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 an hour. After this time, the gauze pad should be removed and discarded.
  • Avoid vigorous mouth rinsing or touching the wound area following surgery. 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 typically when the local anesthetic begins to diminish.
  • 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.

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. 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 our office 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 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.
  • 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 (36) hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

  • Begin taking pain medication as soon as you feel the local anesthetic wearing off.
  • For moderate pain, Tylenol or Extra Strength Tylenol may be taken every 4-6 hours as directed on the packaging.
  • Do not exceed 4000mg of Tylenol in any 24 hour period. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen, bought over the counter comes in 200 mg tablets: 3-4 tablets may be taken every 6-8 hours as needed for pain.
  • For severe pain, the prescribed medication should be taken as directed.
  • Do not take any of the above medication if you are allergic, or if you have been instructed by your doctor not to take it.

Diet

  • After general anesthetic or I.V. sedation, liquids should be initially taken.
  • Do not use straws. Instead, drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot.
  • You may eat anything soft by chewing opposite the surgical sites. High calorie, high protein intake is very important.
  • 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. Try not to miss a single meal. You will feel better, have more strength, experience 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 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.
  • Please call our office if you have any questions or concerns.

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. Sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.

Additional Post-Surgery Information

  • 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 but rather bony walls which supported the tooth. These projections usually smooth out spontaneously however, if not, our oral surgeons can remove them.
  • 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.

Final instructions to patients

  • Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged however this is no cause for alarm. Simply 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.
  • The pain and swelling should subside increasingly each day following surgery.
  • If your post-operative pain or swelling worsens or unusual symptoms occur, call our office for further instructions.
  • There will be an open area (cavity) where the tooth was removed. The cavity will gradually close over the next month and will heal with new tissue. In the meantime, the area should be kept clean especially after meals with salt water rinses or a soft 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 to the ear may occur 2-3 days following surgery. If this occurs, please call our office for further instructions.
  • 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.