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

  • Please keep the gauze pad placed over the surgical area in place for one hour. After this time, the gauze pad should be removed and discarded.
  • 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.
  • Please take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
  • Please restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Please 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 directly over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, place a moistened tea bag directly over the area and bite firmly for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, please sit upright, avoid exercise, and don’t become excited. 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 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 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.

Pain

For mild to moderate pain, ibuprofen (Motrin or Advil) two to three 200 mg tablets may be taken every 3-4 hours.

For severe pain, please take the tablets prescribed as directed. The prescribed pain medicine may make you groggy and may slow down your reflexes. Please do not drive an automobile or work around machinery. Please avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists or increases, it may require attention.  Please call our office.

Diet

After general anesthetic or I.V. sedation, please drink liquids until the numbness wears off. Please do not use straws; drink from a glass. The sucking force may cause more bleeding by dislodging the blood clot. Once the numbness wears off, you may eat anything soft by chewing it away from 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

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery please begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a half 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. This is a normal post-operative occurrence, which may appear 2-3 days post-operatively and take about a week to go away. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

Antibiotics are not usually given after surgery.  If you have been placed on antibiotics, please take them as directed until they are all gone.  Please discontinue antibiotic use in the event of a rash or other unfavorable reaction, and call our office.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, please do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on Sprite, ginger ale. Please sip slowly over a fifteen-minute period. When the nausea subsides you may 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. Please be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. Please be careful. If the  numbness has not resolved by one month after surgery, please call our office for a follow up appointment.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, please notify our office. Tylenol or ibuprofen may be taken to reduce the fever.
  • Please careful moving from a lying down to a standing position. You were not able to eat or drink prior to surgery, and it will be more difficult than normal to take fluids after surgery. This may make you weaker than normal.  The pain relieving medication may also make you dizzy. If you stand up suddenly you may get light headed. Before standing up, please sit for one minute to allow your body to adjust, then get up.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. These are not roots.  They are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If they are not gone in three months, please call our office.  If needed, they can be surgically removed by Dr. Miller.
  • If the corners of your mouth were stretched during the surgery, they may dry out and crack. Please keep your lips moist with an ointment such as Vaseline.
  • A sore throat and pain when swallowing are not uncommon. The surgery may have caused the throat muscles to get swollen, and the normal act of swallowing may then become painful. This will usually subside in 3-4 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 usually resolve in time.

Finally

Sutures may be placed in the area of surgery to minimize post-operative bleeding and to help healing.  Please don’t be alarmed if they become dislodged. Just remove the suture form your mouth and discard it. The sutures usually dissolve and come out on their own in a week to 10 days.

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, please call our office for instructions.

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, please keep the area clean with salt water rinses or with a toothbrush gently, especially after meals.

Your case is individual, no two mouths are alike. Please do not accept well intended advice from friends. Discuss your problem with the persons best able to help you effectively: Dr. Miller or your family dentist.

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

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and usually pain radiating to the ear may occur 3-4 days following surgery. Please call the office if this occurs.

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, please stop exercising.