After Wisdom Tooth Removal
After surgical extraction of wisdom teeth, post-operative care is very important. Unnecessary pain and complications from infection and swelling can be minimized if the instructions are followed carefully.
Immediately Following Surgery
- The gauze placed over the surgical area should be kept in place for a half hour with light to moderate biting pressure. After this time, the gauze should be removed and discarded or replaced with a new gauze if needed.
- 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 have your prescriptions filled.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable. Avoid exertional activity the first 5 days after surgery. 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.
- Place ice packs on the sides of your face adjacent to where surgery was performed. Refer to the section on swelling for further explanation.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or red discoloration of your saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing gauze over the area and biting firmly for 30 minutes. 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, sit upright and avoid exercise or other activity that requires exertion. 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 and eventual repair. The swelling will not reach its maximum until 2-3 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. The 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 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.
For moderate pain, take Ibuprofen, (Motrin or Advil) three-four 200 mg tablets may be taken every 6-8 hours.
For severe pain, take the tablets prescribed as directed. The prescribed pain medication will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should worsen the first few days, (along with the swelling), and then subside more and more every day. If pain persists, it may require attention and you should call the office.
After general anesthesia or I.V. sedation, start your diet with clear liquids. 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. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by drinking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. Drink at least 5-6 glasses of liquid, (preferably water) 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. Be sure to keep your mouth clean. 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 gently at least 5-6 times a day with a cup of warm water mixed with a teaspoon of salt.
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 after surgery. Moist heat applied to the area may speed up the removal of the discoloration.
If you have been placed on antibiotics, take the medication as directed. Continue to take it for the indicated length of time, even if signs and symptoms of infection are gone. Antibiotics are given 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 clear liquids. Examples of clear liquids are: ice, water, soft drinks, tea, Kool-Aid, ice popsicles, sports drinks, and Jell-O. You should sip slowly over a 15 minute period. If you are doing well with sips, try to start drinking larger amounts frequently. It is important to try to replace the fluids you have lost from vomiting. 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 stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite these areas without knowing and not feel the sensation. So be careful when chewing. Call the office if you have any questions.
- Slight elevation in temperature immediately following surgery is not uncommon. If your temperature persists, notify our office.
- You should be careful going from a lying down position to standing. You were not able to eat or drink prior to surgery and it has also been more difficult for you to take in fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute, then get up.
- Occasionally, patients may feel hard projections in their mouth with their tongue. They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out over time on their own.
- 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 around the area become swollen due to the surgery. 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 several days following surgery. This is a normal post-operative occurrence which will resolve in time. Jaw stretching exercises may also be of help.
Sutures are sometimes placed in the area of surgery to minimize post-operative bleeding and to help healing. Occasionally they become dislodged. There is no cause for alarm. Just remove the suture from your mouth and discard it.
Pain and swelling should start to go down after it peaks two or three days after surgery. If your post-operative pain or swelling worsens after 3 or 4 days or unusual symptoms occur call the office for instructions.
There will be a hole where your tooth was removed. The hole will gradually heal over in the following weeks. It will fill in with new tissue. In the mean time, the area should be kept clean with salt water rinses, especially after meals.
Brushing your teeth is okay – just be gentle around the surgical sites.
A dry socket is when the blood clot gets dislodged or prematurely lost from the tooth socket. Symptoms include increased pain at the surgical site 3-5 days following surgery. Avoid smoking, don’t use straws for a week and avoid vigorous rinsing which may dislodge the blood clot.
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.