After Wisdom Tooth Removal

The removal of impacted 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 1-2 hours. After this time, the gauze pad should be replaced every 1-2 hours with the extra gauze given.  The gauze should be used until the bleeding has slowed or stopped.  Each time a new piece of gauze is placed you should get it moist with water so it does not stick to the tissues.  Do not sleep with gauze in your mouth. 
  • 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.
  • Take the prescribed pain medications as directed.
  • Restrict your activities for the first 4-5 days after surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed for the first 24-48 hours. Refer to the section on swelling for a more thorough explanation.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Direct pressure by biting on a gauze pad will decrease the bleeding.  Extra gauze will be given to you after surgery to take home to switch out every 1-2 hours until the bleeding stops. The gauze should be moist with water when placed in your mouth to avoid sticking to the tissues.  If bleeding continues, bite on a moistened black tea bag for thirty minutes. 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 is uncontrollable and is not slowing down after 24 hours please call 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 3-4 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Ice packs should be applied to the sides of the face where surgery was performed for the first 24-48 hours. The ice packs should be left on continuously 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. 48 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

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. 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.

Pain

You should begin taking pain medication prior to feeling the local anesthetic wearing off. Most patients will receive percocet or vicodin for severe pain control, as well as ibuprofen to keep inflammation down.  We recommend that when you get home, get a little food in your stomach and take one tablet of the narcotic medicine.  Three hours later you may take the ibuprofen.  Three hours after that you may take another narcotic tablet.  Alternating like this throughout the first day after surgery every three hours will provided the most optimal pain control and keep you comfortable.  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.

Keep the mouth clean

Good oral hygiene is essential to good healing. The day after surgery, use the prescribed Peridex Oral Rinse 2-3 times daily.  You should also be rinsing with warm salt water rinses (one teaspoon of salt in a cup of warm water) 2-3 times a day.  All rinsing should be performed gently and without spitting.  Once you are through rinsing you should lean forward over the sink and let the liquid fall out from your mouth without spitting. Be sure to rinse for at least 30 seconds. Brush your teeth and be careful as you approach the extraction sites so you don’t disrupt the tissue healing.  Be gentle initially while brushing around the surgical areas.

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.  Discolored lines may appear at the corner of the mouth after surgery which typically resolve within 1 week. 

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given if active infection is occurring. 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.  Contact the office if it does not resolve.

Other Complications

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. You will be numb for the first 4-6 hours after surgery from the local anesthetic.  As reviewed in your consultation numbness 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. Breese or Dr. Tracy 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 roots; they are the bony walls which supported the tooth. These projections usually smooth out over time as the bone remodels. If not, they can be removed.
  • 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 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. The sutures are dis-solvable and should fall out within a few days to a week.  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.

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

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 near the ear may occur 3-5 days following surgery. Call the office if this occurs.

If you are involved in regular exercise you should stop for seven days following surgery.  Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.