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 one hour by biting firmly on it. After this time, the gauze pad should be removed and discarded, if bleeding persists place another moist gauze pack and leave in place for one hour- biting firmly on it. The patient should keep head elevated during this time.
Avoid rinsing or touching the surgical site the first day after your procedure. This could increase bleeding, dislodge a blood clot and create a dry socket.
Begin your prescribed pain medications when you remove your gauze packs one-two hours after procedure.
Restrict your activities for 24 hours after surgery and resume normal activity when you feel comfortable.
Place ice packs (or ice in ziplock bags) wrapped in a towel to the cheek for 15 minutes on and 15 minutes off, alternating cheeks. On the second day after surgery use a moist warm towel compress instead.

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 can be controlled by placing a gauze pad over the area and biting firmly for one hour. Repeat if necessary. If bleeding continues, bite firmly on a moistened BLACK tea bag for ONE hour. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. Call the office if any bleeding is not able to be controlled.

Swelling

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 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 used intermittently every 15 minutes 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. On the second day after surgery the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

For moderate pain, one or two tablets of Acetaminophen (Tylenol or Extra Strength Tylenol) may be taken every 3-4 hours or two-four 200 mg tablets of Ibuprofen (Motrin or Advil) may be taken every 4-6 hours. Alternate Ibuprofen with prescribed pain med for help with swelling/pain; Alternate like this: take prescribed pain medication, next 2-3 hours take ibuprofen, next 2-3 hours take prescribed pain medication, next 2-3 hours take Ibuprofen, etc. Gradually stop taking prescribed pain medication as pain subsides, then gradually stop ibuprofen.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine 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 typically peaks on day 3 following surgery and should subside more and more every day after that. If pain persists or increases over time, it may require attention and you should call the office.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink 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 sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. At least 5-6 glasses of water should be taken daily to prevent dehydration. 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.

Keep the mouth clean

No rinsing of any kind should be performed until the day of surgery. You may begin brushing teeth on the day after surgery but remain one tooth away from surgery sites when brushing. The day after surgery you should begin rinsing at least 5-6 times a day, especially after eating, with 8 oz of warm water mixed with a 1/4 teaspoon of salt. Avoid alcohol based mouth washes until healed.

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 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

Antibiotics will be given to help prevent infection. If you have been placed on antibiotics, take the tablets or liquid as directed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and contact the office. 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. Sipping of flat classic coke, tea, or clear non-carbonated liquids is fine. When the nausea subsides you can begin taking solid foods and the prescribed medicine.

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 care should be taken when eating. If numbness persists with no improvement a week after surgery, please call the office so Dr. Hyland can evaluate the situation.
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 were not able to eat or drink prior to surgery. It was also difficult to take 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 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. Hyland.
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 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. The sutures are dissolving and will not need to be removed. If a non-dissolving suture is used you will be informed and a return appointment will be scheduled to remove sutures.

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 (hole) where the tooth was removed. Over the next few weeks to months, the cavity will gradually fill in with the new tissue and bone. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush.

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

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. Call the office if this occurs.

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.