After Wisdom Tooth Removal

The following information applies when you have had one or more wisdom teeth surgically removed.  Proper post-operative care is very important. Unnecessary pain and the complications of swelling and infection 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 replaced with a clean gauze pad until bleeding stops.  Bleeding or oozing may persist throughout the day; please contact our office if bleeding becomes excessive.
• Vigorous mouth rinsing or touching the wound area following surgery should be avoided for 24 hours. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
• You should begin taking pain medication before you feel the local anesthetic wearing off. DO NOT take any pain medication on an empty stomach.
• Restrict your activities the day of surgery and resume normal activity when you feel comfortable.  If you exercise, be aware that throbbing or bleeding may occur at the extraction site/sites.  If this occurs, discontinue exercising.
• Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag,  or a towel filled with ice on the cheek in the area of surgery. Apply the ice for 20 minute intervals for the first 24 hours.

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. If bleeding does not subside, call 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 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 left on for 20 minute intervals while you are awake.   After 24 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.

Pain

You should begin taking pain medication before you feel the local anesthetic wearing off. DO NOT take any pain medication on an empty stomach. For mild pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 4-6 hours. 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 every 6 hours as needed for pain.  For moderate pain 1-2 Tylenol and 3 Ibuprofen (Advil or Motrin) may be taken together every 6 hours. For severe pain, the prescribed medication should be taken as directed (if taking prescribed medication, discontinue taking Tylenol, or any other Acetaminophen product). Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.  If you experience an adverse reaction to any of the pain medication, discontinue use and contact our office .

Dry Socket

Dry Socket (alveolar osteitis) is a temporary dental condition that can occur after an extraction of a single tooth or multiple teeth.  A dry socket occurs when the blood clot at the site of a tooth extraction becomes dislodged or dissolves exposing the underlying bone and nerves causing discomfort.

Dry Socket is one of the most common complications following tooth extractions, especially the removal of lower wisdom teeth.  They develop in about 5% of tooth extraction cases.  When it occurs, a dry socket usually becomes symptomatic about three days after the extraction.  It is not an infection requiring antibiotics but significant discomfort is a hallmark.

Symptoms

• Severe pain within a few days following a tooth extraction
• Loss of the blood clot at the extraction site, which may look empty (dry socket)
• Visible bone in the socket
• Bad breath or a foul taste
• Pain that radiates from the extraction site toward the ear or front teeth

 

Risk Factors

• Smoking
• Oral Contraceptives (Birth Control Pills)
• Not following post operative instructions i.e. aggressive rinsing, spitting, drinking through a straw or vigorous exercise
• Poor oral health
• Past history of a dry socket

 

Treatment

The treatment of a dry socket is geared toward reducing the pain.  This generally includes irrigation of the extraction site followed by placing a medicated dressing into the socket.  The dressing is changed every 1-2 days until symptoms have resolved.

Once the extraction site has been irrigated and the dressing placed, the pain should subside within an hour.  Complete healing usually takes between 1 to 2 weeks, but varies patient to patient.

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 form the surgical sites. High calorie, high protein intake is very important. 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.

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 3-4 times a day especially after eating with a cup of warm water mixed with a half teaspoon of salt.

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

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics may 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 clear liquids such as soda, water, 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.

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.
• 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. Hall, Dr. Bienstock, or Dr. Jones.
• 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 (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

Sutures are sometimes 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 form your mouth and discard it.

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 our office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. 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. Hall, Dr. Bienstock, Dr. Jones, or your family dentist.

Brushing your teeth is okay – just be gentle at the surgical sites.

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.

It is our desire that your recovery be as smooth and pleasant as possible.  Following these instructions will assist you, but if you have questions about your progress, please call the office.  Please try to call during office hours; however a 24-hour answering service is available if you need to speak to a doctor after hours.