After Wisdom Tooth Removal

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the chance of infection and excessive swelling can be minimized if instructions are followed carefully.

Immediately Following Surgery

• The gauze pad placed over the surgical area should be kept in place for one 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 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 an explanation.

Bleeding

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 folded gauze pad over the area and biting firmly for 30 minutes. The gauze should be placed to make contact with the gums at the extraction site. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 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.

Swelling

The swelling that is normally expected is often 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 two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be rotated on and off while you are awake. Ice is most effective during the first 48 hours. Swelling or jaw stiffness may persist for several days. This is a normal reaction to surgery. Elevation of the head for 2 to 5 days will help diminish swelling.

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four hours or two 200 mg tablets of ibuprofen (Motrin or Advil) may be taken every four to six hours.

For more severe pain, take the pain medication prescribed as directed. The prescribed pain medicine may make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. While taking this medication, avoid alcoholic beverages. Pain or discomfort following surgery usually peaks 2 to 3 days post-operatively and should improve more each day thereafter. If pain persists, it may require attention and you should call the office.

Diet

Drink liquids after general anesthesia or IV sedation. Do not use straws when drinking 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 site(s). High calorie, high protein intake is important for healing. Try to maintain a normal diet. You should prevent dehydration by taking fluids regularly. Your food intake may be limited for the first few days. You can compensate for this by increasing your fluid intake. At least five to six glasses of liquid should be taken daily. Try not to miss a single meal. 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 one minute before standing. Please exercise caution or have someone assist you.

Keep the Mouth Clean

No vigorous rinsing 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 five to six times a day with a cup of warm water mixed with a one-half teaspoon of salt, especially after eating.

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 usually a normal post-operative occurrence, and may occur two to three days post-operatively.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics may be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if this occurs, or if you have any questions.

Nausea & 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 apple juice, tea, or ginger ale. Sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. For persistent nausea, please call the office.

Other Complications

• Numbness of the lip, chin, or tongue may occur after surgery. Most often 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 Dr. Whelan if you have any questions.
• A slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen can be taken to reduce the fever.
• You should be careful going from the lying down position to standing. Remember, you were not able to eat or drink prior to surgery. It may also be difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit for enough time so you do not feel dizzy or faint standing up.
• Occasionally, patients may feel something hard in the mouth with their tongue. These 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. Whelan.
• Your lips should be kept moist with an ointment, such as Vaseline.
• Sore throats and pain when swallowing are not uncommon. The normal act of swallowing can become painful. This will subside in two to three 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 that will resolve in 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. Some sutures will be removed approximately one week after surgery. Others may be left to dissolve.

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 the office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue over the next few weeks. In the meantime, the area should be kept clean, especially after meals, with salt-water rinses or a toothbrush.

Your care and response to treatment is individual. No two mouths are alike. Please do not accept the well-intended advice from friends or strangers. Discuss any problems or questions with the persons best able to effectively help you: Dr. Whelan or your family dentist.

Brushing your teeth is okay just be gentle around the surgical sites.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. Please refrain from vigorous exercise for one week following surgery.