After Wisdom Tooth Removal

Post-operative care is very important. Unnecessary pain and complications can be minimized if these instructions are followed carefully.

Immediately Following Surgery

  • The gauze pad placed over the surgical area should be kept in place by biting down on them for 30-45 minutes. After this time, the gauze pad should be removed and discarded. Replace the gauze pads every 30 minutes for active bleeding. You will need to look in your mouth to be able to tell.
  • Do not disturb the surgical area today. Do not rinse, spit or probe the area with any objects and do not use a drinking straw. Vigorous mouth rinsing and/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 possible.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for a more thorough explanation.
  • Please do not smoke for at least 72 hours, since this is very detrimental to healing and may cause a dry socket. Smoking at any time during the first week can contribute to a dry socket.
  • 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 up for one minute before standing.

Bleeding

Intermittent bleeding or oozing overnight is normal. Active bleeding may be controlled by placing fresh gauze over the areas and biting down for 30-45 minutes at a time. Bleeding should never be severe. If it is, it usually means that the gauze packs are being clenched between teeth and are not exerting pressure on the surgical areas. Try repositioning the packs. If bleeding persists or becomes heavy you may substitute a tea bag (dipped in water and squeezed dry) for 20-30 minutes. If bleeding remains uncontrolled, please call our office.

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 a cold packs, ice bags or a bag of frozen peas wrapped in a towel and applied firmly to the cheek next to the surgical area(s). Ice packs are most effective in the first 36 hours. They should be applied twenty minutes on and twenty minutes off during the first 36 hours after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed. 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

Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first pill before the anesthetic has worn off, you should be able to manage any discomfort better. Some patients find that stronger pain medicine causes nausea, but if you precede each pain pill with a small amount of food, chances for nausea will be reduced. The effects of pain medications vary widely among individuals. If you do not achieve adequate relief at first, you may supplement each pain pill with an analgesic such as motrin or ibuprofen. Some patients may even require two of the pain pills at one time. Remember that the most severe pain is usually within six hours after the local anesthetic wears off; after that your need for medicine should lessen.

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3200mg daily for an adult. Consult our practice for individuals under 18. Do not take the two medications at the same time.

For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. 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.

A moist heat compress can be applied to the sides of the face to help soothe and loosen sore and/or tight jaw muscles.

Diet

After general anesthetic or IV sedation only liquids should initially be consumed. Do NOT use a drinking straw for the first week after surgery, drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. It’s best to start with small sips of water or a clear juice. If the sips are being tolerated with no nausea you can proceed to eating soft foods. Eat any nourishing foods that can be eaten with comfort. Avoid extremely hot foods. Our staff can provide suggested diet instructions. You should prevent dehydration by taking fluids regularly. It is sometimes advisable, but not absolutely required, to confine the first day’s intake to liquids or pureed foods — soup, pudding, yogurt, ice cream, milk shake, mashed potatoes, scrambled eggs, etc. Please avoid foods like rice, nuts, sunflower seeds, or popcorn which may get lodged in the socket areas. Over the next several days you may gradually progress to solid foods. You should compensate for your limited diet by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss any meals. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.

Keep the Mouth Clean

Keeping your mouth clean after surgery is essential. However, no rinsing of any kind should be performed until the day following surgery. The day after surgery you should begin rinsing. Use 1/4 teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with the solution, taking five minutes to use the entire glass. Repeat as often as you like or at least 2-3 times a day, especially after eating. Do not use over the counter mouth rinses, such as Listerine, as they can irritate the surgical areas and slow the healing process. Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth without causing discomfort.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, yellow or white 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.

Antibiotics

If you have been placed on antibiotics, take the medication as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. 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, tea, or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and minimize dosing of the prescribed pain medicine. If you do not feel better, please call our office.

Activity

Keep physical activities to a minimum immediately following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

Other Complications

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, 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. Call Dr. Fay 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 could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting up.
  • Occasionally, patients may feel hard or sharp 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 on their own. If they cause concern or discomfort please call our office.
  • 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 (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 resolve in time.  You may apply warm compresses (hot moist towel) to the sides of your face to help relax the muscles.

Finally

Normal healing after a tooth extraction should be as follows: The first two days after surgery are generally the most uncomfortable and there is usually some swelling. On the third day you should be more comfortable and, although still swollen, can usually begin a more substantial diet.  The remainder of the post-operative course should be gradual, steady improvement. If you don’t see continued improvement, please call our office.

If you have been given a plastic irrigating syringe, do NOT use it for the first five days. After five days use it daily according to the instructions until you are certain the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket.

Sutures are sometimes placed in the area of surgery to minimize post-operative bleeding and to help healing. These sutures are dissolvable but sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it, it’s also okay if they’ve been swallowed.

There will be a void where the tooth was removed. The void will fill in with new tissue gradually over the next month. 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 is reduced. Exercise may weaken you. If you get light headed, stop exercising.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call our office. A 24-hour answering service is available to contact Dr. Fay after hours. Calling during office hours will afford a faster response to your question or concern.