After Wisdom Tooth Removal

The removal of impacted teeth is a 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 can be changed as needed and discontinued once bleeding has largely subsided.  If after 1-2 hours bleeding pesists, the patient may bite on a tea bag for 30 minutes.  Soon after arriving home, the patient should be encouraged to begin sipping small amounts of clear liquids such as Propel, Gatorade, or Kool-Aid. 
  • Approximately 2-3 hours after surgery, if the patient’s stomach is settled, encourage them to consume something thick such as applesauce, banana, pudding, or a fruit or protein smoothie.
  • If the patient’s stomach remains settled after this, having been home approximately 2-3 hours at this point, they should now be encouraged to take their pain medication before their numbness from the local anesthesia wears off.
  • 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.
  • Activities the day of surgery should be restricted, but normal activities can gradually be resumed as the patient feels more comfortable.
  • Ice or cold packs should be applied to the sides of patient’s 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 the mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, the patient may 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, the patient should not become too active, and avoid exercise, and try to stay upright and sleep propped up on pillows. 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. Swelling may 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. The ice packs should be left on continuously while you are awake. After 36 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 part of surgical recovery. 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.

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every 4-6 hours or  one to two tablets of Ibuprofen 200 mg (Motrin or Advil) may be taken every 6-8 hours.

For severe pain, the medication prescribed should be taken as directed, but one should not take either Tylenol or Ibupofen or any other over the counter medication with the prescription medication without first checking with Dr. Nail The prescribed pain medicine can make patients groggy and canl slow down  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, it may require attention and you should call the office.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. Sucking from a straw 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. 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 may 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

No rinsing of any kind should be performed until the day following surgery. If you have been prescribed an antibacterial mouth rinse, you may use it the evening of surgery, but do not swish forcefully with it. 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 teaspoon of salt.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of purple, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal occurrence and typically occurs a few days post-operatively. Moist heat applied to the area will speed up the removal of the discoloration.

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 the office if you have any questions.

Nausea and 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. You should then sip on Coke, Spritete, Gatorade, or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.

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 chew with caution. Call Dr. Nail 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.
  • 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 stand up.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls felt throught the gingiva which previously supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Nail.
  • 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 (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. More often than not, the sutures used dissolve on their own and fall out in pieces over a week.  Sometimes sutures are used that require later removal.  When sutures begin to dissolve, pieces may become dislodged in the mouth. This is no cause for alarm. Just remove the suture form your mouth and discard it. If sutures are used that require removal, they will be removed approximately 1-3 weeks following surgery, depending on the procedures that were performed. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is generally no discomfort associated with this procedure. 

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

Your case is individual, no two mouths are alike. Do not accept well intended advice from friends, as their past experiences are not generally relevant to your care. Discuss your problem with the persons best able to effectively help you: Dr. Nail or your family dentist.

Brushing your teeth is okay – just be gentle near the surgical sites.

If you are involved in regular exercise, be aware that you have had surgery.  People tend to minimize oral surgical procedures and think that such procedures will not affect them, but it is surgery and requires a recovery. You will find that you will have reduced energy levels for exercise for 1-2 weeks following surgery.  If you feel weak or light headed, stop exercising.