After Wisdom Tooth Removal

Removing impacted teeth is a serious surgical procedure, so post-operative care is very important to keep in mind when healing. Unnecessary pain and the complications of infection and swelling can be minimized if you deliberately follow the instructions carefully.

Immediately Following Surgery

  • The gauze pad that has been placed over the surgical area should be kept in place for a half an hour. After this time, the gauze pad should be removed and discarded.
  • Avoid touching the wound or rigorous mouth rinsing following the surgery. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • As soon as you start to feel the local anesthetic wear off, and start to feel some discomfort, take the prescribed pain medications.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable and ready.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an 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 over the area and biting firmly to create pressure for 30 minutes. Repeat if necessary. If the bleeding still continues, try biting down on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting the bleeding vessels. To minimize further bleeding that you may be experiencing, sit upright to keep the head elevated, and avoid exercise. If bleeding still does not subside, call our office for further instructions.

Swelling

The normal swelling that is 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 two to three days post-procedure. However, the swelling can be minimized by the immediate use of ice packs. Two plastic bags filled with ice, ice packs, or bags of frozen peas should be applied to the sides of the face where the surgery was performed. The ice packs should be left on continuously while you are awake. However, after 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm, as this is a normal reaction to surgery. Thirty-six hours following your surgery, the application of moist source of 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 three to four hours. You may also take two to four 200 mg tablets of Ibuprofen (Motrin or Advil) ever three to four hours.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes, so be sure that you no not drive an automobile or work around machinery during this time. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require our medical attention, so call the office as soon as you are able.

Diet

Only drink liquids after general anesthesia or an IV sedation. Do not use straws when drinking from a glass, as the sucking motion can cause more bleeding by dislodging the blood clot. You may eat soft items as long as you are chewing away from the surgical site(s). It’s important to drink plenty of fluids, and have a high calorie, high protein diet to maximize nutrition and prevent dehydration.  You will feel better, have more strength, less discomfort, and heal faster if you continue to eat and hydrate yourself. It’s obvious that your food intake will be limited for the first few days after surgery, but you should compensate for this by increasing your fluid intake. Drink at least five to six glasses of liquid daily, and try not to miss a single meal.

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 to two minutes before standing.

Keep The Mouth Clean

No rinsing of any kind should be performed until the day following your surgery. You can gently brush your teeth the night of surgery but be careful when rinsing, and do it very gently. The day after surgery you should begin rinsing at least five to six times a day with a cup of warm water mixed with one teaspoon of salt, especially after eating.

Discoloration

In some cases, discoloration of the skin will follow the swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading underneath the tissues. This is a normal postoperative occurrence, which may occur two to three days post-surgery. Applying moist heat to the area may speed up the removal of this 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, or call the office if you have any questions.

Nausea & Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including your prescribed medication. You should then slowly sip on Coke, tea, or ginger ale over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medication.

Other Complications

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As is stated before the 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 you need to be extra careful. Call Dr Reisman if you have any questions.
  • A slight elevation of temperature immediately following surgery is not uncommon. Tylenol or ibuprofen should be taken to reduce the fever. If the temperature persists, notify the office.
  • You should be careful going from the lying down position to standing. Taking pain medications can make you dizzy, as will not eating or drinking enough, so it wouldn’t be uncommon for you to get light headed when you suddenly stand up. To avoid dizziness,sit up for a minute or two before standing up completely.
  • 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 on their own, but if not, they can successfully be removed by Dr. Reisman.
  • 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 so then the normal act of swallowing can then become painful. This should subside within two to three 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 that will resolve with time.

Finally

Sutures are placed in 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 from your mouth and discard it. Unless otherwise discussed, dissolvable sutures have been placed and will fall out on their own.  Sutures that do not dissolve on their own will then be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is typically no discomfort associated with this procedure.

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

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

Remember that no two mouths are alike and everyone’s healing times will vary. Do not accept well-intended advice from friends. Discuss any problems you are having with the persons that are best able to effectively help you, who are Dr. Reisman or your family dentist.

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

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket and symptoms of pain at the surgical site and even pain to the ear may occur following the surgery. Typically, we can assume that a dry socket is present if increasing dosages of pain medicine do not resolve pain and discomfort to a tolerable level. Call the office if this occurs. Pain continuing for four or more days after the extraction is often associated with muscle irritation, but heat and a soft diet will help resolve this condition. Call the office if this occurs.