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. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take the recommended or prescribed pain medications as soon as possible (for narcotics not on an empty stomach as nausea and vomiting may result), so that hopefully they will be effective prior to the loss of the effect of the local anesthetic.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable. Strenuous activity (i.e. exercise) should be avoided for approximately 48 hrs. following surgery.
  • 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 for 12-24 hours following oral surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Firm pressure on the gauze pads that were placed in your mouth following the surgery, for 30-60minutes is important in reducing persistent bleeding. Inserting and replacing gauze pads at the surgical site can sometimes disturb the blood clot and worsen bleeding, therefore do not replace the initial gauze pad if only slight bleeding/oozing is occurring as this will likely stop on its own. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad, large enough to provide pressure to the area, directly over the bleeding area and biting firmly for another thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag wrapped in a gauze pad for sixty 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, avoid vigorous rinsing or spitting and avoid strenuous activity/exercise. If bleeding does not subside, call for further instructions.

Occasionally, episodes of bleeding may occur up to a several days after surgery. If this fails to stop spontaneously treat as above.

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 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. Two baggies filled with ice, bags of frozen vegetables or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be kept in place for 30 minutes on and 15 minutes off continuous cycles for the first 24-36 hours 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. Beginning 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 associated jaw stiffness. Another strategy to minimize swelling is to keep your head elevated, especially while sleeping, with several pillows or by sleeping in a reclining chair for the first 48 hours.

Pain

Discomfort is a consequence of most oral surgical procedures. Local anesthesia is usually administered and typically provides several hours without pain. As the numbness subsides the pain will usually increase. It is best to address the discomfort before it becomes significant. For adult patients who can tolerate aspirin/ non-steroidal anti-inflammatory products, ibuprofen (Motrin or Advil) two or three 200 mg tablets may be taken every 4 hours. In addition, or for patients who do not tolerate aspirin/NSAIDs, one or two tablets of acetaminophen (Tylenol or Extra Strength Tylenol) may be taken every 4-6 hours. Most children are permitted to take ibuprofen and acetaminophen, but the dose must be adjusted according to age/weight (follow the instructions on the bottle).

You may have received a prescription for pain medicine. This medication should be used only if necessary and should not be taken on an empty stomach. For moderate-severe pain, take this medication as directed. This medication can be taken in combination with ibuprofen, unless otherwise notified, but should not be taken in addition to acetaminophen (Tylenol) as the prescription pain medication will likely already contain acetaminophen. The prescribed pain medicine will make you groggy and will slow down your reflexes. This may be exacerbated by alcohol and some other prescription medications. Do not drive an automobile or operate hazardous machinery. Avoid alcoholic beverages. Application of ice to the face adjacent to the surgical site should also help alleviate pain. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

If discomfort increases after the third day following surgery and does not respond well to ibuprofen alone, especially if it is associated with inability to sleep through the night or perform normal daytime activities, this may be an indication of premature loss of the blood clot (dry socket) or another healing issue such as infection. These issues are best evaluated and treated during an office visit. Please call the office and our receptionist will try to schedule you as soon as possible.

Activity

Resumption of normal activity usually correlates with the severity of the surgery. Typically, strenuous activity/exercise should be avoided for both the day of and the day following surgery. Otherwise activity can be resumed as tolerated. Patients who have received intravenous (I.V.) anesthesia must not drive or operate machinery which could injure themselves or others or make important decisions on the day of surgery.

Diet

After general anesthetic or I.V. sedation, liquids only should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You should not chew on the day of surgery. High calorie, high protein intake is very important. Suggested examples of acceptable foods include: any beverages, soups without solids which require chewing to swallow, jello, pudding, apple sauce, ice cream, yogurt, milkshakes, protein shakes, etc.. If you are experiencing any nausea dairy products may not be well tolerated. 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 8-10 glasses of liquid should be taken daily.

After the day of surgery, you may eat anything soft by chewing away from the surgical sites. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Due to jaw soreness and stiffness chewing may be difficult for up to 7-10 days following surgery. It is best to limit chewing to those foods of a consistency that does not cause discomfort.

Smoking

Smoking is extremely detrimental to healing. Ideally, smoking should be avoided for 3 days following surgery. Smokers have a much greater risk of developing dry socket, a typically very painful post-operative complication and poor wound healing. If smoking can not be avoided, the greater the time between procedure and first cigarette the less the likelihood of developing problems.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. You can brush your front teeth the night of surgery, but avoid traumatizing the surgical sites. Do not rinse or spit afterward. The day after surgery you should begin vigorously rinsing at least 4-5 times a day, especially after each meal with mouthwash or a cup of warm water mixed with a teaspoon of salt. You should start brushing your back teeth the day after surgery, but avoid traumatizing the swollen gum tissue and sockets with the toothbrush.

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. The effectiveness of oral birth control pills may be compromised when antibiotics are taken. An alternative method of birth control should be used for the remainder of that monthly cycle. Call the office if you have any questions.

Nausea and Vomiting

Nausea and vomiting may occur following oral surgery. This may be the result of swallowed blood, pain medication or anesthesia. Nausea may be avoided by letting blood drool out of mouth instead of swallowing and not taking pain medications on an empty stomach. 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 of water, coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. If the nausea persists stop prescription pain medications entirely and use ibuprofen (Advil, Motrin) and/or acetaminophen (Tylenol) only. If nausea and vomiting fail to resolve after a few hours, please call the office. If necessary, a prescription for a suppository to treat the symptoms will be phoned in.

Numbness

Numbness of the lip, chin, or tongue secondary to local anesthesia may last between 2-12 hours. If numbness persists beyond this time frame it may indicate injury to one of the sensory nerves close to the area of the surgery. Typically, there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should notify the doctor of the persistent numbness at your follow-up visit. Be aware that if your lip or tongue is numb, you could bite it and not feel the sensation, so be careful. Call the office if you have any questions.

Sinus Communication

Occasionally, the proximity of the upper back teeth roots to the sinus cavity may result in an opening from the mouth through the extraction socket to the sinus. If you notice an air leak, whistling or if liquids pass from your mouth to your nose during drinking this may have occurred. If you were informed or suspect that this has occurred it is extremely important that you comply with the following restrictions:

  • Do NOT blow your nose
  •  Do NOT smoke
  •  Do NOT use a straw
  •  Sneeze with your mouth open
  • Avoid swimming or strenuous exercise

Please contact our office to schedule an evaluation as soon as possible.

Dry Socket

Dry socket is the premature loss of the blood clot at the site of an extraction. This typically occurs approximately 2-3 days following the surgery. The loss of the blood clot causes the bone which was around the roots of the tooth to become inflamed and painful. The pain is classically described as throbbing in nature and may radiate to the ear, temple or through the jaw and other teeth. Dry socket will resolve on its own, but the discomfort may last for 7-10 days. The symptoms are often relieved with ibuprofen (Advil, Motrin) alone. In those cases where these medications do not adequately relieve the pain, a medicated dressing can be placed by the doctor to eliminate the pain. This dressing, while very effective in reducing the discomfort, actually slows the healing of the socket. The dressing typically must be replaced every 1-3 days on several occasions until the pain has completely subsided.

Other Complications

  • Slight elevation of temperature immediately following surgery is not uncommon. A temperature of less than 100.5°F is not generally considered significant. If a fever 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 lightheaded if 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 the doctor.
  • If the corners of your mouth are stretched, they may dry out and crack. The corners of 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 usually subside in 2-3 days.
  • Stiffness (Trimus) 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 over time, but may last for 7-14 days.

Finally

Sutures may be placed in the area of surgery to assist healing. The sutures are expected to fall out on their own in approximately 4-7 days following the surgery, however, they sometimes become dislodged earlier. This is no cause for alarm. Just remove the suture form your mouth and discard it. If necessary, 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 should subside more and more each day following surgery. If your post-operative pain worsens or unusual symptoms occur call our office for instructions.

Surgical swelling typically can worsen for up to three days after treatment and will then resolve gradually over the next few days.

There will be a hole or defect where the tooth was removed. The cavity will gradually fill in with new tissue over 6-8 weeks. In the mean time, the area should be kept clean, especially after meals with mouthwash or salt water rinses.

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: Drs. Porter, Salman or Martin or your family dentist.

Brushing your teeth is recommended – just be gentle and avoid traumatizing the surgical sites.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get lightheaded, stop exercising.