After Wisdom Teeth Removal
The removal of impacted wisdom teeth is a surgical procedure, and 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 at least a half hour. After this time, the gauze pad may be removed and discarded. If some bleeding is still noted, you should replace this with a fresh gauze pad and continue to bite down on it until bleeding stops.
- 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. It is reasonable to begin taking pain medication while the effects of the local anesthetic (numbing medicine) are still present. This can help to minimize the onset of post-operative pain when the effects of the local anesthesia eventually wear off. Be cautious of taking your prescribed pain medicine on a completely empty stomach, as this may have a tendency to produce nausea in some individuals.
- 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.
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 thirty minutes. Repeat if necessary. If bleeding continues, 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, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call the office and an on-call surgeon can provide further instructions.
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 the start of the healing response. The swelling often will not become apparent until the day following surgery, and will not reach its peak 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 may be left on continuously while you are awake, or you can alternate 30 minutes on/30 minutes off. After 24 hours, ice has no significant effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. 48 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling and helping with stiffness.
Typically, you will be given a prescription for pain medication at your consultation, or it may be called in to the pharmacy prior to your surgery. Take this as directed for post-operative pain. Many times these medications contain Tylenol (Acetaminophen) and so caution should be used before taking any additional Tylenol while you are taking the prescribed medication. It is often advisable to take some pain medication prior to the local anesthesia wearing off to avoid sudden discomfort when its action is no longer present. Generally, over-the-counter Ibuprofen (Advil or Motrin) may be taken in conjunction with your prescribed pain medication. Do not take any of the above medications if you are allergic, or have been instructed by your doctor not to take them.
After general anesthetic or IV sedation, liquids should be initially taken. Do not use straws, since the sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing on the teeth in front of 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 meals. 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 a minute before standing.
Keep the mouth clean
No vigorous rinsing of any kind should be performed on the day of surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing gently at least 3-4 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.
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 occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics are given to treat or help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions or concerns regarding prescribed medication use.
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 clear liquids as tolerated. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. If nausea persists contact the office and nausea medicine can be prescribed.
- If numbness of the lip, chin, or tongue occurs there is no immediate cause for alarm. The effects of local anesthesia may be present for up to 12 hours after surgery in some cases. As stated before surgery, this is usually temporary in nature. You should be aware that while areas such as the lip or tongue are numb, you could inadvertently bite them. So be cautious in the early period after surgery when eating, drinking, etc. If numbness is still present the day after surgery, contact the office and your surgeon will provide further instructions. Sometimes steroid medications may be used to minimize or limit the severity of the numbness.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. 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 may be mildly dehydrated. 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 get up.
- Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the borders of the bony socket which supported the tooth. These projections are usually less noticeable a few days after surgery.
- 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 normal act of swallowing may also be painful. This will typically subside in 2-3 days.
- Stiffness 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.
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 from your mouth and discard it. The sutures will fall out on their own approximately 4-7 days after 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 may be a hole in the gums where the tooth was removed. This hole will diminish gradually over the next month as it fills in with the new tissue. In the meantime, the area should be kept clean especially after meals with salt water rinses or a toothbrush. 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 even pain to the ear may occur 3-4 days following surgery. Call the office if this occurs, and we will be happy to see you for an early follow-up.