After Wisdom Tooth Removal

The removal of impacted wisdom teeth is a significant surgical procedure. Post-operative care is very important. Unnecessary pain and complications like infection or swelling can be minimized if these instructions are followed carefully.

Immediately Following Surgery

  • A gauze pad placed over the surgical area should be kept in place for a half hour and then changed every half hour until the bleeding has stopped flowing and is just oozing. Usually this takes two to three hours.
  • The first 24 hours after surgery do not brush your teeth, rinse, or touch the wound area. This can increase bleeding  and delay healing.
  • Take the prescribed pain medications as soon as possible.  It is better to take pain medication before you are experiencing pain. Once the level of pain becomes great, it is more difficult to bring it down to a tolerable level.
  • Restrict your activities the day of surgery and resume normal activity when your pain is controlled without prescription pain medicine and you are eating adequately.  Strenuous activity like running or weight lifting should be avoided for one week.
  • You doctor wants you to use ice packs to minimize the amount of swelling. See the information below for directions.
  • Change positions slowly immediately after surgery.  If you stand from a lying position too quickly you may become dizzy.

Bleeding

Bleeding is expected following surgery and is controlled by placing a gauze pad over the area and biting down for thirty minutes. Before inserting the gauze, put a few drops of tap water on it so it will not cling to any blood clots and pull them out. Fold the gauze into a one inch square and place it over the extraction area. Change gauze every 30 minutes and repeat until bleeding is controlled (the red on the gauze is 1/2 inch spots or less) for approximately three hours. If at any time the bleeding fills up the mouth or after three hours the gauze is completely red, please call our office immediately. If after three hours the red area is more than 1/2 inch but not completely red, bite on an unused moistened tea bag for thirty minutes two times. This should adequately slow the bleeding enough to discontinue the gauze. To minimize further bleeding, do not become excited, sit upright, or exercise for several hours after surgery.  It is normal to have slight bleeding or some blood in the saliva for a couple of days.

Swelling

Swelling is usually proportional to the amount of surgery involved. It is the body’s normal reaction to surgery and it is not uncommon to have swelling around the mouth, cheeks, eyes, and sides of the face.  Swelling becomes apparent the day following surgery and peaks around 48 hours post-operatively. You can minimize swelling by the immediate use of ice packs the first 24 hours after surgery. Store bought chilled cold packs or homemade packs made with two baggies filled with crushed ice or frozen  peas should be applied in 30 minute on/off intervals to the sides of the face along the lower jawline. Leave packs off at bedtime and continue use in the morning until 24 hours after surgery. After 24 hours, ice will not affect swelling. It is normal for swelling and jaw stiffness to persist for several days. Thirty-six hours following surgery, the application of moist heat to the sides of the face may be helpful.

Pain

For moderate to severe pain, take prescription pain medication as as soon as possible, repeating doses as prescribed.  Do not go to school or work, drive an automobile, work around machinery or drink alcoholic beverages while taking prescription pain medication.

For milder pain, one or two tablets of Acetaminophen/Tylenol may be taken every four hours as directed on package.  Do not exceed 3 grams per day of Acetaminophen/Tylenol.  If your doctor prescribed anti-inflammatory medication (Lodine/Etodolac) do not use Ibuprofen (Motrin or Advil) or Naproxen (Aleve) while taking Lodine/Etodolac.  If your doctor did not prescribe Lodine, and you have no medical reasons to not take Ibuprofen (Motrin or Advil), you may take two 200 mg tablets every 6 to 8 hours, as needed for pain. Do not exceed 3.2 grams of Ibuprofen per day.

Pain or discomfort following surgery should get better with time. It is normal to have pain for several days up to a couple weeks, but if the pain or swelling gets worse after 72 hours it may require attention and you should call our office.

Diet

After general anesthetic or I.V. sedation you could become nauseated if a regular diet is resumed too quickly. It is important for you to begin drinking clear liquids as soon as you get home. Do not use straws. The sucking action can cause bleeding or dislodge the blood clot. Once you have taken clear liquids for two hours without experiencing nausea, your diet should be advanced to things like pudding, milkshakes, smoothies, yogurt, plain ice cream, or sherbet. If you tolerate these foods without nausea for two hours you are ready to eat soft foods. You may eat any soft food by chewing away from the surgical sites. The day following surgery you may eat whatever you are comfortable eating, except hard, crunchy foods (nuts, taco chips, or granola).

During the recovery period good nutrition is very important. Nourishment and fluids should be taken regularly. It may take a few days for you to resume your normal food intake. If you cannot eat food at mealtime you should compensate by drinking nutritious drinks (protein drinks, juice, smoothies, or milkshakes). Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.

Keep the mouth clean

The day after surgery you should resume careful tooth brushing and begin rinsing with the prescription antibacterial rinse as directed. No vigorous swishing or spitting until five days post op because it can dislodge the blood clot and delay healing.

Bruising

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 after 36 hours may help discoloration to go away.

Antibiotics

If you have been placed on antibiotics, take them as directed. Call the office if you develop a rash, diarrhea, or any other concerning symptoms while on antibiotics.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery sip on clear liquids until the nausea passes. When two hours have passed without nausea you can advance your diet to pudding, milkshakes, yogurt, plain ice cream, or sherbet. As long as the nausea does not reoccur you can advance to soft foods by dinnertime. If nausea reoccurs, go back to clear liquids and try again. It’s not unusual to vomit once after anesthesia, but if you vomit a second time or nausea persists more than four hours please call our office.

Other Complications

  • If numbness of the lip, chin, or tongue lasts longer than expected there is no cause for alarm. This is usually temporary in nature. While your lip or tongue are numb be careful that you do not accendentally bite yourself. Call our office if you have any questions.
  • Slight elevation of temperature the first 72 hours following surgery is not uncommon. Call our office if your temperature is over 100 degrees or your temperature is elevated beyond 72 hours.
  • 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. Smeltzer, Dr. Masonbrink or Dr. Frey.
  • 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. Throat muscles get swollen and the normal act of swallowing can then become uncomfortable. This will subside in 2-3 days.
  • Stiffness (Trimus) 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 in time.

Finally

Sutures are often placed the area of surgery to minimize post-operative bleeding and to help healing.  The sutures will dissolve and come out on their own in a few days.

Pain and swelling will gradually subside. If your post-operative pain or swelling worsens after the first 72 hours or unusual symptoms occur call our office for instructions.

Where lower wisdom teeth were removed there will be a void until new bone fills in the area. It is important not to disturb the extraction site the first five days after surgery. Begining on day six the area should be kept clean after eating using the irrigation syringe and tap water. Do not insert the tip of the syringe in the extraction site, position it above the site and use gentle pressure  to flush out food particles.

Your case is individual, no two surgical experiences are alike. Do not accept well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Smeltzer, Dr. Masonbrink or Dr. Frey or your family dentist.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. To avoid this from happening do not smoke, drink through a straw, suck on candy, vigorously rinse, or spit for five days after surgery. Call our office if pain gets worse, is not relieved with medication, or radiates to the ear.

Regular activities like work, school, driving, and walking/light jogs may be resumed once your pain is controlled with over-the-counter pain medicine. Streneous exercise like weight lifting, running, or team sports should be delayed until one week after surgery. Until your food intake is back to normal your strength may be limited. Listen to your body: if you get light headed, stop exercising and try another time.