Wisdom Tooth Removal

After Wisdom Tooth Removal

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

Immediately After Surgery

• The gauze pad placed over the surgical area should be kept in place for a half-hour. After 30 minutes, check to see if the area is still bleeding. If it is not, the gauze pad can be removed. If bleeding persists, replace the gauze for another 30 minutes.
• Limit talking. The more you talk, the more your tongue moves and disturbs the blood clots.
• Do not vigorously rinse your mouth or touch the wound. This may cause 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 wearing off.
• Restrict your activities the day of surgery. You can resume normal activities when you feel comfortable .
• Place the ice pack on the side of your face where surgery was performed. (You can also use a zip-lock bag filled with ice and covered with a towel, towel filled with ice, or a bag of frozen peas wrapped in a towel.) We recommend intervals of 20 minutes on, then 20 minutes off, for as much as possible for the first 24 hours. Be careful not to nap with the ice left in place, and do not leave the ice in place longer than 20 minutes at a time.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon and can last for one to two days.

If bleeding is excessive, you can control it by trying any of these things:

• Place gauze over the surgical site and holding firm pressure for 30 minutes at a time. Repeat as necessary. Do not frequently change the gauze because this can dislodge the early formation of clots.
• 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 constricting bleeding vessels.
• Sit upright
• Avoid becoming excited and do not exercise.
• Do not apply ice to the face if you are having trouble controlling the bleeding. The cold temperature can decrease platelet function.

If bleeding still does not subside, call for further instructions.

Swelling

Swelling around the mouth, cheeks, eyes, and sides of the face is common. This is the body’s normal reaction to surgery and eventual repair.

The swelling will not reach its maximum until two to three days after surgery, but it can be minimized by using ice packs as soon after surgery as you can. After 24 hours, ice has no beneficial effect. (If you don’t have an ice pack, you can use a zip-lock bag filled with ice and covered with a towel, a towel filled with ice, or a bag of frozen peas wrapped in a towel.)

Place the ice pack on the side of the face where surgery was performed for 20 minutes, then remove it for 20 minutes. Continue the 20 minutes on, 20 minutes off interval for as much as you can for the first 24 hours. Do not keep the ice packs on continuously, and be careful not to nap with the ice left in place.

If swelling or jaw stiffness persists for several days, there is no cause for alarm. This is a normal reaction to surgery. After the first 24 hours, use moist heat to reduce the amount of swelling. DO NOT use heat if you are being treated for an acute infection.

Pain

For moderate pain, use over-the-counter pain relievers like Tylenol or ibuprofen.

For severe pain, take the prescribed medications as directed. The prescribed pain medicine can 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 subside over time. If pain persists, it may require attention and you should call the office.

Do not take any of these medications if you are allergic or have been instructed by your doctor not to.

Diet

On the day of surgery, drink plenty of fluids and eat soft food. Do not use straws because the sucking motion can cause more bleeding by dislodging the blood clot. Until the local anesthesia has worn off, avoid hot liquids or food.

Eat a bland diet and eat prior to taking medications to avoid nausea and vomiting.

The next day, you may eat anything soft by chewing away from the surgical sites. Be sure to drink plenty of fluids and eat regularly to help maintain your strength. Avoid nuts, seeds, popcorn, and chips for two weeks after surgery.

Oral Hygiene

Very gentle rinsing can be done later in the day of surgery. Do not brush your teeth until the following day.

Discoloration

In some cases, you may have black, blue, green, or yellow discoloration on your face. This is normal and is caused by blood spreading beneath the tissues. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics, take as directed. Antibiotics are prescribed for a purpose and should be completed. Call the office if you have an adverse reaction. It is important to discern side effects versus true allergies.

Nausea and Vomiting

If you are nauseated or vomiting after surgery, call the office. If it’s severe, we can give you a prescription. A bland diet and eating before taking medications can help prevent it.

Other Reactions

• Numbness of the lip, chin, or tongue is common and usually temporary. But because your lip or tongue is numb, you could accidentally bite it, so be careful.
• A slight elevation of temperature immediately after surgery is not uncommon and a natural inflammatory response. If the temperature persists, call the office.
• Be careful going from the lying-down position to standing because you may get dizzy. This can be caused by the pain medication, along with not eating and drinking as you usually would. Before standing, sit for one minute then get up.
• Occasionally, patients may feel hard projections in the mouth with their tongue. These are the bony walls that supported the tooth (not the roots), and they usually smooth out spontaneously.
• The corners of your mouth may dry out and crack. Keep them kept moist with an ointment like Vaseline.
• A sore throat and pain when swallowing are common. This will subside.
• Stiffness of the jaw muscles may make it hard to open your mouth for a few days after surgery. This will get better, and you will not hurt the wound by opening your mouth.

Finally

• You may begin brushing your teeth the day after surgery — just be gentle at the surgical sites.
• Sometimes sutures can become dislodged, but there is no cause for alarm. Just remove them from your mouth. Your other sutures will dissolve on their own. Removal is not required except for special circumstances. You will be notified if an appointment is needed to remove any sutures.
• Pain should subside more and more each day after surgery. If your pain worsens or unusual symptoms occur, call the office.
• There will be a hole where the tooth was removed. The hole will gradually fill in with the new tissue over the coming month. In the meantime, the area should be kept clean especially after meals with rinses or a toothbrush.
• A dry socket is when the blood clot gets dislodged from the tooth socket too soon. This can happen four to six days after surgery, and symptoms can include pain at the surgical site and even pain near the ear. Call the office if this happens.
• If you exercise regularly, be aware that your normal nourishment intake is reduced. If you feel weak or lightheaded, stop exercising.
• Your case is individual, and no two mouths are alike. Do not accept well-intended advice from friends or internet blogs. Discuss your problem with the people best able to help you — surgeon and his staff.