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. After surgery, you will be given home care instructions (written), as well as a prescription, and a packet of gauze.

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. Try not to chew on the gauze. Steady pressure gives the best results.
Vigorous mouth rinsing, using staws, 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. You may begin gentle rinsing with water or mouthwashes after 24 hours.
Unless you have received different instructions from the doctor, take 2-3 tablets of ibuprofen 200mg (Advil, Motrin IB) every 4-6 hours.
Restrict your activities the day of surgery (rest and keep your head up) 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.
Do not drive the day of surgery if you had an IV anesthetic.
Do not smoke for at least 5 days following surgery. See your doctor about a nicotine patch if needed. Smoking is a primary cause of dry sockets and post-operative healing complications.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon for the first 24-36 hours. 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, try not to become agitated, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions. It is normal to have blood tinged (red) saliva (spit) for a few days after your extractions.

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. Expect swelling to last the almost 5 or 6 days. 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. Swelling that reoccurs several days after the initial swelling goes down could be a sign of an infection. If this occurs, call our office.

Pain

If you find that ibuprofen is not controlling your pain well enough, you may take the prescription pain medication in addition to ibuprofen, but not in place of ibuprofen. Think of the narcotic prescription medication as an ‘as needed’ medication. The prescribed pain medicine could make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery while taking the prescription narcotics. Avoid alcoholic beverages.

Make sure that you take your ibuprofen medication regularly for the first few days to stay ahead of the pain. If your pain increases after the first 4 or 5 days, then please contact our office.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot leading to what is known at the ‘dry socket’. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of this writing. 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, 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. Water or mouth washes from the store are suitable. Your doctor may have prescribed a mouthwash for you. If so, rinse with the prescription mouthwash twice per day in addition.

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 if needed. 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, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip 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. Nausea is often the result of low blood pressure, low blood sugar, narcotic use, and sometimes swallowing some blood from the surgery. Nausea that persists longer than 24 hour usually requires treatment, and you should contact our office should this occur.

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 Dr. Wees, Dr. McDermott, Dr. Glow or Dr. Shnayder 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, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Call Dr. Wees, Dr. McDermott, Dr. Glow or Dr. Shnayder.
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 (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. Heat and massage to the area will help with this.
Small bone chips or slivers may appear at the extraction socket. This may be felt as a sharp area sticking out of the gum line by the socket. They usually just work themselves out, but you can always call our office if this occurs and we will be happy to remove them for you.

Finally

Sutures are sometimes placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged or fall out but this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures will otherwise dissolve and fall out within 2 weeks of surgery.
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 cavity where the tooth was removed. The cavity will gradually fill in over the next month with new tissue. During the healing time, the area should be kept clean especially after meals with rinses or a toothbrush.
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: Dr. Wees, McDermott, Glow, Shnayder or your family dentist.
Brushing your teeth is okay - just be gentle at 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 light headed, stop exercising.

The Dry Socket

And finally, a dry socket is when the blood clot gets dislodged prematurely or dissolves from the tooth socket. Food and debris could then get into the socket. Symptoms of pain at the surgical site and even pain to the ear may occur in the next 2 or 3 day. It is also not unusual for there to be a foul odor, or bad taste associated the pain. A dry socket is not an infection, but will require treatment. Dry sockets occur most often in the lower jaw and are usually associated with removal of the molar teeth. Stitches, which are usually placed after the removal of an impacted tooth, do not prevent dry sockets. Women taking birth control pills and smokers are more prone to dry sockets. Call the office if you believe you are developing a dry socket.

Common sense is probably the single most important element in successful healing. Don’t be afraid to call our office and speak to our triage coordinator for post-operative care. You aren’t expected to know everything about having teeth removed and we are happy to help you.