After Wisdom Tooth Removal

Home Instructions After Wisdom Teeth Extraction

The removal of impacted wisdom teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling 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 for 35-45 minutes. After this time, the gauze pad should be removed and discarded.
  • 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. Rinsing in general should be started the day following surgery.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for a more thorough explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. This may even continue for 3-4 days. Excessive bleeding (your mouth fills rapidly with blood) 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 to an hour. Repeat if necessary. If bleeding continues, bite on a moistened black tea bag for thirty minutes to an hour. The tannic acid in the black tea 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 our office 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 used in the following manner: 20 minutes on and 5 minutes off while you are awake. After 48 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. 72 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

You should begin taking pain medication as soon as you can before the local anesthetic wears off.  Light liquid foods such as apple sauce can be used to coat the stomach. For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every 4-6 hours. If possible Ibuprofen (Advil or Motrin) is preferred and 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 or every 6-8 hours not to exceed 3200mg daily for an adult. Consult our practice for individuals under 18. 

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.

Diet

After general anesthetic or IV sedation only liquids should initially be consumed. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot which can lead to increase pain.

Avoid hot liquids, hot food or spicy foods. Soft food and liquids should be eaten on the day of surgery and for a week after on average. Return to a normal diet after a week unless otherwise directed.

You may eat anything soft by chewing away from the surgical sites. A high calorie, high protein intake is very important. Our staff can provide suggested diet instructions. 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 any 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 up for one minute before standing.

Keep the mouth clean

Good oral hygiene is essential to good healing. The usual oral rinse that will be recommended is a warm salt water rinse that is started the day after surgery and should be used after meals about 3 times a day. This solution is obtained by mixing 1/3 – 1/2 teaspoon of salt and 1 – 1  1/2 cups of water. There will be a void where the tooth was removed. The void will fill in with new tissue gradually over the next month. We often give a rinsing syringe that you fill with salt water to flush these voids or holes out. This prevents infection and also promotes healing. A special oral rinse called Peridex may be prescribed and should be used twice daily after salt water rinsing. Be sure to rinse for at least 30 seconds then spit it out gently.  Brush your teeth the day following surgery making sure to stay away from the surgical sites.  Be gentle initially while brushing the surgical areas. A soft bristle brush if recommended

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 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 the prescribed medicine.

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. Johnson 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 projections in the mouth with their tongue. They are not usually roots; they are the bony walls which supported the tooth which can sometimes shatter and break off. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Johnson.
  • 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. The application of moist heat to the sides of the face is helpful.

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 with gentle pressure and discard it. If it is not loosened or is stuck then leave it alone. If they become a source of irritation or painful please let the office know. The sutures will 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 usually no discomfort associated with this procedure.

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 our office for instructions.

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. We often give a rinsing syringe that you fill with salt water to flush these voids or holes out. This prevents infection and also promotes healing.

Your case is unique, no two mouths are alike. Discuss any problems with the trained experts best able to effectively help you: Dr. Johnson or your family dentist.

Brushing your teeth is okay – just be gentle at the surgical sites and use a soft bristle tooth brush.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. These symptoms of pain may be different from the usual post surgical discomfort and may be accompanied by headaches, ear aches, a bad smell and pain radiating to the front of the mouth or jaw. These symptoms  may occur 3-4 days following surgery. Call the office if this occurs and we can instruct you on what to do next.

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. Limited daily activity is usually recommended for one week.