Care After Wisdom Tooth Removal
The removal of impacted teeth can be 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 your prescribed pain medications as soon as you get home and before your local anesthetic wears off. Generally, we recommend beginning with ibuprofen and continue this medication as directed for the first 24 hours.
- 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.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon for 24 hours or more. 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 for 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, inflammation, 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. 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 left on 20 min’s then off 20 min’s for the first 12 – 24 hours. After 36 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. 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.
You should begin taking pain medication as soon as you get home, before your local anesthetic wears off. For moderate pain, 1 or 2 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 – 4 tablets (400 – 800 mgs) may be taken every 6 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.
After general anesthesia or I.V. sedation, liquids should be initially taken. Do not use straws for the first 24 hours. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Please refer to the section on suggested diet instructions at the end of this section. 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 several moments before standing.
No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with warm water mixed with salt (1/2 tsp salt mixed in 8 oz’s of warm water).
REMEMBER: A clean wound heals better and faster.
Wearing your Prosthesis or Night Guard or Retainer
Partial dentures or full dentures should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise. Please contact the office if there is any question. When it is placed it should not heavily touch the gums in the area of the surgery. If it does, this can cause ulceration of the wound edges and breakdown of the suture margins. This can lead to loss of the graft. If you have questions about the fit of your partial or complete denture, do not wear it until your general dentist or Drs. Elias, Stephens or Verratti can see you.
Discoloration & Bruising
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 rare but 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 prescribed 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 clears liquids such as flavored waters, tea, or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking soft foods and the prescribed medicine. If your nausea continues for more than 6 hours, please contact Drs. Elias, Stephens or Verratti.
- 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 Drs. Elias, Stephens or Verratti if you have any questions.
- Slight elevation of temperature immediately following surgery is not uncommon. If your fever persists, notify our 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 after surgery. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for a few moments then get up.
- Occasionally, patients may feel hard projections in the mouth with their tongue. These projections are frequently bony projections now noticed after removal of the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Drs. Elias, Stephens or Verratti.
- 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 or other lip balms.
- Sore throats and pain when swallowing are not uncommon. The muscles adjacent to the surgical sites can become inflamed and subsequently give some discomfort during swallowing. This will subside in 2-3 days.
- Stiffness (trimus) of the jaw muscles may cause some difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event, which will resolve typically in several days.
Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. These sutures are frequently dissolving sutures, which will typically fall out in 5 – 7 days. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. So it’s really nothing to worry about.
A dry socket is when the blood clot becomes dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur typically 2-3 days following surgery. Call the office if your surgical pain significantly increases during this time. This condition can easily be treated with medicated packs.
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 or reduce your exertion. Do not assume up-side-down positions for 1 – 2 weeks.
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 cavity where the tooth was removed. The cavity will gradually close over the next month fill in with the new hard and soft tissue. In the mean time, the area should be kept clean especially after meals with saltwater rinses or a toothbrush.
Remember, your case is individual and no two mouths are alike. Try not to accept well-intended advice from friends. Discuss your problem with the person best able to effectively help you, Drs. Elias, Stephens or Verratti.