After Wisdom Tooth Removal

The removal of 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

  • The gauze packing placed over the surgical area should be kept firmly in place until you arrive home.
  • Once you are home, you should remove the gauze briefly in order to eat something cool and soft such as apple sauce, pudding, or yogurt.  After eating, take your first dose of pain medication, even if you are still numb.
  • Place new gauze directly over the extraction site, changing the gauze every 45 minutes.
  • Vigorous mouth rinsing or touching the wound area following surgery should be avoided on the first day. This may result in the blood clot being dislodged.
  • Restrict your physical activities the day of surgery and the day following surgery. You may begin to resume normal activity on the subsequent day, if and when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for further explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing or redness in the saliva is not uncommon. Persistent bleeding may be controlled by gentle rinsing or wiping any old clots from your mouth and then placing a folded gauze pad over the area and biting firmly on the gauze for 45 minutes.

Remember, it is the pressure over the surgical site, not the absorbency of the gauze that will help in the clot formation to slow and stop the bleeding. Change the gauze every 45 minutes 4 or 5 times over the next 4-6 hours.  If bleeding continues, continue using the gauze and make sure that the gauze is positioned directly over the extraction sites. Ensure that you are biting firmly on the gauze.

Elevating the head with 2-3 pillows or sitting up in a recliner will also help stop the bleeding by decreasing the blood pressure in the mouth. If bleeding persists, biting on a moistened tea bag (black tea) over the extraction site in 30-45 minutes intervals may help control the bleeding. The tannic acid in the tea leaves helps to form a clot.

You should not have to go to bed in the evening with gauze in your mouth.

To minimize further bleeding, try not to become too excited or to partake in strenuous physical activities, try not to talk too much, avoid using straws, and avoid vigorous mouth rinsing.  If bleeding does not subside, call for further instructions.  

Pain

For severe pain, take the pain medication as prescribed (usually every 4-6 hours). The prescribed pain medicine may 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, or increases after 36 hours, it may require attention and you should call the office.

For moderate pain, over the counter Ibuprofen (Motrin or Advil), can be effective in controlling pain, 600mg (3 over the counter tablets of 200mg each) is equivalent to prescription strength Motrin. This dosage can be taken every 6 hours.

Some patients find that 600mg of Ibuprofen (Motrin or Advil) works well in conjunction with their prescribed narcotic pain medication. It is important to remember that whenever taking any pain medication, it is best to take them with some food to help avoid an upset stomach.

Nausea and Vomiting

Nausea can be caused by the anesthesia, the blood in your mouth and stomach from the surgery, or the prescribed pain medication. In the event of nausea and/or vomiting following surgery, stop taking anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a 15 minute period.

When the nausea subsides, you can begin eating solid foods. Before trying the prescribed narcotic medicine, try taking Ibuprofen or Tylenol for pain. There is less chance of nausea with these medications. You may find that they are completely effective at managing your discomfort.

If nausea and vomiting persist, please call the office (during regular business hours) or the doctor directly on his cell phone (after-hours, evenings, nights, weekends) for 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 postoperatively; 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. After 12-24 hours, ice has no beneficial effect.  Sleeping with your head elevated for the first 3-4 days helps minimize the swelling. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal response 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.

It is normal to have generalized swelling for the better part of the week following wisdom teeth extractions.

Should you have an increase in swelling after 72 hours, please give us a call for instructions.

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

Diet

Initially, after general anesthetic or IV sedation, liquids should be taken. Drink from a glass and do not use a straw. The sucking action through the straw can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical site(s). High-calorie/high-protein intake is very important. Nourishment should be consumed regularly.

You should prevent dehydration by drinking 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. If you continue to eat, you will feel better, have more strength, less discomfort, and heal faster.

Keep the Mouth Clean

Until the day following surgery, no vigorous rinsing should be performed. On the night of surgery, it’s okay to gently rinse and brush your teeth. The day after surgery, begin rinsing at least 5-6 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt.  Avoid vigorous rinsing.  Remember to gently brush your teeth 2-3 times per day.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed.  Discontinue antibiotic use in the event of a rash or other unfavorable reaction, but be sure to notify the doctor.  Call the office if you have any questions.

Dry Sockets

A dry socket is a condition that occurs when the blood clot dissolves or becomes dislodged prematurely from the extraction socket. It results in increased symptoms of pain/throbbing/aching at the surgical site that radiates into the ear.  Dry sockets are rare, if one were to occur, it is usually not before the 4th or 5th day following the surgery.  They are not dangerous but can be quite painful requiring attention.

If you experience increased symptoms like these, call the office (during business hours), or your doctor’s cell phone (if non-business hours). Dry sockets are usually very easily treated.

Infection

Infection following wisdom teeth extraction is rare, but can occur. Typically, if an infection were to occur, it would be in the first 3-5 days following surgery. Signs and symptoms include increased swelling after 3 days, failure of the swelling to begin to subside after four days, new/increased pain, or drainage/pus at the surgical site. 

Infection is typically managed by antibiotics, but sometimes can require drainage. Should you be experience these signs or symptoms, please call for instructions.

Other Conditions, Concerns, or 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. If the numbness continues after 72 hours, please call the office for instructions.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists after 48 hours, notify the office. Meanwhile, Tylenol or ibuprofen should be taken to reduce the fever.
  • You should be careful going from the lying down position to standing. Taking pain medications can cause you to become lightheaded or even faint when you stand up. Before standing up, you should sit upright for one minute before attempting to stand up.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not tooth roots left behind; they are either stitches or the bony walls that supported the tooth.  These projections usually smooth out spontaneously. If not, your doctor can address them.
  • If the corners of your mouth are stretched, they may dry out, become chapped, 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 usually subside in 2-3 days.
  • Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days. This is a normal post-operative event, which will resolve over 7-10 days.

Finally

Dissolvable sutures are typically placed in the area of surgery to minimize postoperative bleeding and to help healing.  They will dissolve or become dislodged sometime between 2-14 days. When this happens, there is no cause for alarm, just remove the loose portion of suture form your mouth and discard it.

In spite of the use of stitches, there will still be a hole where the tooth was removed. The hole will gradually heal over the next 4-6 weeks, filling in with the new tissue. In the meantime, the area should be kept clean especially after meals with salt-water rinses or a toothbrush.

If you are involved in regular exercise, be aware that your normal nourishment intake will likely be reduced. Exercise may further weaken you. If you get light headed, stop exercising.