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 or replaced if necessary.
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 begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
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, especially for the first 24 – 48 hours following the 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 or until the active bleeding has stopped. Take out the gauze when sleeping, eating or drinking fluids. 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, sit upright, do not become excited, and avoid exercise. Ice should also be applied to the side of the face that is bleeding. If bleeding does not subside, call 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. However, the 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 should be applied for 15 minutes on and 5 minutes off as much as possible. After 48 hours, ice has no beneficial effect. 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. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery.

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four hours or Ibuprofen, (Motrin or Advil) two 200 mg tablets may be taken every four hours.

For severe pain, take the tablets prescribed as directed. Most prescription pain medications contain Tylenol. Therefore additional Tylenol should not be taken. The prescribed pain medicine may make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery within 24 hours of having general anesthesia or within 8 hours of taking pain medications. Avoid alcoholic beverages. 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.

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. 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 the brochure. 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. Eat only soft, cool foods until the local anesthetic wears off completely.

Keep the mouth clean

You can brush your teeth the night of surgery but rinse gently. If you have a peridex prescription, use per instructions on the bottle. Otherwise, starting the day after the surgery, rinse your mouth gently every four hours using one half teaspoon in a glass of warm water. Gently swish the rinse in your mouth. Continue for five days.

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. This may last up to 10-14 days.

Antibiotics

If indicated you may have been placed on antibiotics. Take the tablets or liquid as directed. Antibiotics may be given to help prevent infection if needed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. If you are given antibiotics make sure to complete the entire prescription. 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 on 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 nausea continues, please call for an anti-nausea prescription.

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 Drs. Howerton, Hopkin and Kennedy 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 Drs. Howerton, Hopkin and Kennedy.
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 or weeks following surgery. This is a normal post-operative event which will resolve in time.

Finally

Sutures are sometimes placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures are dissolvable unless otherwise informed and will dissolve in 7 – 10 days. Occasionally they can dissolve as soon as 24 hours after the surgery as well as last up to two weeks after the surgery. The part of the suture that closes the surgical area will dissolve and the remainder will often fall out.

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 the office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush. If an irrigation syringe was given, please use as instructed.

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. Howerton, Hopkin and Kennedy 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 worsening pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. Call the office if this occurs.

If back teeth are removed (such as wisdom teeth) an incision is made into the cheek from the extraction area. Also an incision may be made around the adjacent teeth to help access. Do not be alarmed by sutures in the cheek or between the teeth.

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. Please refrain from vigorous activity and get plenty of rest for the first 24 – 48 hours.