After Wisdom Tooth Removal
The removal of impacted wisdom teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the chance of complications can be minimized if instructions are followed carefully.
IMMEDIATELY FOLLOWING SURGERY
- Keep the gauze pad in place over the surgical sites with firm biting pressure for one (1) hour. After this time, remove and discard the gauze pad. A new, moist gauze pad does not need to be replaced unless bleeding continues or recurs.
- Avoid vigorous mouth rinsing, sucking on straws, smoking, and touching the surgical sites. These may cause continued bleeding by dislodging the blood clot.
- Take the prescribed pain medication before you begin to feel discomfort. This usually coincides with the start of the local anesthetic wearing off.
- Restrict your activities the day of surgery and avoid exercise. Lie down with your head elevated on two or three pillows or sit in a recliner and take it easy.
- Place an ice pack on the outside of your face over the area where surgery was performed for the first 24 to 48 hours to help minimize swelling.
- Drink plenty of fluids – at least six to eight glasses of liquid a day. Do not use straws as this may encourage more bleeding. Do not drink hot fluids or eat hot food the first day. Very soft food for the first several days is recommended as it can be chewed and swallowed easily.
A certain amount of bleeding is to be expected following surgery. Slight oozing or blood-tinged saliva is not uncommon for the first 12 to 24 hours. Excessive or continued bleeding may be controlled by first rinsing or wiping any old clots from your mouth and then placing a new, moist gauze pad over the area with firm biting pressure for an additional hour and repeating as necessary. If bleeding continues, you may bite on a moistened tea bag in the same manner. Tannic acid in tea helps blood to clot. If bleeding does not subside, please call the office for further instructions.
Swelling is normally expected after most surgical procedures and is usually proportional to the extent of surgery performed. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal and healthy reaction to surgery. Most swelling will not become apparent until the day following surgery and will not reach its maximum until 48 to 72 hours post-operatively. However, swelling and discomfort may be minimized by the immediate use of ice packs. Ice packs should be applied to the outside of the face over the area where surgery was performed for the first 24 to 48 hours. Ice packs should be left on for 30 minutes and then left off for 30 minutes while awake. After 48 hours ice has no beneficial effect. Instead, the application of heat may be helpful in reducing the size of swelling more quickly. On occasion, some residual swelling may last a week or longer.
Take the prescribed pain medication before you begin to feel discomfort. This usually coincides with the start of the local anesthetic wearing off. Taking pain medication on an empty stomach may cause nausea, so it is recommended to take the pills with food or drink. Pain medication may make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery while medicated. It is also best to avoid alcoholic beverages. Aspirin or other over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen (Advil/Motrin) may be used when appropriate. Discomfort following surgery may increase on the second or third day following the procedure and then should improve each day thereafter. If pain persists or worsens after four (4) days, please notify the office as it may require attention.
In some cases bruising of the skin may follow swelling. The development of black, blue, green, or yellow discoloration is due to blood oozing and spreading beneath the tissues of the mouth and face. This is a normal post-operative occurrence that may occur two to three days after the procedure and take one to two weeks to gradually fade away.
Continuing to eat a nutritionally balanced diet is essential for feeling better, regaining strength, experiencing less discomfort, and more rapid healing after surgery. Try not to miss a single meal. It’s understandable that your food intake will be limited for the first few days after your procedure. It is best to wait until after the local anesthetic has completely worn off before beginning to eat. Start with plenty of fluids (juice, milk, water) during the first 24 hours. At least six to eight glasses (two quarts) of liquid a day will help prevent dehydration. Do not use straws as this may encourage more bleeding by dislodging a blood clot. Do not drink hot fluids or eat hot food the first day. You may eat anything soft and cool the first day by chewing away form the surgical sites. It’s best to progress to more solid foods and return to your normal diet as soon as possible.
Begin gentle, warm salt water rinses (1/2 teaspoon of salt in a glass of warm water) the morning after surgery. Rinsing four to five times a day for several days, especially after meals, will help to gently flush food particles away. Continue to brush your teeth as best you can – remembering to stay away from the surgical sites for several days. Our doctors may prescribe an antibiotic mouth rise to use in place of salt water. Furthermore, an irrigating syringe may be provided for use starting a week after the procedure.
Antibiotics may be prescribed for certain patients after a surgical procedure to help prevent or cure an infection. If you have been placed on an antibiotic, take the tablets or liquid as directed until gone. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and notify our office immediately.
NAUSEA AND VOMITING
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least a half an hour including prescribed medicines. Sitting in a darkened environment, limiting movement, and applying a cold compress to your forehead may be helpful. Taking an over-the-counter diphenhydramine (Benadryl) may stave off mild nausea. Start again with bland fluids (water, ginger ale, 7-Up, Sprite), sipping them slowly over a fifteen-minute period. When nausea subsides, begin taking solid foods and the prescribed medications again. If nausea persists or you have trouble keeping anything down, notify the office as an anti-nausea medication and/or a change in pain medication may be necessary.
GOOD THINGS TO KNOW
There is always the possibility of developing a dry socket when a tooth is removed. Please notify our office if severe pain develops between the fourth and six day following your procedure which is unrelieved by pain medication, radiates to your ear, or wakes you up at night. Dry sockets are easily and effectively treated and should not cause undue alarm.
If persistent numbness of the lip, chin, or tongue occurs, there is no cause for alarm. As stated during your consultation, this is almost always temporary in nature. It may persist for a few days to several months, but rarely is permanent. Should any numbness or altered sensation persist after the first 24 hours, please notify the office.
A slight elevation of temperature immediately following surgery is not uncommon. If an elevated temperature persists or a fever develops, please notify the office.
Be careful going suddenly from a lying down position to a standing, upright position. You may get light-headed standing up suddenly. Before standing up, you should sit for one minute then get up slowly.
Keep your lips moist with a lip ointment. Due to stretching of the mouth during surgery, your lips may dry out and crack – especially at the corners.
A sore throat and pain when swallowing are not uncommon due to swelling and inflammation of the nearby muscles or some of the medications used for I.V. anesthesia. These issues will subside in two or three days.
Stiffness of the jaw muscles (trismus) may occur and cause difficulty when opening your mouth and during chewing for several days following surgery. This is a normal post-operative event that resolves on its own in five to ten days. Chewing gum may help relax muscle tension and bring relief. Taking an anti-inflammatory medication such as ibuprofen (Advil/Motrin) may also help.
You may have sutures in your mouth to minimize post-operative bleeding and to help healing. If one or two becomes dislodged early, there is no cause for alarm. Just remove the loose suture from your mouth and discard it. Our doctors will tell you if your sutures are dissolvable or if you will need a return visit to have them removed.
There will be a cavity where your tooth was removed. This cavity will gradually close over the next month fill in with new tissue. Be sure to keep the area clean to promote better healing.
You may feel hard projections in your mouth with you tongue near the surgical sites. These projections are not forgotten tooth roots but the bony walls of the empty tooth sockets. These projections usually smooth themselves out as the tooth sockets heal. If not, your surgeon will smooth them off for you.
If you regularly exercise please be aware that your normal caloric intake may be reduced and you may be dehydrated after surgery. Exercise may further weaken you. It is best to avoid strenuous activity for two to three days following surgery.
Please notify the office if you have:
- Increased pain after four days.
- Increased swelling after the third day.
- An elevated temperature or fever after two days.
- Excessive or uncontrollable bleeding.
- A bad reaction to any of your medications.
- Any questions or concerns.