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 a half hour and then removed and discarded. Replace gauze if necessary.
- 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 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 resume normal activity when you feel comfortable.
- Place ice packs on the sides of your face where surgery was performed. Refer to the section on swelling, below, for further explanation.
A certain amount of bleeding is to be expected following surgery and usually lasts 24-48 hours. 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 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, stay calm, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face are 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. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs 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.
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours.
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 following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.
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 form the surgical sites. High calorie, high protein intake is very important. For the first few days, a soft diet is recommended, for example: soups, yogurt, mashed potatoes, soft-cooked pasta, pudding, etc. After that, gradually advance your diet slowly over the next few weeks. Do not attempt to bite on anything hard for at least 6 weeks as this could cause a jaw fracture. Also, avoid contact sports for 6 weeks. Upon resuming sports, wear a mouth guard. Nourishment should be taken 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 to at least 5 – 6 glasses of liquid 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.
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 but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day (especially after eating) with a cup of warm water mixed with a teaspoon of salt.
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 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 the prescribed medicine. You should then sip on coke, tea or ginger ale. Sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.
On rare occasions, anti-nausea medication is prescribed, however, this medication must be administered via rectal suppository because medication taken orally will usually be vomited up and, therefore, ineffective. If you feel anti-nausea medication is necessary, please contact our office.
- 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 them and not feel the sensation. Call Dr. Gadler 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.
- Since you were not able to eat or drink prior to surgery, you should be careful changing positions from lying down to standing. You could feel light-headed when you stand up suddenly. Before standing up, you should sit for one minute then get up slowly. Taking pain medications can make you dizzy.
- 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. Gadler.
- 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 of the jaw muscles, Trimus, 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.
Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged or fall out, this is no cause for alarm. Just remove the suture form your mouth and discard it. Dr. Gadler uses resorbable (self dissolving) sutures whenever possible. Occasionally, Dr. Gadler will place non-resorbable sutures. These sutures will be removed approximately one to two weeks 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 subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call my office for instructions.
There will be a cavity where the tooth was removed. The cavity will gradually fill in with the new tissue over the next month or two. In the meantime, the area should be kept clean especially after meals with salt water rinses or a toothbrush.
Your case is unique, 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. Gadler or your family 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, across the jaw, and even pain to the ear may occur 2-3 days following surgery. Contact our 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 fell light-headed, stop exercising.