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 to a full hour. After this time, the gauze pad should be removed, discarded, and replaced if necessary with another damp gauze pad.
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- leading to a Dry Socket or cause an infection.
Take the Ibuprofen and, if needed, the prescribed pain medication prior to feeling 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 (usually within a couple of days).
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 damp gauze pad over the area and biting firmly for thirty to forty five minutes. Repeat if necessary. If bleeding continues, bite on a moistened black tea bag for 30 for 45 minutes. The tannic acid in the tea bag helps to form a clot by contracting blood vessels. To minimize further bleeding, do not become excited, sit upright, spit or rinse vigorously, 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, ibuprofen, and steroid if prescribed. Two baggies filled with ice, ice packs, or bags of frozen vegetables should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously for 30-45 minutes, then off for 15-30 minutes while you are awake. After 24-36 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. 36 hours following surgery, the application of moist heat to the sides of the face may be beneficial in reducing the size of the swelling.

Pain

For moderate pain, Ibuprofen (Motrin or Advil) two-three 200 mg tablets may be taken every 4-6 hours or 1-2 tablets of Tylenol or Extra Strength Tylenol may be taken every 4-6 hours.

For severe pain, you may additionally take the tablets prescribed as directed while also continuing to take the Ibuprofen. The prescribed pain medicine will make you groggy and will slow down your reflexes. You may also experience nausea, vomiting, and constipation. 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.

Diet

After general anesthesia or I.V. sedation, liquids should be initially taken until the numbness subsides. 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. Refer to the section on suggested diet instructions at the end of the office 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.

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 very gently. The day after surgery you should begin gently rinsing at least 4-5 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt. You may gently rinse with the anti-bacterial mouthrinse if prescribed starting 2-3 days after your surgery to help in keeping your mouth clean and bacterial numbers low.

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 which will likely last for a week or two.

Antibiotics

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. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. Anti nausea medication can be prescribed if needed for persistent nausea/vomiting.

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 Dr. Conkin if you have any questions and let him know of this occurrence.
Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists for several days, 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. Conkin.
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 4-5 days.
Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for many days following surgery. This is a normal post-operative event which will resolve in time as your swelling decreases.

Finally

Sutures are placed 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. The sutures typically dissolve approximately one week after surgery. The removal of sutures requires no anesthesia or needles if this should be required. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.

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 close over the next month and fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses, the irrigating syringe, and brushing.

Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your problem with the person best able to effectively help you: Dr. Conkin or your family dentist.

Brushing your teeth is okay – just be gentle around 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 to the ear may occur 4-6 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.