After Wisdom Tooth Removal

The removal of impacted teeth is a significant 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 an hour or two. After this time, the gauze pad should be removed and discarded. If excessive saturation of the gauze occurs, the gauze should be removed earlier. Further care on post-surgical bleeding is listed below. The gauze can be removed from the wound site when you can not see any active oozing from the socket(s). This may require looking in the mouth with a flashlight. Since the gauze will draw blood into it and cause it to be pink for a long period of time, it is usually acceptable to remove the packing when the gauze is light pink.
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 prescribed pain medications as soon as you get home and prior to feeling any discomfort. We would like the pain medication to take effect before the local anesthetic wears off.
Restrict your activities the day of surgery and resume normal activity when you feel comfortable and are no longer taking the prescribed pain medicines.
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. In fact, it is not uncommon to have oozing last for 24 hours after surgery. In most surgeries, the bleeding will be steady for 8-10 hours and then begin to slow down over the next 8 to 10 hours. The more you apply light constant pressure on the wound sites, the sooner the bleeding will subside. If the patient sleeps a lot after surgery, often the lack of light pressure on the gauze will allow the patient to bleed more. If excessive bleeding occurs it 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 forty-five 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, make sure that the patient is not feeling undo discomfort, does not become excited, sits upright, and avoids exercise. If bleeding does not subside or you are concerned with the amount of bleeding, feel free to call the office.

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 bodys 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 use of ice packs and elevation of the head. Ice packs can be made by placing a zip-loc bag within a second zip-loc bag and filling the inner bag with ice. Some patients prefer to use frozen vegetables or commercial gel packs. In any event, the ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on for 45-50 minutes every hour. It is important to allow the skin to warm to room temperature every hour to avoid the risk of a thermal burn. After 36 hours, ice has no beneficial effect. If swelling persists on the fourth post-operative day, heat (either moist or dry) may be applied to the face to help resolve the swelling. The heat is applied in a similar method as the ice packs. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery.

Pain

Your doctor and surgery staff will review your post-operative pain treatment with you and/or your family members after your surgery. If you have any questions about how to take the medications prescribed please call the office for clarification.

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. Since pain medication, especially in the post anesthetic patient, can make you more susceptible to light headedness and fainting with positional movement, we recommend you are assisted with all ambulation the first day of surgery. Pain or discomfort following surgery should subside more and more every day. If pain persists and you do not see improvement of your symptoms, it may require attention and you should call the office.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws as they cause the bleeding to persist longer. Drink from a glass. We recommend that you stay on clear liquids until the heavy bleeding subsides. It is important that you keep hydrated and drink fluids at least every hour. Once the bleeding has slowed down you may resume drinking full liquids (fluids with cream and milk) or begin a soft diet. Make sure that all chewing is away from the surgical sites. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment taken regularly will not only help avoid dehydration but will also provide your body with the needed calories to begin the healing process. Since you may not be able to eat normally for a couple of days, make sure you compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. You may find this easier if you have 4 or 5 meals a day rather than your normal 2 or 3. You will feel better, have more strength, less discomfort and heal faster if you take adequate fluids and nourishment.

Keep the mouth clean

No salt water rinses should be performed until the day following surgery. If you have been prescribed a prescription mouth rinse, you should use it the night of surgery and then twice daily for one week or as instructed by the doctor and staff. 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. Do not rinse with salt water immediately after the prescription rinse, if applicable, because it will negate the effectiveness of mouth rinse.

Discoloration or Bruising

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 will resolve without any long term discoloration and is a normal post-operative occurrence. The discoloration may become noticeable between 2-5 days after your surgery. In rare cases, the bruising may extend down the neck onto the chest due to the normal anatomical flow of your bodys lymphatic system, although, this is usually associated with extensive surgery located in the front of the mouth. 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, difficulty breathing, itching or any other unfavorable reaction. Call the office if you have any of these symptoms or have any questions.

Nausea and Vomiting

Although not common, nausea and/or vomiting following surgery can occur. Motion from the automobile ride home can occasionally make patient feel nauseated. Do not be alarmed if vomiting occurs. Simply rinse the mouth with water and replace the gauze packs. If the nauseated feeling goes away, resume your normal post-operative care. The most common reason for post-operative nausea is swallowing blood and taking the pain medication. Make sure you are checking and changing the gauze packs on schedule (even in a sleeping patient). You may find that taking a sip on coke, tea or ginger ale may reduce your nausea. You should sip slowly over a fifteen-minute period. If your nauseated feeling does not go away, call your doctor.

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 doctors if you have any questions.
Slight elevation of temperature immediately following surgery is not uncommon. If the temperature is greater than 101.5 F, 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 and ambulate with assistance.
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 doctors. In any event, your doctor will be happy to discuss any issue you have on the post-operative visit.
If the corners of your mouth are stretched, they may dry out and crack. Your lips can be kept moist with an ointment such as Vaseline for the first 2 to 3 days.
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 (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 in time.

Finally

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. In most cases, the sutures that are used are dissolvable. As the sutures dissolves they may become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures can be removed approximately one week after surgery. Usually, the removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is minimal discomfort associated with this procedure. So its 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 after the fourth or fifth day call my office for instructions.
There will be a cavity where the tooth was removed. The cavity will gradually fill in 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. Use the irrigation syringe to flush the socket, if you were given one.
The syringe can be filled with regular water and used to flush the socket after all meals.
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 or your family dentist.
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, pain which radiates to the ear or a bad taste or odor from the mouth may occur 4-5 days following surgery. Call the office if this occurs.
If you are involved in regular exercise, be prudent with return to vigorous exercise. No exercise should be performed while on pain medications. Remember, if you get light headed, stop exercising.