young children and dispose of appropriately.  Do not keep or share unused narcotic prescriptions.  Your local police department will have a safe drop box for discarding unused pain prescriptions. 
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.


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. The tannic acid in the tea bag helps 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, call for further instructions. In the unlikely event we are not available, proceed to the nearest emergency room.


Pain is expected following any surgical procedure. It will peak 24-48 hours following your procedure.  It is important to try to avoid the narcotic (Percocet, Vicodin) pain meds.  These are very addicting and may cause you to be nauseous.

Begin 1-2 over-the-counter ibuprofen (Motrin, Advil), alternating with 1 regular strength acetaminophen (Tylenol) immediately.  These smaller doses can be alternated every couple of hours. As an example, take 400mg ibuprofen by mouth every 4-6 hours.  You may take a 325mg tylenol by mouth in between these ibuprofen doses.   

For severe pain, take the narcotic tablets prescribed as directed. It may be taken along with the above regimen. Try 1/2 tablet along with the above ibuprofen or tylenol.  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.

Be sure to drink plenty of fluids.


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 surgery and eventual repair. The swelling will 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. Two 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 36 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. 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.


After general anesthetic or I.V. sedation, liquids should be initially taken. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Drink plenty of liquids.  Straws may be used. 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, and heal faster if you are well nourished.

Keep the mouth clean

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. Keeping the surgery sites clean will lessen the chance of infection.  Use the provided irrigating syringe to clean the lower wisdom teeth sockets.  Point the syringe into the “hole”.  The cleaner these are kept, the less the chance you will develop an infection.  


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.


If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will 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, avoid all narcotic medications. The most frequent cause of nausea/vomiting after oral surgery or anesthesia is the use of the narcotic pain prescriptions.  Be sure to drink plenty of clear liquids.  Liquids with electrolytes are very helpful (Gatorade, Vitamin Water etc).  Cola, tea or ginger-ale are also helpful.  If the nausea and/or vomiting continues please contact our office for assistance. In the unlikely event we are not available, proceed to the nearest emergency room.

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 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. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, 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 which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by our team.
  • 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 following oral surgery. This is a normal post-operative event which will resolve in time.


Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call my office for instructions.

There will be a hole or bone defect where the tooth was removed. This will heal and fill-in gradually over the next month, with the new tissue. In the meantime, the area should be kept clean especially after meals with salt water rinses or a toothbrush.

Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Our doctors.

Brushing your teeth and rinsing following oral surgery are important – just be gentle at the surgical sites.

A “dry socket” is a poorly named condition that occurs in only a few patients but is very uncomfortable. It involves severe pain that does not respond to medication. It is due to severe inflammation within bone of the extraction site. These symptoms of severe pain at the surgical site, and even pain to the ear may occur following surgery. Call the office with questions. These same symptoms may also occur due to an infection.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced.  Limit yourself until you feel well enough to return to your regular activities.