After Wisdom Tooth Removal
Home Instructions After Wisdom Teeth Extraction
The removal of impacted wisdom teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.
Immediately Following Surgery
- The goal is to have a blood clot form within the surgery site. We use 4 x 4 gauze pads. One is folded and placed over the surgical site. These are held in place with pressure from biting and holding the jaws closed. The gauze pads should be kept in place for half hour periods of time. After each 30 minute time period, the gauze pads should be removed, discarded, and replaced as needed. Also, saliva will soak into the gauze which will make it less effective. It may take a few hours for the bleeding to stop and a clot to form.
- Vigorous mouth rinsing and/or touching the wound area should be avoided. This may initiate bleeding by causing the blood clot that has formed within the surgery site to become dislodged.
- Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
- Restrict your activities the day of surgery and gradually resume normal activity when you feel comfortable and as tolerated.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for a more thorough explanation.
- You should be careful going from the lying down position to standing. You could get light headed from low blood pressure, low blood sugar, or the medications. Before standing up, you should sit for one minute before getting up.
- A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon.
- Excessive bleeding or restarting of bleeding may be controlled by taking a piece of gauze and wiping any old loose clots from your mouth or that might be on the gum tissue near the surgery site. Then place a folded 4 x 4 gauze pad over the surgical area and bite firmly for thirty minutes. Repeat if necessary.
- Another suggestion is to bite on a moistened green or black tea bag for thirty minutes. The tannins in the black tea can help to form a clot.
- To minimize further bleeding, do not become excited or active. If bleeding does not subside, call our office or the on-call doctor.
- Do not smoke, drink through a straw, or spit for 24 hours after surgery. All of these actions cause a vacuum or suction to occur, which may dislodge the clot.
- The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, lower 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 after your procedure.
- Swelling will occur, but may be minimized by the immediate use of an ice pack starting as soon as you arrive home from the procedure. You can use either a baggy filled with ice that is covered with a damp washcloth, or a standard old-fashioned ice bag that may be purchased at a drugstore. This should be applied to the region of the face where surgery was performed. The ice pack 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 as well as creating a feeling of comfort.
For mild to moderate pain,
- One or two tablets of Tylenol or Extra Strength Tylenol may be taken every 3-4 hours, not to exceed 3,000mg (reduced from the previous recommendation of 4,000mg maximum).
- Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3,200mg daily for an adult. Consult our practice for individuals under 18.
For severe pain,
- The prescribed narcotic medication should be taken as directed.
- Do not take additional Tylenol with this prescribed narcotic medication. This medication already contains Tylenol.
- If you are able to take Ibuprofen (Advil or Motrin), this may be used along with the prescribed narcotic medication. A suggestion is to stagger these medications at 2-3 hour intervals.
- There are many instances where a narcotic medication is not indicated or needed, and will not be prescribed.
- Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. Discontinue use in the event of a rash or any other unfavorable reaction and contact our office or the on-call doctor immediately.
- Do not drive an automobile or work around machinery. Some pain medications can cause drowsiness/sedation and impair judgment.
- Avoid alcoholic beverages.
- Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office or the doctor on call.
- After IV anesthesia, only liquids should initially be consumed. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot.
- Always remove the gauze packs when eating or drinking.
- You may eat anything soft. Chew away from the surgical sites. This food may be warm, cool, or cold. A high calorie, high protein intake is very important. General suggestions may include items such as soups, stews, meatloaf, chicken pot pie, shepherds pie, lasagna, scrambled eggs with hash browns or grits. Nourishment should be consumed regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss any meals. 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 up for one minute before standing.
Keep the mouth clean
- No rinsing of any kind should be performed until the day following surgery.
- The day after surgery you should begin gently rinsing at least 5-6 times a day, especially after eating, with a teaspoon of salt mixed into one cup of warm water.
- Brush your teeth, but avoid teeth adjacent to the surgical site until healing has progressed.
- 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.
- If you have been placed on antibiotics, take the tablets, capsules, or liquid as directed. Antibiotics will be given to help prevent infection.
- Birth control pills may not be effective while taking antibiotics. This includes the entire cycle.
- There are many instances where an antibiotic is not indicated or needed, and will not be prescribed.
- Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office or the on-call doctor immediately.
- Some types of antibiotics can cause significant gastrointestinal upset or even severe, cramping diarrhea. If this does occur please call our office or your medical doctor.
- Call the office if you have any questions.
Steroid Dose Pack
- A steroid dose pack may be prescribed. The goal is to help reduce the amount of post op swelling.
- There are many instances where this is not indicated or needed, and will not be prescribed.
- This type of dose pack can be compared to those used for bee stings or allergic reactions. This is not the type of anabolic steroid used by “body builders”.
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 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 prescribed medicine.
- If the nausea and/or vomiting continues, please call our office or the on-call doctor.
- If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, 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. Please contact us if you have any questions.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office or the on-call doctor. Tylenol or ibuprofen should be taken to reduce the fever.
- Occasionally, patients may feel sharp slivers or hard projections at the surgical sites with their tongue. These are not roots; they are the pieces of bone or bony walls which supported the tooth. These usually dislodge or smooth out spontaneously. If not, they can be removed by us during an office visit.
- 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 or chapstick.
- Having what feels like a sore throat and pain when swallowing is not uncommon. The muscles in this area can become inflammed. The normal act of swallowing can then become painful. This will subside in 2-3 days.
- Stiffness (Trismus) 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.
For your information
- Sutures are placed in the area of surgery to stablize the soft tissues, minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. Any remaining sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is usually no discomfort associated with this procedure.
- The pain and swelling should trend down and subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call our office for instructions.
- After the post op suture removal appointment, you will often be given an irrigating syringe to clean and flush debris from the LOWER SOCKETS. Do NOT flush the upper jaw sockets. There will be a void or socket where the tooth was removed. The void will gradually fill in from the bottom and sides with new tissue during the next 1-2 months. In the meantime, the area should be kept clean by irrigating it with warm salt water several times a day.
- A “dry socket” or localized alveolar osteitis is when the blood clot gets dislodged from the socket and is lost prematurely. Symptoms of pain at the surgical site and even pain near the ear may occur 3-5 days following surgery. Call the office if this occurs.
- If you are involved in regular exercise, be aware that your normal nourishment intake will probably be reduced. Exercise may weaken you. If you get light headed, stop exercising.