After Wisdom Tooth Removal

The removal of impacted teeth is a serious surgical procedure and post-operative care is very important.  Unnecessary pain as well as the complications of infection and swelling can be minimized if the instructions from the oral surgeon are followed carefully. Immediately following surgery:

• Bite on the gauze pad placed over the surgical site for an hour. After this time, the gauze pad should be removed and discarded and replaced by another gauze pad. Refer to the section on bleeding for specific details.
• Avoid vigorous mouth rinsing or touching the wound area following surgery. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
• To minimize any swelling, place ice packs to the sides of your face where surgery was performed. Refer to the section on SWELLING for explanation.
• Take the prescribed pain medications as soon as you can so it is digested before the local anesthetic has worn off. Having something of substance in the stomach to coat the stomach will help minimize nausea from the pain medications. Refer to the section on PAIN for specific details.
• Restrict your activities the day of surgery and resume normal activity when you feel comfortable. If you are active, your heart will be beating harder and you can expect excessive bleeding and throbbing from the wound.
• Do not smoke whatsoever.

Bleeding

• A certain amount of bleeding is to be expected following surgery. On the skin where the surface is dry, bleeding clots in 10 minutes. In the mouth where things are wet, it takes 6-8 hours for the clot to gel up and the bleeding to subside. Slight bleeding or oozing causing redness in the saliva is very common. For this reason, the gauze will always appear red when it is removed. Saliva washes over the blood clots and dyes the gauze red even after bleeding from the sockets has actually stopped.
• First GENTLY rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for sixty minutes, may control excessive bleeding. Repeat as 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. This can be repeated several times.
• To minimize further bleeding, sit upright, do not become excited, maintain constant pressure on the gauze (no talking or chewing) and avoid exercise.
• If bleeding does not subside after 6-8 hours, call the office for further instructions.

Swelling

• The swelling that is normally expected is usually proportional to the surgery involved. There is usually a fair amount of cheek retraction involved with the removal of impacted wisdom teeth. Therefore, you should expect swelling of the cheek after your surgery.
• 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. Sealed plastic bags filled with ice, ice packs, or a bag of frozen peas or corn wrapped in a washcloth should be applied to the side of the face where surgery was performed.
• The ice packs should be applied 20 minutes on/20 minutes off for the afternoon and evening immediately following your extraction. After 24 hours, ice has no beneficial effect.
• Thirty-six (36) hours following surgery the application of moist heat to the side of the face may help some in reducing the size of any swelling that has formed.
• If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. Soft, puffy swelling that you can indent with your finger after oral surgery is very normal.
• Bright red, rock hard, hot swelling that does not indent with finger pressure, which is getting bigger by the hour, would suggest infection. This usually would develop around day 3-4 after surgery when you would expect swelling to be going down, not up. If this should occur, please call our office.

Temperature

• It is normal to run a low-grade temperature (99-100F) for 7-10 days following oral surgery. This reflects your immune response to the normal bacteria that are present in your mouth. A high temperature (>101F) might exist for 6-8 hours after surgery but no more than that.
• 2 Tylenol or 2-3 200mg Ibuprofen (Motrin/Advil) every 4-6 hours will help to moderate a temperature.
• A temperature >101F several days after surgery, especially if accompanied by rock hard swelling and increased pain, are usually indicative of infection. You should call the office for instructions if this should occur.

Bruising

• When the bone requires smoothing to allow for the fit of the denture, there is a good chance there will be some bruising on the surface skin over the area. The most common location is over the upper eye teeth (on the cheek and below the eye).
• Bruising may not be obvious for a day or two. By the time it reaches the surface it may have already turned from purple to green to yellow in color.
• Over several days the yellow color will settle down the neck to about the nipple line on the chest before it disappears.

Pain

• Pain or discomfort following surgery is expected to last 4-5 days. For many patients, it seems the third and fourth day may require more pain medicine than the first and second day. Following the fourth day pain should subside more and more every day.
• Many medications for pain can cause nausea or vomiting. It is wise to have something of substance in the stomach (yogurt, ice cream, pudding or apple sauce) before taking prescription pain medicines and/or over the counter pain medicines (especially aspirin or ibuprofen). Even coating the stomach with Pepto Bismol or Milk of Magnesia can help prevent or moderate nausea.
• For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen (Motrin or Advil) two-three 200 mg tablets may be taken every 4-6 hours.
• For severe pain take the tablets prescribed for pain as directed every 4 hours in addition to the Tylenol or Ibuprofen. The prescribed pain medicine will make you groggy and will slow down your reflexes.If prescription pain medications are required beyond 4 days, further treatment may be indicated. Please call the office and discuss your situation with us.
  • Do not drive an automobile or work around or operate heavy machinery if you are taking prescription pain medicine.
  • Alcohol and prescription pain medicines do not mix!

Antibiotics

• Antibiotics are NOT given as a routine procedure after oral surgery. The over use of antibiotics leading to the development of resistant bacteria is well documented so careful consideration is given to each circumstance when deciding whether antibiotics are necessary. In specific circumstances, antibiotics will be given to help prevent infection or treat an existing infection.
• If you have been placed on antibiotics take the tablets or liquid as directed. You should take them on schedule until they are completely gone.
• Discontinue antibiotic use in the event of a rash or other unfavorable reaction. You should call the office  to report any such finding or if you have any questions.

Diet

• Drink plenty of fluids. Try to drink 5-6 eight-ounce glasses the first day.
• Drink from a glass or cup and don’t use a straw. The sucking motion will suck out the healing blood clot and start the bleeding again.
• Avoid hot liquids or food while you are numb so you don’t burn yourself.
• Soft food and liquids can be eaten on the day of surgery. The act of chewing doesn’t damage anything, but you should avoid chewing sharp or hard objects at the surgical site for several days.
• Return to a normal diet as soon as possible unless otherwise directed. You will find eating multiple small meals is easier than three regular meals for the first few days.
• You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
• If you suddenly sit up or stand from a lying position you may become dizzy. Therefore, immediately following surgery, if you are lying down, make sure you sit for one minute before standing.

Oral Hygiene

• Good oral hygiene is essential to proper healing of any oral surgery site.
• You can brush your teeth the night of surgery but rinse very gently. Vigorous rinsing should be avoided until the day following surgery.
• The day after surgery you should begin rinsing at least 5-6 times a day especially after eating. Salt water (cup of warm water mixed with a teaspoon of salt) is ideal but plain water is also OK.
• Mouthwash has an alcohol base to it so it may be pretty “zingy” when it comes in contact with fresh oral wounds. After a few days, dilute the mouthwash in half with tap water and rinse out your mouth. This will make it taste and smell better. You can gradually build up to full strength mouthwash, as you feel more comfortable.

Smoking

• No smoking for 48 hours after surgery. Smoking retards healing dramatically. Nicotine constricts blood vessels, which slows the formation and expansion of the healing blood clot in the socket. This leads to the painful complication called a “Dry Socket”.
• After 48 hours, if you feel you need so much as one Tylenol or aspirin to control pain, you should avoid any smoking of any kind. This usually reflects that the clot has not grown enough to cover all the exposed bone in the socket. The exposed bone is filled with raw nerve endings. Until the nerve endings are covered with a healthy blood clot, they will cause pain. Smoking will just slow this process significantly and make the pain even worse.
• Therefore, if there is any question about smoking…DON’T DO IT.

Activity

• You should keep physical activities to a minimum for 6-12 hours following surgery.
• If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising.
• Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.

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. Avoid milk products. You should sip slowly over a fifteen-minute period.
• Before you resume taking any medicine always try to coat the stomach with something of substance.
• Coating the stomach with Pepto Bismol or Milk of Magnesia may help get the nausea to subside.
• If nausea and/or vomiting persist after 12 hours, please call the office so we can help resolve the problem.

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 it so be careful.
• 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 (the walls of the tooth socket). These projections usually smooth out spontaneously. You may not notice this for days to weeks after surgery. If the rough edges bother your tongue or cheeks, call the office so we can evaluate the area and smooth them down for you.
• 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 (Trimus) of the jaw muscles may cause difficulty in opening your mouth for 7-10 days following surgery. This is a normal post-operative event, which will resolve in time. The muscles that operate the jaw are not used to holding open for prolonged times (like gardening for the first time in the spring). The physical therapy of eating, talking, yawning and chewing help the stiffness to resolve.