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. If bleeding continues replace the gauze pad every thirty minutes until bleeding stops.  Minor bleeding may continue for up to 12 hours.
• 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 to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for 30 minutes may control excessive bleeding. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, sit upright, and avoid exercise and remain calm. If bleeding does not subside, call for further instructions.

Swelling

Post surgical swelling is normal and 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 two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be applied 15 minutes on followed by 15 minutes off 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.

Pain

For moderate pain, ibuprofen (Motrin or Advil) two to four 200 mg tablets may be taken every six hours.  Do not exceed 800mg of ibuprofen every six hours.  To improve pain management we advise taking the ibuprofen dose every six hours for the first 3 days and as needed after that.  If you cannot take ibuprofen, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four hours.  You should not combine prescription pain medication with Tylenol.  Most of the prescription narcotics have Tylenol mixed in them already.  

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.

Diet

Drink clear liquids (non diet soda, juices) after general anesthesia or IV sedation. Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. After 2 hours you may eat anything soft by chewing away from the surgical site(s). Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake.  Some suggested foods for the first few days after surgery are yogurt, pudding, Jell-O, applesauce, soup, pasta, oatmeal and scrambled eggs.  For the first twenty-four hours food and drink should be lukewarm or cool. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.  

Oral Hygiene

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but be gentle at the surgical sites. The day after surgery you should begin gentle rinsing at least five to six times a day with a cup of warm water mixed with a teaspoon of salt, especially after eating.

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 postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area after the third day may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics are often 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 & 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 cola, tea (not hot), or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.  If nausea persists for more than 8 hours, please call the 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 Dr. Boerman if you have any questions.
• A slight elevation of body temperature immediately following surgery is not uncommon. If the fever persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
• CAUTION: You should be careful going from the lying down position to standing. Since you were not able to eat or drink prior to surgery you may have a lower blood pressure. Taking pain medications can also make you dizzy. You could get light headed if you suddenly stand up. Before standing up, you should sit for one minute and then stand.
• 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 they persist for more than 2 weeks, Dr. Boerman can remove them.
• 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 two to three 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 that will resolve in time.

Finally

Sutures are 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. Most sutures are resorbable and will fall out on their own in about a week.

Pain and swelling typically peak by the third day and should decrease to normal 7-10 days after surgery.  If your post-operative pain or swelling worsens or unusual symptoms occur, call the office for instructions.

There will be a socket (hole) where the tooth was removed. The socket will gradually fill in with new tissue over the next month. In the meantime, 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. Boerman or your family dentist.

Brushing your teeth is encouraged.  The better your oral hygiene is the quicker the healing--just be gentle at the surgical sites.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms include:  throbbing pain at the surgical site and pain radiating to the ear or adjacent teeth.  Dry socket symptoms typically do not occur until the 5th or 6th post-operative day.  Call the office if this occurs.

Exercise increases your blood pressure, and may consequently increase bleeding or pain.  You may return to light exercise within 24 hours and routine exercise within 72 hours, as tolerated.