After Wisdom Tooth Removal

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain, infection, and swelling can be minimized if these instructions are followed carefully.

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Immediately Following Surgery

The gauze pad your surgical assistant placed over the surgical area should be kept in place for thirty minutes. After this time, the gauze pad should be carefully removed and discarded.
Avoid vigorous mouth rinsing, spitting, or touching the wound following surgery. This may initiate bleeding by dislodging the blood clot that formed.
Begin taking medications as prescribed by your doctor. It is best to take the initial dose of medication before the anesthesia wears off.
Restrict your activities on the day of surgery and the following day.
Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for an explanation.

IF YOU HAD IV SEDATION OR GENERAL ANESTHESIA DO NOT DRIVE FOR 16 HOURS.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. We ask you to bite firmly on the gauze pad placed by the surgical assistant and once home, the pad can be gently removed. If bleeding persists, place a fresh, folded gauze pad over the area and apply pressure by biting firmly for 30 minutes. Repeat if necessary. If excessive 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. 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. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed for thirty minutes on and thirty minutes off for the day of surgery and the day following surgery.

Starting the 3rd day it may be helpful to apply moist heat to the swollen area. Use caution with heating pads as some may burn facial skin. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery.

Pain

It is best to take the initial dose of medication before the anesthesia wears off. Don’t be afraid to use the medication as it is designed to make those first days after surgery more comfortable. When taking oral medication, drink at least 1/2 cup of water or juice to aid in absorption and reduce stomach irritation. For medically healthy patients over the age of 12 we recommend starting with 400mg of over the counter ibuprofen plus 500mg of over the counter acetaminophen, taken simultaneously every 4 hours for the first 24 hours. After 24 hours, take the combination every 4-6 hours as needed.

If the over the counter combination does not manage your pain, and you were given a prescription pain reliever, you may take as directed. The prescribed pain medicine may cause drowsiness and will slow down your reflexes. Do not drive an automobile or operate heavy machinery. Avoid alcoholic beverages.

Pain or discomfort following surgery usually peaks by the third day following surgery and then slowly gets better each day thereafter. If pain persists, it may require attention and you should call our office.

Diet

Immediately following procedure it is important that you drink plenty of fluids and not use a straw. Water and juices are good choices. Soft foods such as ice cream, pudding, gelatin, soups and applesauce should be eaten at meal times, if possible. If swallowing is difficult, meals may have to be eaten five to six times daily in small portions.

After 24 hours add more solid foods such as pancakes, eggs, mashed potatoes, soft pasta, anything you can cut easily with a fork, to your diet. It is best to avoid crunchy, hard foods like popcorn, nuts and chips for one week following surgery.

Oral Hygiene

The day of surgery avoid rinsing or spitting as this may dislodge the blood clot and delay healing.

The day after surgery resume brushing your teeth. Make sure to be gentle around the surgical area(s). Also begin rinsing every four to six hours, especially after meals, with a warm salt water solution (dissolve 1/2 teaspoon of salt with 1/2 cup of warm water). Continue warm salt rinses for one week.

Activity

Immediately following procedure reduce your activity as much as possible. Too much chewing or talking will contribute to greater swelling. It is best to nap with your head elevated on several pillows. Rest is important to start you on a good recovery.

After 24 hours and the few days following surgery, you may increase your activity as tolerated, but avoid bending and heavy exercise through the first week.

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 our office if you have any questions.

Nausea and Vomiting

Immediately following procedure it is not uncommon to experience nausea or vomiting. Medications, anesthetics, diet changes and swallowed blood can easily upset your stomach. A small bland meal or clear carbonated beverage may coat your stomach and help alleviate your discomfort.

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. Rodenburg, Dr. MacMenamin, Dr. Brown, Dr. Burns, Dr. Shearen, Dr. Tyler or Dr. Capp 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.
Be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery and it may have been difficult to drink fluids. In addition, pain medications can make you dizzy. You may become 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. Rodenburg, MacMenamin, Brown, Burns, Shearen, Tyler or Capp.
If the corners of your mouth are stretched, they may dry out and crack. Keep your lips moist with an ointment such as Vaseline.
A sore throat 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.

Sutures (stitches)

Sutures may have been placed in the area of surgery to minimize post-operative bleeding and to help healing. The sutures are dissolvable and will eventually fall out as you heal. Sutures that become dislodged are no cause for alarm. Just remove the suture form your mouth and discard it. Any remaining sutures will be removed at your one week follow up appointment. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. It’s really nothing to worry about.

There will be a hole where the tooth was removed. The hole will fill in gradually over the next month with the new tissue. In the mean time, keep the area clean with salt water rinses or a toothbrush, especially after meals.

Your recovery is unique, 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. Rodenburg, MacMenamin, Brown, Burns, Shearen, Tyler or Capp 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. Although uncommon, if this happens, you may experience pain at the surgical site that radiates to the ear. Symptoms may occur 2-3 days following surgery. If you are having pain that isn’t controlled with medication, call the office.

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.

Finally

One Week after your surgery, resume normal diet and activities. You should avoid popcorn until the surgery areas have completely healed. You will be provided with a plastic syringe to be used no sooner than one week after surgery. Using the syringe during the first week may delay the healing process. The syringe is to be used two to three times per day until the surgery areas are completely healed. It is important to use the syringe because even with proper hygiene food may collect in the surgery areas.

To use the syringe:

Fill syringe with warm water
Place syringe above surgery area.
Gently flush area and empty mouth.
Use syringe 2-3 times per day (especially after eating).
Flush each area until water is clear or until food particles are no longer present.
It may take several weeks for the surgical areas to heal.

Please call our office if you have any questions or concerns.