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. After this time the gauze pad should be removed and discarded.
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 wearing off. Local anesthesia may last for 2-4 hours following surgery.
Restrict your activities the day of surgery and resume normal activity when you feel comfortable. Most patients will need to refrain from vigorous physical exercise for 5-7 days following surgery.
Patients may need to be absent from work or school for a minimum of 3 days and possibly up to 5-7 days following surgery.
Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

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 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, do not become excited, sit upright, and avoid exercise.

A small amount of bleeding can persist for 24 hours following surgery. This bleeding often mixes with the saliva and can collect around the remaining teeth. This is not alarming. Inspection of the surgical wounds visually should not show evidence of bleeding that pools quickly in the mouth. If bleeding does not subside call for further instructions.

Swelling

Swelling can become quite large and extensive. 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.

As swelling becomes apparent you may experience limited mouth opening (stiffness). This is normal and will resolve in 5-7 days for most patients.

The swelling will not become apparent until the day following surgery and will reach its maximum 2-3 days after your surgery. The swelling may be minimized, however, 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 for 20 minutes. Application of the ice packs can be repeated every 20 minutes. Ice packs will also aid in pain relief. 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 regions of the face where swelling is present is beneficial in reducing the swelling.

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four to six hours (maximum daily dose of Tylenol should not exceed 3000mg). Ibuprofen, (Motrin or Advil) 200mg to 400mg may be taken every 4-6 hours. Specific dosing of over-the-counter pain medication should be taken as per directions on the medication container. Dr. Bundy may prescribe a higher dose of Ibuprofen. If so, this prescription Ibuprofen may be taken as directed for pain relief.

For more severe pain Dr. Bundy may prescribe other medications such as narcotics(i.e. Norco, Lortab, Vicodin, Percocet, Tylenol with Codeine, Ultram). Take these medications as prescribed and directed. Narcotic pain medicine may make you sleepy and will slow down your reflexes. Do not drive an automobile or work around dangerous machinery if you have been prescribed a narcotic medication. Avoid alcoholic beverages. You should also refrain from making any pertinent decisions regarding significant business or personal matters while taking these types of medications. 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.

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. Refer to the section on suggested diet instructions at the end of the brochure. 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. At least 5-6 glasses of liquid should be taken 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. 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.

Sutures

Sutures are sometimes placed in the area of surgery to minimize post-operative bleeding and to help promote healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it.

Most often the sutures that are placed will dissolve or fall loose on there own (resorbable sutures). If not sutures will be removed at your check-up appointment. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.

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.

Discoloration / Bruising

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 show up 2-3 days after surgery. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been prescribed antibiotics take the medication as directed. You should take all of the medication. 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.

Antibiotics can compromise the effectiveness of oral contraceptives (“birth control pills”). If you are taking oral contraceptives another form of birth control should be used for the remainder of your cycle.

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 any prescribed medicines. You should then sip on a carbonated beverage such as 7-UP, coke, tea or ginger ale. You should sip slowly. When the nausea subsides you can begin consuming bland foods such as soda crackers and soups (broth). Then slowly advance your diet. You may resume prescribed pain medicines as needed, however, you may want to lower the dose initially. If nausea persist call our office.

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 be careful. Call the office if you are still experiencing numbness the day following your surgery.
Slight elevation of temperature immediately following surgery for 24 – 48 hours is not uncommon. If the elevated temperature persists notify our office.
You should be careful going from the lying down position to sitting or standing. You were not able to eat or drink prior to surgery. It may also be difficult to consume fluids after surgery. This can lead to mild dehydration. Taking pain medications can make you dizzy too. 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 as you heal. This can take many weeks. If they do not smooth out they can be removed by Dr. Bundy at a later date.
If the corners of your mouth are stretched, they may dry and crack. Your lips should be kept moist with an ointment such as vaseline as necessary.
Sore throats and pain when swallowing are not uncommon. The muscles of the mouth get swollen after surgery. The normal act of swallowing can then become uncomfortable. This will usually 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.

Finally

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 (hole) where the tooth was removed. The cavity will gradually fill in with the new tissue.This may take up to 6 weeks. 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. Bundy and his staff 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. Typical symptoms of pain at the surgical site and even pain radiating to other teeth in the region or to the ear may seem to worsen 4-5 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.