After Wisdom Tooth Removal

Removal of impacted teeth can be a difficult surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if instructions are followed carefully.

Immediately Following Surgery

Roll 2-3 pieces of gauze together and place directly over the surgical area and keep in place for one hour. Bite down firmly on the gauze pads. After this time, the gauze pad should be carefully removed and discarded. It is not unusual for the area to bleed off and on the day of surgery, so replace the gauze pad if needed during this time.
Avoid vigorous mouth rinsing or touching the wound area following surgery. This may initiate bleeding by disrupting the wound or newly-established blood clot.
Take the prescribed pain medications as soon as possible after you eat so that the medications begin working before numbness wears off.
Restrict your activities for 2-3 days after the day of surgery. Resume normal activity when you feel comfortable or as directed by your doctor.
Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

Bleeding

Change gauze pads (2-3 rolled together) every 45-60 minutes until active bleeding stops (usually within 2-3 hours). Slight bleeding is expected, normal, and may last up to48 hours following surgery. Moisten and roll or fold gauze pads (2-3) and place directly over the wound – – not just between the teeth – – and bite firmly, applying constant biting pressure directly on the wound. If bleeding continues, bite on a moistened tea bag for 30-60 minutes. The tannic acid in the tea bag helps to form a clot by contracting the blood vessels. Assume a semi-upright position (a reclining chair or in bed with at least 2 pillows). Avoid spitting, drinking through a straw, smoking, and chewing tobacco. Avoid excessive activity. If bleeding does not subside within 24 hours, call our office.

Swelling

Swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is common. This is the body’s normal reaction to surgery and eventual repair. Swelling usually is not 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. Use a barrier between the ice pack and the skin. The ice packs should be left on continuously while you are awake. 48 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. Swelling or jaw stiffness may persist for several days. There is no cause for alarm. This is a normal reaction to surgery.

Beyond 3-4 days, pain and swelling should gradually subside following surgery. If your post-operative pain or swelling worsens after the initial 3-4 days following surgery, or unusual symptoms occur, call our office for instructions.

Pain

If you have been given a prescription, have it filled and begin taking the medication as soon as you arrive home and are settled. Be sure to read and follow the instructions carefully as printed on the bottle. Take the medications with food to help avoid nausea. While taking prescribed narcotic pain medication, do not drive a vehicle or work around machinery. The prescribed pain medicine may make you groggy and can slow down your reflexes. Avoid alcoholic beverages. After the first 3-4 days, pain or discomfort should subside more and more every day. If pain persists or worsens, it may require attention and you should call our office.

Diet

While you are numb, a soft, no-chew diet is important. Food intake may be limited for the first few days. Compensate for this by increasing your fluid intake. Do not use straws – drink from a glass. Resume a normal diet starting the day following surgery, but avoid hard or crunchy foods. High calorie, high protein intake is very important. Nourishment is important. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.

Do not smoke or chew tobacco for 5-7 days following surgery.

Keep the Mouth Clean

Do not rinse your mouth until the day after surgery. If numbness has worn off you can brush your teeth the night of surgery, but rinse gently. The day after surgery begin rinsing at least 5-6 times a day, especially after eating, with a cup of warm water mixed with one-half teaspoon of salt.

Discoloration

In some cases, discoloration (bruising)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 common post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area will speed up removal of the discoloration. The scab in the extraction site may be white or gray in color. This is a normal appearance.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help treat or 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, sip on de-fizzed liquids (poured from glass to glass to de-fizz)such as 7-Up, Sprite, or ginger ale every hour for 5-6 hours. Sip slowly over a 15-minute period. When nausea subsides you may begin taking solid foods and the prescribed medicine.

Other Complications

If paresthesia (numbness of the lip, chin, or tongue) lasts longer than three (3) days, contact our office. This is usually temporary in nature. Be aware that if your lip or tongue is numb, you could bite down and not feel the sensation. So be careful.
A slight elevation of temperature immediately following surgery is common. If the temperature persists longer than 48 hours following surgery, notify the office. Tylenol or ibuprofen can be taken to reduce the fever.
Be careful for a while going from the lying down position to standing. You were not able to eat or drink prior to surgery. It also may have been difficult to take fluids after surgery. Taking pain medications can make you dizzy. You may become light-headed when standing up suddenly. Before standing up, sit for one minute and then get up slowly.
Occasionally, patients feel hard projections in the mouth near the surgery site with their tongue or fingers. They are not roots; they are the bony walls which supported the tooth. These projections usually smooth out over time on their own. If not, they can be removed by our doctors. Call our office if they are painful.
If the corners of your mouth were stretched during surgery, they may dry out and crack. Your lips should be kept moist with a cream or anointment such as Vaseline or lip balm.
A sore throat and pain when swallowing are common. The throat muscles get swollen. The normal act of swallowing can become painful. This normally will subside in 2-3 days.
Stiffness 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.

Additional Considerations

Sutures – Sutures sometimes are placed in the area of surgery to minimize post-operative bleeding and to help healing. Occasionally they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. Unless you are told otherwise, your sutures will dissolve and fall out on their own within 2 weeks following surgery.

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

Brushing – Brushing your teeth is okay – just be gentle around the surgical sites.

Dry Socket – A dry socket is when the blood clot dissolves or becomes dislodged prematurely from the tooth socket. Symptoms of increased pain at the surgical site and even ear pain may occur 4-7 days following surgery. Call the office if this occurs.

Exercise – If you are involved in regular exercise, be aware that normal nourishment intake is often reduced. Exercise may weaken you. If you get light-headed, stop exercising.

Activity – If you have had general anesthesia or IV sedation, do not drive a vehicle or be around or operate machinery for at least 24 hours. Avoid fatigue – – go to bed early at night and get adequate rest during the day.

Your surgical care is individual,no two mouths are alike. Do not accept well intended advice from friends. Discuss your questions and concerns with the persons best able to help you- – the staff and doctors at Centrasota Oral & Maxillofacial Surgeons.