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 45 minutes to an hour. 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.
- 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 a more thorough explanation.
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. (Fold the 4″ x 4″ gauze in half, twice, so it looks like a 1″ x 4″ sleeping bag, then roll it tight like a sleeping blanket.) Repeat if necessary. If bleeding continues, bite on a moistened tea bag (not green tea) for thirty minutes. The tannic acid in the tea helps to form a clot by constricting 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.
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 may not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs or gel packs. Two baggies filled with ice (ice packs) or cold gel packs, should be applied to the sides of the face where surgery was performed. On the day of surgery, ice packs should be left on continuously while you are awake. 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 can be 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. Gel packs can be warmed in a microwave and used for heat as well. (Do not over heat, as gel packs can explode.) Continue applying heat daily, until your jaws are no longer sore.
You should begin taking pain medication before, or as soon as you feel the local anesthetic starting to wearing off. For moderate pain, healthy adults may take both Ibuprofen (Advil or Motrin) and Acetaminophen (Tylenol or APAP). Ibuprofen bought over the counter comes in 200 mg tablets: 2 tablets may be taken every every 3 hours, not to exceed 3200 mg in a 24 hour period. Acetaminophen comes in 325 mg tablets: 1 tablet may be taken every every 3 hours, not to exceed 4000 mg in a 24 hour period. You may take the two medications at the same time. Consult our practice for individuals under 18.
For severe pain, the prescribed medications should be taken as directed. Do not take any of the above medications if you are allergic to them, or have been instructed by your doctor not to take it. Do not take more than 4000 mg in a 24 hour period, of combined Acetaminophen, Tylenol, and/or APAP containing medication (often found in narcotics and many over the counter medications). 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.
After IV general anesthetic or IV conscious sedation only liquids should initially be consumed. Drink from a glass or use a spoon, and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft and cool. 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
No rinsing of any kind should be performed until the day following surgery. The day after surgery you may begin brushing and gently rinsing, especially after eating and before bedtime.
In some cases, bruising 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 this discoloration.
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.
- 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. Burchard if you have any questions.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office.
- 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 spontaneously. If not, they can be removed by Dr. Weber or Dr. Burchard.
- If the corners of your mouth are stretched, they may dry out and crack. Your lips may 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 several days following surgery. This is a normal post-operative event which should resolve in time.
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 will usually dissolve, approximately 5 to 10 days after surgery. The removal of sutures is normally not required. But if removal is needed, 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 several weeks to months. In the meantime, the area should be kept clean, especially after meals. Starting the week after surgery, an irrigation syringe may be used with tap water to gently rinse any residual food debris.
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 increased pain at the surgical site, and especially pain radiating towards the ear, may occur 3-5 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.