Wisdom Tooth Removal

After Wisdom Tooth Removal

The removal of impacted teeth is a 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. If bleeding is persistent, replace the gauze for another 30 minutes.
• Limit talking. The more you talk, the more your tongue and associated muscles move, disturbing the clots.
• 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 on the day of surgery and resume normal activity when you feel comfortable and resume a normal diet.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for an explanation. Do not leave the ice in place longer than 20 minutes at a time.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon and can last for 1-2 days. Excessive bleeding may be controlled by placing gauze over the surgical site and holding firm pressure for 30 minutes at a time. Repeat if necessary. Do not frequently change out the gauze because you are dislodging the early formation of clots. 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 constricting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. In addition, do not apply ice to the face if you are having trouble controlling the bleeding. The cold temperature can decrease platelet function. If bleeding still 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 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 packs should NOT be left on continuously. The ice should be applied intermittently for 20 minutes on and 20 minutes off. After 24 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. Twenty-four hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the amount of swelling. Heat should NOT be applied if you are being treated for an acute infection.

Pain

For moderate pain, over-the-counter analgesics may be used such as Tylenol or ibuprofen.

For severe pain, take the prescribed medication(s) as directed. The prescribed pain medicine can 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 over time. If pain persists, it may require attention and you should call the office.

Diet

After general anesthetic or IV sedation, liquids or ice cream should be consumed first. Do not use straws, as 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 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 6-8 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. Please avoid nuts, seeds, popcorn, and chips for 2 weeks.

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

Very gentle rinsing can be done later on the day of surgery. Do not brush your teeth until the following day.

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. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics, take them as directed. Antibiotics will be given for a purpose and should be completed. Call the office if you have an adverse reaction. It is important to discern side effects versus true allergies.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, a prescription may be provided if severe enough. Keep to a bland diet. Eat prior to taking medications to buffer your stomach.
Other Complications

• If numbness of the lip, chin, or tongue occurs, there is no cause for alarm. As stated prior to 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 use caution. Call if you have any questions.
• Slight elevation of temperature immediately following surgery is not uncommon. In fact, it is an expected natural inflammatory response. If the temperature persists, notify the office.
• 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 lightheaded 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 that supported the tooth. These projections usually smooth out spontaneously.
• 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/or pain when swallowing are not uncommon. The muscles get swollen, making it possible that the normal act of swallowing can then become painful. This will subside.
• 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 that will resolve in time. You will not hurt the wound by opening your mouth.

Finally

• Sutures are placed in surgery for various reasons. They are not always required. Sometimes they become dislodged and this is no cause for alarm. Just remove the suture form your mouth and discard it. Your sutures will dissolve on their own. Removal will not be required except for special circumstances. You will be notified if an appointment is needed to remove any sutures.
• The pain should subside more and more each day following surgery. If your post-operative pain worsens or unusual symptoms occur, call the office for instructions.
• There will be a cavity where the tooth was removed. The cavity will gradually fill in with the new tissue over the coming month. In the meantime, 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 or internet blogs. Discuss your problem with the people best able to help you – the surgeons and trained staff familiar with your case.
• Brushing your teeth is okay starting the following day – just be gentle at the surgical sites.
• 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 in the ear may occur 4-6 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 lightheaded, stop exercising.