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

  • Place gauze over the surgical areas and apply pressure for 20 minutes and repeat as required.
  • Do not rinse your mouth or spit the day of your surgery.  Such activity can dissolve or dislodge the blood clot in the tooth socket and give rise to bleeding or infections.
  • Take the prescribed pain medication as is recommended on your Pain Management Schedule sheet.
  • Restrict your physical activities for at least 4 days.
  • Only use the ice pack on your cheeks for the first 24 hours.  Place it on your cheeks for 20 minutes and then remove for 20 minutes, etc. to help minimize swelling.  Using ice past 24 hours  may result in increased pain and slow down your healing.
  • Avoid laying flat on the day of the surgery.  Lay on your side with your had elevated.
  • Do not drink alcohol for 24 hours following surgery or while taking pain medications.
  • Begin eating and drinking once you are alert.  Begin with cool clear fluids to start and then add cool soft foods.
  • Do not operative motor vehicle or any equipment which requires concentration for 24 hours following your surgery.
  • Avoid smoking if at all possible since it affects wound healing.
  • Do not use a straw or eat nuts, popcorn, small seeds or chips.
  • Your lower lip may remain numb for several hours after surgery.  Avoid hot liquids and foods.

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. The nursing staff will provide you with a reusable ice pack that can be placed over the surgical site using a 20 minute on, 20 minute off schedule.  Do not use ice longer than 24 hours.  If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery and will generally subside within 7 – 10 days.

Pain

The nursing staff will thoroughly review the use of pain medication with you prior to your discharge from the office.  Following the instructions provided should assist with your comfortable recovery from your surgery.  Should you experience any difficulties with pain control, please do not hesitate to contact us at the office during the daytime hours, or at the emergency number provided after hours.  If you experience pain that is not being controlled with your pain medications, do not hesitate contacting the office or Dr. McCann.

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 but chewing is not recommended. 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 8 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 next day following surgery. The next day after surgery you should begin rinsing following meals and before bedtime or if food seems lodged in the surgical area. Mix one cup of warm water  with a half-teaspoon of table salt.  Do not start to use your irrigation syringe until the 5th day following surgery.  Be sure to use warm water in the syringe.

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 occur 2-3 days post-operatively.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. While antibiotics are not routinely prescribed following removal of wisdom teeth, they may be prescibed in certain cases to either treat or reduce the risk of infection. Should you experience side effects from antibiotic use such as rash or diarrhea, please contact Dr. McCann.

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 fluids. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.  Over-the-counter antinausea medications such as Gravol are effective in many cases.  Many of the pain medications will aggravate nausea or vomiting.  This tendancy can be minimzed by taking pain medications with some food in your stomach, and by lying down for an hour following the use of pain medications.  Please contact our office or Dr. McCann if nausea and vomiting persist.

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. McCann if you have any questions.
  • Slight elevation of temperature immediately following surgery is not uncommon. Dehydration is a very common cause of fever.  By maintaining fluid intake, this can be minimized.  If the temperature persists, or if your temperature exceeds 39.4 C/103 F, 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. McCann.
  • 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 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 form your mouth and discard it. Most suture materials will ‘melt away’ within 3 – 5 days, so you will not be required to return to the office for removal.  In the event that a suture that does not melt away has been used, you will be given a follow up visit for suture removal.

The pain and swelling often reach a peak by the third or fourth day following surgery. If you experience pain that is not managed by the pain medications that have been suggested, please contact the office, or the Oral Surgeon on call.

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 person best able to effectively help you: Dr. McCann.

Brushing and flossing 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 pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. Call the office if this occurs.

 Returning to your normal physical activities will be very variable, and will depend on the nature of the surgery, and the type of sport that you participate in.  It is always best to begin slowly, and gradually return to normal levels over time.  If you have any doubts, please contact Dr. McCann