After Wisdom Tooth and Impacted Tooth Removal

The removal of wisdom teeth and 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

Do not disturb the surgical area today. Do NOT rinse vigorously or probe the area with any objects or your fingers. You may brush your teeth gently. Do NOT smoke, drink carbonated beverages, use straws, suck on hard candy or cough drops, or spit for at least
72 hours since it is very detrimental to healing. If you have upper back teeth removed, Do NOT blow your nose for 7-10 days.

  • The gauze pad placed over the surgical area should be kept in place for 1 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 before you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
  • Restrict your activities the day of surgery and the following day. 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. 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 gently closing your teeth together for 30-40 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30-40 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.

Pain 

Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication, and if you take the first pill before the anesthetic has worn off, you will be able to manage any discomfort better. Effects of pain medicines vary widely among individuals. Some people may even require two of the pain pills at one time  during early stages (but that may add to the risk of upset stomach). If you do not achieve adequate relief, please call our office for recommendations on what medication you may supplement each pill with. Remember that the most severe discomfort is usually within the first six hours after the anesthetic wears off; after that your need for medicine should lessen.

For mild to moderate pain, Tylenol or Ibuprofen, (Motrin or Advil) may be taken every 4 hours. Please ask your surgeon for dosage recommendations.

For severe pain, take the tablets prescribed 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.

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.

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 3-4 days post-operatively.

You can minimize this by using a cold pack or ice bag wrapped in a towel and applied firmly to the face or cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off as often as possible during the first 36 hours after surgery. The 3rd day will often be the peak day for any swelling and/or discomfort.

After 36 hours, ice has no beneficial effect. Swelling or jaw stiffness can persist for several days. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face may be beneficial in reducing the size of the swelling.

The pain and swelling should subside more and more each day following surgery. If your postoperative pain or swelling worsens or unusual symptoms occur call my office for instructions.

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 postoperative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Diet 

After surgery, liquids or non-chewing food (Mashed potatoes, scrambled eggs, cottage cheese, yogurt etc.) 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 from the surgical sites. 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.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. Begin your normal hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort. The day after surgery you should begin soaking the area at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.

STITCHES

Unless you are told differently, the stitches that are in your mouth will dissolve. Don’t worry if you see them loosen or fall out – that is supposed to happen. Depending on the type of stitches that were put in, it may take anywhere from a few days to a couple of weeks for them to dissolve completely.

Nausea

Nausea is not a common event after surgery, but it is sometimes caused by stronger pain
medicines. Nausea may be reduced by preceding each pill with a small amount of soft food like
mashed potatoes, cottage cheese or scrambled eggs, then taking the pill with a large volume of
water. Try to keep taking clear fluids and minimize the pain medication, but call us if you do not
feel better or repeated vomiting is a problem. Cola drinks that have less carbonation may help
with nausea.

SHARP EDGES

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 or small slivers of bone may work themselves out during the first week or two. If not, they can be removed by your surgeon. Please call the office if you are concerned

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 office 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.
  • If you had an IV sedation 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.
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment.
    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.
  • There will be a cavity where the tooth was removed. The cavity will gradually, over the next month or two, fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses.
  • 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: Your Surgeon, their assistant or your family dentist.
  • 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.

Thank you for the privilege of serving your health care needs. It is our desire that your recovery be as
smooth and pleasant as possible. Following these instructions will assist you. If you have any questions about
your progress, please call our office. We will be happy to help you.