After Wisdom Tooth Removal

Home Instructions After Wisdom Tooth 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 gauze pad placed over the surgical area should be kept in place for thirty (30) to sixty (60) minutes. After this time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing and/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 the prescribed pain medications before the numbness wears off. This will allow the medication to work more effectively.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for a more thorough explanation.
  • DO NOT SMOKE for at least three (3) days, since it is very detrimental to healing and can contribute to the development of a “dry socket”.

Bleeding

A certain amount of bleeding is to be expected for a day or two (2) 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 thirty (30) to sixty (60) minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty (30) to sixty (60) minutes. The tannic acid in the tea helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited or sit upright, and avoid exercise. If bleeding does not subside, call our office 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 may 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.

Two (2) baggies filled with ice then wrapped with a towel, or ice packs, should be applied to the sides of the face where surgery was performed. For the first twenty-four (24) hours, ice packs should be utilized every 20 minutes (20 minutes on, 20 minutes off) while you are awake. After thirty-six (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 (36) hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. Taking two (2) to three (3) 200mg tablets of Ibuprofen every four (4) hours may also help reduce the swelling the in first two (2) to three (3) days. 

Diet

Good nutrition is extremely important for healing. Start off with clear liquids after general anesthesia or IV sedation. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. Once you are able, you may eat anything soft by chewing away from the surgical site(s). You may want to confine the first day’s intake to bland liquids or pureed foods (soups, puddings, yogurt, milk shakes, etc.). Avoid foods like nuts, sunflower seeds, popcorn, etc, which may become lodged in the surgical site(s). You should prevent dehydration by taking fluids regularly. At least 5-6 glasses of liquid should be taken daily. You will feel better, have more strength, less discomfort and heal faster if you continue to eat and drink.

Pain

Unfortunately, most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first dose before the anesthesia has worn off, you will be able to manage any discomfort better. Effects of pain medicines vary widely among individuals. For moderate discomfort, one (1) or two (2) Tylenol or one (1) Extra Strength Tylenol may be taken every 3-4 hours, unless you are on Coumadin/warfarin. Ibuprofen bought over the counter comes in 200mg tablets. Two (2) to three (3) 200mg tablets (400 – 600mg total) of Ibuprofen may be taken every four (4) hours as needed for discomfort.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. If you do not achieve adequate relief from your prescription, you may supplement your prescription with two (2) to three (3) 200mg tablets of Ibuprofen every four (4) hours, if you are NOT also on Coumadin/warfarin. Some people may even require two (2) of the prescription tablets at a time during the early stages, but that may add to the risk of upset stomach. The more severe discomfort is usually expierience withing the first three (3) days after the surgery. Pain or discomfort following surgery usually subsides more and more each day after that, and your need for medicine should lessen as well. Sometimes, the pain increases as the swelling increases over the next two (2) to three (3) days. If significant pain persists for more than three days, it may require attention and you should call the office.

Oral Hygiene

Mouth cleanliness is essential to good healing. No vigorous rinsing of any kind should be performed the day of surgery. The day after surgery, you should begin rinsing after meals and additionally, for a total of at least 4-6 times a day, with an 8oz glass of warm water mixed with one-half teaspoon of salt. Continue this procedure until the gums fill in over the surgical site(s).

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 may be given to help prevent or treat an 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 any other unfavorable reaction Antibiotics make birth control pills ineffective. Women who take birth control pills should use another form of contraception for on complete cycle after the course of antibiotics has been used. Call the office if you have any questions.

Nausea and Vomiting

Nausea may occur after surgery, and is sometimes caused by stronger pain medications. Nausea may be reduced by preceding each tablet with a small amount of food, then taking the tablet with a large volume of water. 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 tea, or ginger ale (after stirring out the carbonation). You should sip slowly over a fifteen-minute period. If you are not on Coumadin/warfarin, you may also try Alka-Seltzer or Pepto Bismol. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. If nausea persists for more than four hours, call the office.

Sutures

Sutures may be placed in 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 from your mouth and discard it. In most cases, sutures will dissolve unnoticed within a week. Occasionally, sutures require removal after one week. The removal of sutures is a quick procedure that requires no anesthesia or needles and is usually associated with minimal to no discomfort.

Activity

Keep physical activities to a minimum immediately following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake may be reduced. Exercise may waken you. If you get light-headed, stop exercising.

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, It is important to be especially careful when eating because you could bite it and not feel the sensation. Call the office if you have any questions, or if the numbness persists for more than a week.
  • A 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. If a temperature of 101 degrees Fahrenheit persists for longer than a day after surgery, notify the office.
  • You should be careful going from the lying down position to standing. Since you may not have been able to eat or drink prior to surgery, your body may be low on fluid. Because of this, you could get light-headed if you stand up suddenly. Taking pain medications can also make you dizzy. Before standing up, you should sit for one minute and get up slowly.
  • Occasionally, patients may feel hard projections or sharp edges in their mouth with their tongue. They are most likely the bony walls which previously supported the tooth, not roots. These projections usually smooth out spontaneously in a few weeks. If not, they can be removed by Dr. Burns.
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with lip balm or an ointment such as Vaseline.
  • A sore throat and discomfort when swallowing are not uncommon. The muscles of the throat may become swollen, and the normal act of swallowing can then become painful. This should subside in 3-4 days.
  • Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for several days following surgery. This is a normal post-operative event which will resolve in time. Chewing solid food, gentle jaw-opening exercise or chewing gum will help relieve the stiffness.

Finally

The pain and swelling should subside more and more each day following the third day after surgery. If your post-operative discomfort or swelling worsens or unusual symptoms occur, call our office for instructions.

There will be a hole or socket where the tooth was removed. The void will gradually fill in with new tissue over the 2-3 months. In the meantime, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.

Occasionally, small slivers of bone may work themselves to the surface of the gums during the first week or two (2) after surgery, or even up to three (3) months afterward. They are not pieces of tooth, and they usually work themselves out. Gently massaging the gums in the area can help with this process. If the pieces do not come out on their own after a week, or if you experience significant discomfort in the area, please call during office hours for assistance.

Your case is unique. No two mouths are alike. Discuss any problems with the people best able to effectively help you: Dr. Burns or your general dentist.

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. Symptoms of pain at the surgical site and even pain near the ear may occur 2-3 days following surgery. Call the office if this occurs.

It is our desire that your recovery be a smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, call the office location where you had your surgery. Please try to call during office hours in order to obtain a quicker result. A 24-hour answering service is available if necessary. The after-hours telephone numbers are 317-823-4260 or 866-823-4260.