After Wisdom Tooth Removal

Home Instructions After Wisdom Teeth Extraction

The removal of impacted wisdom teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these 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 replaced every half hour if continued bleeding. Tea bags can be used for continued bleeding.
• Any form or rinsing, spitting, including brushing the teeth; should be avoided for 24 hours. This may initiate bleeding by causing the blood clot that has formed to become dislodged, and contribute to “dry socket.”
• Take the non narcotic pain medication prior to local anesthetic wearing off within 2-3 hours of leaving the office. We advise regular use of non narcotic pain medications over the first 2-3 days to diminish the need for narcotic pain medication.
• Restrict your activities the day of surgery and the day after. We recommend no school, work, or exercise during this time. You can resume normal activity two days after surgery if you feel comfortable.
• Place ice packs to the sides of your face where surgery was performed for the first 48 hours. If swelling is seen after this period, you may switch to warm moist compresses and massage to expedite the resolution of the swelling.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first wiping any saliva or blood from the mouth, then placing a tightly rolled gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened black tea bag for thirty minutes. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call our office 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. Ice packs, should be applied to the sides of the face where surgery was performed for the first 48 hours. You can use one ice pack and alternate placement on the sides of the face in intervals of 30 minutes.  If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Forty eight hours following surgery, the application of moist heat to the sides of the face with massage is beneficial in resolving swelling that may have occurred, as well as loosening the jaw muscles.

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every 6 hours. Do not exceed 3000mg daily. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 3 tablets may be taken four times daily, not to exceed 3200mg daily for an adult. Consult our practice for individuals under 18.

For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. Do not drive an automobile or work around machinery. 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 IV sedation only liquids should initially be consumed. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. A high calorie, high protein intake is very important. Our staff can provide suggested diet instructions. 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 any meals. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.

The day of surgery should be cold very soft foods such as yogurt, apple sauce, jello, ice cream, shakes, and smoothies (without the use of straws). The next few days should be warm very soft foods such as soup, oatmeal, porridge, mashed potatoes, over-cooked pastas or vegetables. Advance as tolerated to soft foods, and avoid crunchy hard foods until your doctor allows it after a week.

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 up for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be performed until 24 hours after surgery. The day after surgery you should begin rinsing with warm salt water after eating, with a teaspoon of salt mixed into one cup of warm water. This should be done for the first week after surgery. Gentle brushing can resume 24 hours after surgery, with care to avoid the surgical sites.  At your follow up visit, the staff will review the use of a syringe if food gets lodged in the lower extraction sites. This should not be done until 5-7 days after surgery to minimize dry socket.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of bruising 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. If there is bruising or swelling or tenderness at the IV site, massage with a warm compress and elevation helps resolve this.

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 any other unfavorable reaction and contact our office immediately. 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. Narcotics should be avoided is there is any nausea present. When the nausea subsides you can begin taking solid foods and the prescribed medicine. If needed, an anti nausea medication can be prescribed to avoid dehydration.

Other Complications

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, 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. Call Dr. Chandra or Dr. Pham 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 could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting 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. Chandra or Pham.
• 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 (Trismus) 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. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will dissolve approximately 5-8 days after 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 void where the tooth was removed. The void will fill in with new tissue gradually over the next month. In the meantime, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.

Your case is unique, no two mouths are alike. Discuss any problems with the trained experts best able to effectively help you: Drs. Chandra or Pham or your family dentist.

Brushing your teeth can resume 24 hours after surgery – just be gentle at the surgical sites for the first few days.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain near the ear may occur 2-3 days following surgery. Call the office if this occurs. The best way to prevent dry socket is to avoid any type of smoking for the first 3 days, avoid using straws to drink for the first 3 days, and avoiding rinsing or spitting or cleaning the mouth for the first 24 hours..

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. Light activity may begin 48 hours after surgery, but please consult with your doctor before.