After Wisdom Tooth Removal

The removal of impacted teeth can be seen as somewhat of a serious surgical procedure. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.

Do’s and Don’ts

Do not disturb the surgical area the day of surgery.  Do not rinse vigorously or probe the area with any objects or your fingers.  You may brush your teeth gently.  Please do not use a straw for 3-5 days.  DO NOT SMOKE for at least 1 week, as it is very detrimental to healing.  No carbonated sodas, forceful spitting, acidic drinks (orange, grapefruit juice).

Bleeding/Gauze

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. Bleeding should never be severe.  If it is, it usually means that the packs are being clenched between your teeth rather than exerting pressure on the surgical areas, and you should try repositioning fresh packs.  Repeat if necessary. If the bleeding continues, bite on a moistened black tea bag (soaked in hot water, squeezed damp-dry and wrapped in moist gauze) for thirty minutes. The tannic acid in the tea helps to form a clot by contracting bleeding vessels.  If the bleeding does not subside, please call the office for further instructions.  Remove gauze to eat or drink then replace when finished.  The surgical sites may ooze for several hours after surgery.  You should remove the gauze before going to sleep.

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 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.

Diet

Start with liquids and eat soft food until the numbness wears off.  It is very important to increase fluid intake for a couple of days after surgery, this avoids dehydration and aids healing and make you feel subjectively better.  After that, eat any nourishing food that can be eaten comfortably.  Temperature of the food does matter so avoid extremely hot foods and drinks.  Avoid foods like nuts, sunflower seeds, popcorn, rice, etc. that may get lodged in the socket area.  Over the next several days you can progress to solid foods at your own pace.  It is important not to skip meals!  If you eat regularly, you will feel better, gain strength, have less discomfort and heal faster.  If you are diabetic, maintain your normal eating habits as much as possible and follow instructions from your physician regarding your insulin schedule.

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 up for one minute before standing.

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.

Prescriptions

Unfortunately most oral surgery is accompanied by some degree of discomfort.  Several medications may have been prescribed to you including pain medication, antibiotics, and/ or steroids.  If you take the first dose of pain medication before the anesthetic has worn off, your discomfort will be more manageable.  Start with 600 mg of Ibuprofen and 1000 mg of Tylenol.  You can take these every 4-6 hours (Do not exceed 3200 mg of ibuprofen or 4000 mg of tylenol within 24 hours).  If you were prescribed oxycodone, you can take 1-2 tabs every 4-6 hours as needed if the pain is not controlled with the tylenol and ibuprofen regimen.  The 

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 any other unfavorable reaction and contact our office immediately. Call the office if you have any questions.

Nausea and Vomiting

Nausea is not an uncommon event after surgery and it is sometimes caused by the prescribed medication.  Preceding each pill with a small amount of soft food, then taking the pill with a large volume of water may reduce nausea.  Keep movement to a minimum.  Increased activity is usually associated with increased chance of nausea.  Try to keep taking clear fluids as dehydration can worsen the nausea and minimize the pain medication.  Please call us if uncontrolled vomiting is persistent.

Exercise

Refrain from strenuous exercise for a minimum of 5 days.  This includes weightlifting, running, hiking, swimming, etc., anything that significantly increases the heart rate and blood pressure.

Oral Hygiene

Keeping your mouth clean after surgery is essential for healing.  Use plain water the first 48 hours and then replace with salt water.  Use 1 teaspoon of salt dissolved into an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glass.  Repeat as often as possible, but at least three times daily for the next ten days, especially after meals.  Avoid using mouthwash for one week.  Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.

Other Complications

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, 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 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 could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting 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 after allowing the body to try and reshape the bone itself.
• 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 in the area 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.

Finally

Sutures are placed in 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 from 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 usually no discomfort associated with this procedure.

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 our office for instructions.

There will be a void where the tooth was removed. The void will fill in with new tissue gradually over the next month. In the meantime, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.

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 near the ear may occur 2-3 days following surgery. Call the office if this occurs.