After Wisdom Tooth Removal

The removal of impacted teeth is a surgical procedure. Post-operative care is very important. Unnecessary pain and swelling and the complications of infection, bleeding and alveolar osteitis (dry socket)can be minimized if the instructions are followed carefully.

Immediately Following Surgery

You should apply firm biting pressure on the gauze pad placed at the tooth removal site for a half hour. At this time, the gauze pad should be removed and checked. If any portion of the gauze remains white, then you are through with gauze application. If the gauze is entirely red, then replace and bite for another 30 minutes. At this point, further gauze application is seldom needed. Further gauze use may disrupt the clot by “wicking” it out of the socket. If you still have concern regarding the amount of bleeding, see below, or please call.
Vigorous mouth rinsing, spitting, 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 prior to the local anesthetic wearing off (typically within 2 hours). Take the medication with something light to eat initially.
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. 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 thirty minutes. Repeat if necessary. 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 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 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 be left on continuously while you are awake. After24 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. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Keep your head elevated at all times for the first 2-3 days. Gravity helps prevent swelling from reaching its maximum. Sleeping in a reclining chair is often best, but an extra pillow or two works well.

If advised to you, consistent use of ibuprofen in the dose of 600-800 mg every 6-8 hours works against swelling and inflammation. Consistent use for the first three days helps to prevent swelling from reaching its maximum.

Pain

The first 2-4 days after having wisdom teeth removed is typically the most challenging. During this time, consistent use of ibuprofen with periodic use of opiod (narcotic) pain medication for break through pain is warranted.

As time goes by, titrate down your use of the opiod pain medication, then the ibuprofen use. Although, it is not uncommon to periodically have pain for up to two weeks, depending on the difficulty of your surgery.

If you have pain that is unrelieved by both ibuprofen and opiod pain medication or your pain diminishes then severe pain returns a day or two later, you may have a dry socket (alveolar osteitis). In simple terms, a dry socket occurs when the blood clot within a socket is lost, and results in severe pain. Fortunately, it is unrelated to infection and antibiotics are not needed. The typical treatment is a dressing that is saturated with pain medication that is placed into the socket as a topical pain treatment directly to the nerves that were exposed now that the clot has been lost. The diagnosis of dry socket is predominantly based upon your symptoms which include pain radiating to your ear and toward your chin. Please contact the office if you feel you would benefit from a topical pain medication dressing.

Diet

After general anesthetic or I.V. sedation, liquids 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 form 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. 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

You can brush your teeth the night of surgery but rinse gently, allow the water to fall out of your mouth into the sink as opposed to spitting. The day after surgery you should begin gently rinsing your mouth in the morning and night and after meals with plain water. The third day after lower tooth removal, use the provided syringe to wash out the socket with water. Place the tip of the syringe just into the opening below the gum tissue and gently inject. Rather than spitting, although the water to flow out of your mouth by leaning over the sink.

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

Bruising

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

NAUSEA and/or 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. The two most common causes are due to the side effect of opiod pain medication and dehydration. Sipping on flattened ginger ale, sprite, gatorade or tea may help. When the nausea subsides you can begin taking solid foods (starting with bland foods such as toast or crackers) and the prescribed medicine. Make sure you maintain hydration with plenty of fluids, especially water. Minimizing your use of the opiod pain medication to none or 1/2 table per dose may help, if you are able. If you have further trouble, please contact the office.

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.
Slight elevation of temperature immediately following surgery is not uncommon, there is no need to monitor temperature routinely.Tylenol (aka acetaminophen, which is included as a component in Norco and Vicodin) or ibuprofenmay be taken to reduce the temperature, if elevated.
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 Drs. Anderson and Junck.
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, however may be relieved by applying warm compresses as well.