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

The gauze pad placed over the surgical area should be kept in place for a half 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.
Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
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 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 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. If you feel bleeding is severe and uncontrollable, at any time, despite biting pressure, then call the office for further instructions immediately. Many times wet gauze soaks up the blood clot, becomes saturated with blood and saliva mix and the overflow can be misinterpreted as bleeding, when no bleeding is actually present. Remove the gauze, dry the area and then look in the mouth with a flashlight. If you see blood streaming out from the tooth socket, then there is actual bleeding or oozing. If not, there is no cause for worry. If you still cannot tell, then by all means call the 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. Usually 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 applied 20 minutes on and 10 minutes off for first 24 hrs only. Warm moist heat packs begin the next day. After 24 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. Twenty-four hours following surgery, the application of moist heat to the sides of the face is beneficial in promoting healing and reducing stiffness. If the swelling is exceptionally firm, does not dissipate and is accompanied by limited opening and pain, this could indicate infection, and you should call our office for further direction.

Pain

For mild to moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol or over the counter Ibuprofen, (Motrin or Advil) may be taken with food every four to six hours. You can begin taking pain medication as soon as you feel the local anesthetic wearing off. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 4-6 hours as needed for pain. Medication for severe pain if prescribed for you, should be taken as directed. Avoid any medication that causes allergic reactions or if there is a medical reason not to take the drug . Always check the instructions on your pill bottle or pill pack and read the accompanying literature.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine may make you groggy and will slow down your reflexes. If you are placed on narcotic medications, do not drive an automobile or work around machinery and 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. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws., sports bottles or soda bottles. No spitting allowed. Drink from a glass. The sucking motion 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 post operative 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 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. If you have questions, call.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. The day after surgery you should begin rinsing gently at least 5-6 times a day especially after eating with a cup of warm water mixed with half a teaspoon of salt. Rinsing should be done particularly after eating and before bedtime.

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 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 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, tea 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. if nausea does not improve, call the office, preferably before 3pm.

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 be careful. Call your surgeon 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 get up slowly. If you have a problem lie down. If this doesn’t resolve, call.
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 spontaneously. If not, they can be removed by your surgeon.
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 should 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 should resolve in time. Application of moist heat may help.
If any symptom does not improve within a reasonable amount of time, call the office for advice.

Finally

Sutures may be 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 form your mouth and discard it. Most sutures will dissolve in less than a week, if not, and they are causing you a problem, please call the office. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.

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 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, the area should be kept clean especially after meals with salt water rinses, a toothbrush and an irrigating syringe.

Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Malloy and Dr. Alabakoff or your referring dentist.

The first day light brushing is recommended, being careful to avoid the blood clot at the surgical site. Gentle rinsing should start the day after the surgical procedure. The irrigating syringe should be started two days following the extractions. Be careful to irrigate gently over the next three days to protect the blood clot. After this, you may gradually increase the force of irrigation. Continue irrigating until the socket is closed. The tip of the syringe must enter the socket or incision site slightly to be effective. If food or debris enters the site, it could delay healing, cause increased discomfort or cause infection to occur.

A dry socket occurs when the blood clot breaks down or gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. 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, stop exercising. It is usually prudent to postpone strenuous exercise for a few days until you are feeling 100% recovered.