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.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you.

Immediately Following Surgery

Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not controlled. The packs may be gently removed after one hour. If active bleeding persists, place enough new gauze to obtain pressure over the surgical site(s) for another 30 to 45 minutes. The gauze may then be changed as necessary (typically every 30 to 45 minutes). It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning.

Spitting, 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.

You will usually have a prescription for pain medication. If you take the first pill before the anesthetic has worn off, you should be able to manage any discomfort better.

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.

PLEASE DO NOT SMOKE for at least 48 hours, since this is very detrimental to healing and may cause a dry socket.

Bleeding

A certain amount of bleeding is to be expected following surgery for 24 hours. Slight bleeding, oozing, or redness in the saliva is common. Bleeding should never be severe. If so, it usually means that the packs are being clenched between teeth only and are not exerting pressure on the surgical areas. Try repositioning the packs and bite firmly for 30-45 minutes. Repeat if necessary. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in a moist gauze) for 20 or 30 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 remains uncontrolled, please call our office.

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 may occur. 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 after the surgery.

The swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice, ice packs, or bags of frozen peas wrapped in a towel should be applied firmly to the sides of the face where surgery was performed. The ice packs should be applied twenty minutes on and twenty 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.

Starting on the 3rd day after the extractions, you may apply warm compresses to the skin over the areas of swelling (hot water bottle, hot moist towels, heating pad) for 20 minutes on and 20 minutes off to help soothe tender areas. This will also help decrease swelling and stiffness.

Pain

Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first pill before the anesthetic has worn off, you should be able to manage any discomfort better. For moderate pain, two tablets of 200 mg ibuprofen (Advil or Motrin) may be taken every four hours. For severe pain, take the medications prescribed as directed. The effects of pain medications vary widely among individuals. If you do not achieve adequate relief at first, you may supplement each pain pill with an analgesic such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Some patients may even require two of the pain pills at one time. Remember that the most severe pain is usually within three days after the surgery; after that your need for medicine should lessen. If you find you are taking large amounts of pain medicine at frequent intervals, please call our office. If you anticipate needing more prescription medication for the weekend, you must call for a refill during weekday business hours. Please keep in mind pain medications cannot be called into the pharmacy. You need to pick up a prescription at our office during weekday business hours. 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. Some patients find that stronger pain medicine causes nausea, but if you precede each pain pill with a full glass of water or a small amount of food, chances for nausea will be reduced. When taking prescription or over the counter medications, always follow manufacturer’s recommended dose. Do not take any medication if you are allergic or have been instructed by your doctor not to take. If you are not sure or have any questions, please contact your doctor, the pharmacy, or our office.

Diet

Eat any nourishing food that can be taken with comfort.
Avoid extremely hot foods.
Do not use a straw for the first few days after surgery and try chewing away from the surgical site(s).
It is sometimes advisable, but not absolutely required, to confine the first day’s intake to liquids or pureed foods (soups, puddings, yogurt, milk shakes, smoothies, mashed potatoes, etc.)
It is best to avoid foods like nuts, sunflower seeds, popcorn, chips, pretzels, etc., which may get lodged in the socket areas.
Over the next several days you may gradually progress to solid foods.
It is important not to skip meals.
If you take nourishment regularly you will feel better, gain strength, have less discomfort and heal faster.
Prevent dehydration by taking fluids regularly.
If you are a diabetic, maintain your normal eating habits or follow instructions given by your doctor.

Oral Hygiene

Keeping your mouth clean after surgery is essential.

Use 1/4 teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily.

Begin your normal oral hygiene routine as soon as possible after surgery.

Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth within the bounds of comfort.

If you are given a plastic irrigating syringe, DO NOT use it for the first five days. Then use it daily according to the instructions until you are certain the tooth sockets have closed completely and that there is no chance of any food particles lodging in the sockets.

Remember: A clean wound heals better and faster.

Discoloration or Bruising

In some cases, discoloration or bruising 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 may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics, take the medications 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

Nausea may occur after surgery.
Sometimes pain medications are the cause.
Nausea can be reduced by preceding each pain pill with a small amount of soft food, and taking the pill with a large volume of water.
Try to keep taking clear fluids and minimize dosing of pain medications, but call us if you do not feel better.
Classic Coca Cola, ginger ale, or 7-Up may help with nausea.

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 our office if you have any questions.

A slight elevation of temperature immediately following surgery may occur. 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 could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and then get up. This usually occurs because of dehydration. You were not able to eat or drink prior to surgery and it is also difficult to take fluids following the surgery. Taking pain medications can also make you dizzy.

If you feel something hard or sharp edges in the surgical areas, it is likely you are feeling the bony walls which once supported the extracted teeth. Occasionally small slivers of bone may work themselves out during the following weeks or so. If they cause concern or discomfort, please call the office.

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 or a lip balm such as Chap Stick.

Sore throats and pain when swallowing may occur. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in two to three days.

Stiffness 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.

Healing

Normal healing after tooth extraction should be as follows:
The first two to three days after surgery are generally the most uncomfortable and there is usually some swelling.
On the fourth day, you should be more comfortable and, although still swollen, can usually begin a more substantial diet.
The remainder of the post-operative course should be gradual, steady improvement.
If you don’t see continued improvement, please call our office.

Activity

Keep physical activities to a minimum immediately following surgery.
Stay away from heavy exercises and lifting for the initial five days following your surgery to avoid complications.
If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising.
Be aware that your normal nourishment intake is reduced.
Exercise may weaken you.
If you get light headed, stop exercising.

Finally

Sutures are commonly placed in the area of surgery to minimize post-operative bleeding and to help healing.
If absorbable sutures are used for your surgery, these will usually become dislodged after appropriate healing period.
If non-absorbable sutures are used for your surgery, these will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so. Sometimes these non-absorbable sutures become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it.

The pain and swelling should subside more and more each day following the initial two to three days after the surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call the office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue over the next month or so. 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. Vahadi 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 severe pain at the surgical site and even pain to the ear may occur two to four days following surgery. Call the office if this occurs.

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. For emergencies, a 24-hour answering service is available to contact the doctor on call after hours. Calling during office hours will afford a faster response to your question or concern.

PLEASE NOTE: telephone calls for narcotic (pain killer) prescription refills are ONLY accepted during office hours. Also, pain medications cannot be called into the pharmacy. You need to pick up a prescription at our office during weekday business hours.