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 pad placed over the surgical area should be kept in place for one hour. After this time, the gauze pad should be removed and discarded. Most of the time it is not necessary to replace the gauze.
• 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 the day of surgery and resume normal activity when you feel comfortable. Avoid vigorous physical activity for four to seven days after surgery.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
• Caution: If you suddenly sit up or stand from a lying position after anesthesia, you may become dizzy or light-headed. If you are lying down following surgery, make sure you sit for one minute before standing, and when you stand, steady yourself before walking. If you become dizzy or lightheaded, sit down or lie down.

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 sixty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for sixty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. The most common reason for continued bleeding is not applying pressure directly to the extraction site. Usually the gauze is between the teeth but not applying pressure to the extraction site. In this situation, active bleeding continues around the gauze, and the gauze becomes saturated with blood. Properly placed gauze should have minimal blood on it and there should be no bleeding while the gauze is in the mouth. Reposition the gauze directly over the hole where the tooth was removed. Avoid talking while the gauze is in position as this can disturb the clot. To minimize further bleeding, keep your head elevated on several pillows or sit upright. Avoid strenuous exercise. If the bleeding does not subside, call the office for further instructions.

Swelling

The swelling is normally expected and 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 use of ice packs. Ziplock baggies filled with ice, frozen peas or ice packs should be applied to the sides of the face where surgery was performed. It is not necessary to keep the ice packs on continuously but apply them while resting, watching TV, etc. The ice packs should be placed twenty minutes on, twenty minutes off. After 48-72 hours, ice has minimal benefit. Swelling or jaw stiffness may persisted for several days after the 72 hour peak, and there is no cause for alarm. This is a normal reaction to surgery. Once swelling has peaked at 48-72 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. Depending on the extent of your surgery, steroids may be prescribe to minimize swelling. Start these medication the day of surgery.

Pain

For moderate pain, one or two tablets of Tylenol (acetaminophen) may be taken every three to four hours or Ibuprofen, 800mg every 6-8 hours (Motrin or Advil 200 mg OTC tablets) four 200 mg tablets may be taken every 6-8 hours. For the average sized adult patient, who has no contraindications to Ibuprophen, we recommend Ibuprophen, 800mg every eight hours for the first three days on a schedule basis. Begin this dosing regiment one hour prior to surgery with a sip of water.

For severe pain, add the narcotic tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery after taking the narcotic pain medicine. Avoid alcoholic beverages. Pain or discomfort following surgery usually peaks on the third day when the swelling peaks and should subside, and become less and less every day after that. If pain persists or is not decreased by the pain medication, it may require attention and you should call the office. It is normal to have some discomfort after surgery, even after taking pain medications,

Diet

After general anesthetic or I.V. sedation, easily digested foods should be initially taken. Avoid high fatty foods for the first meal. Clear liquids, soups, jello are usually good choices. Drink from a cup or use a spoon. Do not use straws. The sucking pressures can cause more bleeding by dislodging the blood clot. You may eat softer foods by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. 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. If you can’t eat calories, you should drink calories!

Keep the mouth clean

No rinsing of any kind should be performed until 8 hours following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a half of a teaspoon of salt.

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. Gravity pulls the blood through the tissue, and the discoloration may be seen to spread into the neck. As the blood breaks down, the discoloration usually changes from a purple to a green and then a yellow before it completed disappears. This is a normal post-operative occurrence, which may occur 2-3 days postoperatively. This bruising usually takes 10-14 days to completely resolve. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

Normally, a prophylactic dose of antibiotics is given through the IV prior to the start of surgery. If you have been placed on antibiotics, it is because an infection was found at surgery. Take the tablets or liquid as directed and complete the full course of antibiotics. Antibiotics will be given to help treat infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and call the office for instructions. Call the office if you have any questions.

Nausea and Vomiting

Nausea can occur after surgery because of the anesthetic medications, swallowing blood, pain medications or from standing up too fast. This nausea is frequently aggravated by motion, therefore lying down, may help to alleviate the nausea. 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. You should then sip on Sprite, 7-up, tea or ginger ale or ice chips. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid, non fatty foods and your prescribed medicines. If your nausea persists in spite of the above measures, call the office as it may be necessary to call in a prescription for anti-nausea type medications.

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, but could take a few weeks to a few months for the numbness to resolve. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Also be careful with shaving. We would want to follow you until the numbness resolves. Call Dr. Harper or Dr. Fisher if you have any questions.
• Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists or for a temperature >102, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
• You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery and postoperatively, it may initially be difficult for you to take adequate fluids. This can lead to a relative dehydration. Also, medications used for anesthesia and pain medications can make you dizzy. You could get light headed if you stand up suddenly. Therefore, before standing up, you should sit for one minute, then stand up and stabilize yourself as you stand.
• 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 over the next month or so. Occasionally an exposure of one of these bony projections occurs and will spontaneously spit itself out. If not, they can be removed by Dr. Harper or Dr. Fisher.
• 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 inflamed and 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.

Finally

Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures we use are generally dissolving and come out on their own within a few days to a week or so after the surgery.

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call my office for instructions.

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

Your case is individual, 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: Dr. Harper or Dr. Fisher and their staff or your family dentist.

Brushing your teeth two to three times daily is okay – just be gentle at the surgical sites.

A dry socket (alveolar osteitis) is when the blood clot gets dissolve or dislodged prematurely from the tooth socket. Symptoms of pain that no longer responds to pain medicine, pain radiating to other teeth or to the ear is common. 4-7 days following surgery is the highest risk time frame. These can occur for a variety of reasons, smoking and poor oral hygiene are the two most risk. Therefore, don’t smoke after surgery and keep the areas as clean as possible. Call the office if this occurs. It is usually treated with irrigation of the extractions sites and placement of a medicated gauze . Until you can into the office for definitive treatment, you may want to purchase an irrigation syringe to keep the extaction sights clean. In addition you can apply topical ambusol or red-cross toothache medicine to the area using a cotton ball.

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.

Occasionally patients will develop a low-grade infection that occurs between two weeks to two months after wisdom tooth extraction. This occurs usually because either a piece of food or other debris got caught in the extraction site and has become secondarily infected or a small bone spicule has lost its blood supply is is trying to spit out. Fortunately most of these infections respond to a course of antibiotic therapy. Those that don’t may require surgical debridement of the area. Contact our office if you experience any unusual “late” symptoms related to the areas where the wisdom teeth were removed.

Someone is always on-call for the office. If you have questions or concerns, please feel free to contact our office at your earliest convenience. Call the office and if we are not there, there are instructions on how to contact the on-call person.