After Wisdom Tooth Removal

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

Immediately Following Surgery

The gauze pad placed over the surgical area should be kept in place for 15 minutes. After this time, the gauze pad should be removed, discarded, and not replaced.
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 medication for discomfort (Ibuprofen) before the local anesthetic effect is gone. You must eat first before taking medication for discomfort. Our patients typically do not take the prescription medication
Restrict your activities somewhat the day of surgery. Laying down and sleeping are not recommended or helpful to healing. Resume normal activity the next day.
Place ice packs to the face in front of the ear where surgery was performed. Ice is used for the first12-18 hours. The more hours of ice the first day the better you will do.
Wide opening and chewing normal food are beneficial to healing after this surgery. A soft diet usually results in more discomfort and swelling.

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 gauze pad over the area and biting firmly for nine minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for nine minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. Direct pressure specifically placed only at the bleeding site for nine minutes is the treatment for bleeding. If bleeding does not subside, call for further instructions.

Swelling

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 will not reach its maximum until 48 hours post-operatively. However, the swelling may be minimized by the use of ice packs for the first 12 – 18 hours. The use of ice is preventative. The more hours of ice the first day the better you will do. Two baggies filled with ice, or ice packs should be applied to the face in front of the ear where surgery was performed. The ice packs should be left on as much as possible immediately after surgery. After 12 – 18 hours, ice has no beneficial effect. Thirty-six hours following surgery, the use of hot salt water soaks in the mouth is helpful in decreasing the stiffness and swelling.

Pain

You must eat first every time before taking any medication for discomfort. You should begin taking medication for discomfort before the local anesthetic wears off. Ibuprofen (Advil or Motrin) bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. As an alternative,1 or 2 Extra Strength Tylenol may be taken every 3-4 hours.You may drive when taking these medications.

For severe pain, the prescribed medication may be taken as directed, but these medications commonly cause nausea and vomiting and are very rarely taken by our patients. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it. You must not drive within 6 hours of taking the prescription medication.

Pain or discomfort following surgery should peak at about 36 hours then subside more and more every day. If pain persists, or worsens on day 3, 4, or 5 it may require attention and you should call the office.

Diet

After surgery soft foods should be eaten immediately while the site still has the local anesthetic effect.After the first soft meal, you may eat anything you desire. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment should be taken frequently. When drinking, drink from a glass, do not use straws. The sucking motion can cause more bleeding .You should prevent dehydration by taking fluids regularly. At least 5-6 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. Foods that require wide opening and normal chewing are beneficial to healing. Maintaining a soft diet after the initial meal is not recommended, and leads to more discomfort and swelling.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery just avoid the sites, and rinse gently. Two days after surgery you may begin hot salt water soaks in your mouth if you find it helpful.

Discoloration

Though uncommon, discoloration of the skin in isolated areas is seen at times. The development of 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 the discoloration.

Antibiotics

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 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 medications. 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 ibuprofen. One of the most common causes of nausea after surgery is using the prescription pain medication.

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 the sensation. So be careful. Call Dr. Langston if you have any questions.
Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
You should be careful going from the lying down position to standing. 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 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. Langston.
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 occur occasionally. 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 a few days following surgery. This is a normal post-operative event which will resolve in time.

Finally

Sutures are placed 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 form your mouth and discard it. Healing is generally unaffected.

The pain and swelling should peak at about 36 hours then subside some 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 hole where the tooth was removed. The site heals from the bottom out gradually over time. Before long the surgery site will be smooth and flat. Meanwhile, the area should be kept clean especially after meals with salt water rinses or a toothbrush.

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. It is not an infection, and you will not notice anything except worsening pain on day 3, 4, or 5. Call the office for symptoms of pain and throbbing at the surgical site, teeth in front of the site, and into the ear worsening on day 3, 4, or 5.

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.