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.
• 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. Slight bleeding, oozing, or redness in the saliva is not uncommon for 3-4 days after surgery. Remove your guaze when eating. Ensure that the guaze is removed prior to going to bed for the night.

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 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag (black tea only) for 45-60 minutes. The tannic acid in the tea bag 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 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 and could last up to one week.

Apply an ice pack to the jaw immediately upon your return home. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. Alternate 15 minutes on and 15 minutes off for the next 48 hours. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. 48 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. Return of normal jaw movement may take up to 2-3 weeks.

Pain

It is advisable to take the prescribed pain medication soon after your surgery. For moderate pain, one Motrin (Ibuprofen or Advil) 600 mg tablet may be taken every 6 hours or one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours.

For severe pain, Tylenol #3 may have been prescribed and should be taken as directed. 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. 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.

Pain medications taken on an empty stomach often result in an unsettling feeling and/or nausea and vomiting. Please attempt to take food or fluids either with your pain tablets or as soon after as possible.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken.  Drink from a glass. Do not use straws for 6-7 days after surgery. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. Cool soft foods are usually tolerated well, i.e. ice cream, applesauce, pudding, jello, yogurt, scrambled eggs, etc. High calorie, high protein intake is very important. 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. The day after surgery you should begin gently brushing your teeth and rinsing with Chlorhexidine or warm salt water (1/2 to 1 tsp. of salt in a large glass with warm water)  3 times daily after breakfast, dinner and before bed. Do not spit when brushing or rinsing.

For lower wisdom teeth removal: 7 days after surgery, you can start to use the curved-tip syringe (provided on the day of surgery). The purpose of this syringe is to clean food/debris out of the lower sockets. Fill the syringe with warm salt water and insert the tip of the syringe into the lower sockets and gently flush. This can be done once a night before bedtime for ONE week only.

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 and will disappear in 7-10 days. 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 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 (especially Tylenol #3). You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. A small dose of Gravol 25-50 mg can also be taken and can be purchased as over-the-counter medication at the pharmacy. When the nausea subsides you can begin taking solid foods and the prescribed medicine.

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. Bureau 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 Dr. Bureau.
• 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

Dissolving sutures are placed the area of surgery to minimize post-operative bleeding and to help healing.  These will dissolve in 1-10 days. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it.

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 my office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually over the next 6-8 weeks 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.

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. Bureau or your family dentist..

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 to the ear may occur 2-3 days following surgery. Call the office if this occurs.

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.

DO NOT Smoke. Smoking is discouraged during the healing period (2-4 weeks). Smoke is a tissue irritant and it can lead to increased risk of infection, delayed healing and dry sockets.

If you are admitted to a hospital within 10 days after the surgery,please contact our office, especially if you believe it may be related to the surgery, we would like to know in order to help you.