After Wisdom Tooth Removal

The removal of impacted teeth is a surgical procedure. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.

Immediately Following Surgery

  • The gauze pack(s) that have been placed over the surgical site(s) should be kept in place for an hour. After this time, they should be removed and discarded. They will need to be replaced only if you see a flow of blood coming from the extraction site(s).  To replace the gauze pack(s), take two pieces of gauze, fold in half and moisten with water so they are damp, and fold in half again.  Place the gauze pack(s) directly over the surgical site(s) and apply pressure for 30-60 minutes.   
  • You will want to take your pain medication before the local anesthesia wears off, usually within a couple of hours. Always try to eat or drink something before taking any medication. Please try an over-the-counter pain reliever first.   If the over-the-counter pain reliever is not effective enough, you may supplement with the narcotic pain medication if prescribed.  Wait three hours after taking the over-the-counter medication before taking the narcotic.  It is important to stagger the doses so you are not taking them both at the same time.   Do not drive or operate machinery while taking narcotic pain medication.  
  • Do not rinse or spit vigorously or drink through a straw for 24 hours following surgery.
  • To minimize swelling, place ice packs on the sides of your face where surgery was performed for 20 minutes on, 20 minutes off, as able for the first two days.  Elevating your head on a couple of pillows when lying down will also help to minimize swelling.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon.  If active bleeding continues, gently rinse or wipe out any old blood clots from your mouth and bite on another gauze pack (see above) placed over the extraction site for 30-60 minutes. Repeat if necessary.  If bleeding is persistant, bite on a moistened black tea bag for thirty minutes. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels. To minimize further bleeding, avoid activity until oozing subsides.  If active bleeding persists, call our office 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. The swelling may 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 for the first 48 hours. Baggies filled with ice, or ice packs, should be applied to the sides of the face where surgery was performed. The ice packs should be left on for a minimum of 20 minutes on, 20 minutes off. On the third day, or after 48 hours, discontinue the ice and switch to warm, moist compresses to help resolve any remaining swelling and alleviate jaw stiffness. If swelling or jaw stiffness persists for several days, there is no cause for alarm. This is a normal reaction to surgery. 

Pain

Take the prescribed pain medication as directed.  Narcotic pain medications will make you sleepy and slow down your reflexes.  Avoid alcoholic beverages and do not drive or operate machinery if you are taking a narcotic.  As pain subsides during recovery, you may discontinue the prescribed pain medication and take an over-the-counter pain medication as needed. 

Diet

After IV sedation, we recommend starting your post-operative diet with  clear liquids (water, fruit juice, 7-Up, Jell-O, broth).  Drink from a glass and avoid using a straw for 24 hours.  The sucking action can cause more bleeding by dislodging the blood clot and can prevent proper healing.  You may gradually introduce soft foods (applesauce, soup, mashed potatoes, scrambled eggs, pasta) if tolerating liquids well and feeling has returned to your lips and tongue. We do not recommend dairy products such as yogurt, ice cream or milkshakes on the day of surgery, as nausea and vomiting may develop in conjunction with the anesthetic and pain medication.  Avoid the surgical sites when chewing. A high calorie, high protein intake is important. Nourishment should be taken regularly. You will prevent dehydration by drinking fluids regularly. Your food intake may be limited for the first few days if you have difficulty eating. You should compensate for this by increasing your fluid intake. Drink at least 5-6 glasses of liquid daily. Try not to miss any meals. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.

Keep the Mouth Clean

Do not rinse your mouth or spit vigorously for the first 24 hours following surgery. The day after surgery you should begin rinsing at least 5-6 times a day for the next week, especially after eating and before bed. Mix one cup of warm water with one teaspoon of salt and one-half cup of hydrogen peroxide. Draw the solution up into the plastic syringe provided and gently squirt it into the areas where the teeth were.  It’s important to rinse out any food particles that can get caught in the sockets.  After the first week, continue rinsing with plain tap water for two to three more weeks or until food no longer gets caught in the extraction sites.  Keeping the areas clean will help to prevent infection. 

Discoloration

In some cases, discoloration of the skin is seen in the days following surgery. This is due to bleeding from the surgical sites into the soft tissue and may be seen under the eyes or extend down into the neck or upper chest.  This discoloration will resolve spontaneously over the next couple of weeks.

Antibiotics

If you have been prescribed an antibiotic, take as directed until gone beginning in the evening. On occasion, the antibiotic is given as a single dose in the IV.  Antibiotics are given when necessary to help prevent infection. Discontinue the antibiotic if you develop a rash or any other unfavorable reaction and contact our office immediately.

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 slowly sip on coke, tea, or ginger ale. When the nausea subsides, you may begin taking soft foods and the prescribed medicine. 

Smoking

Do not smoke for five to seven days following surgery.  Smoking greatly increases the risk of infection and an inflammatory and painful condition commonly referred to as a dry socket.

Other Complications

  • If continued numbness of the lip, chin, or tongue occurs, there is no cause for alarm. As reviewed in your consultation, 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. Call your surgeon if you have any questions.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Acetaminophen 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 from low blood sugar or medications. Before standing, you should sit for a couple of minutes and get up slowly.
  • 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 your surgeon.
  • If the corners of your mouth were stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.
  • A sore throat 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.  Warm, moist heat applied to the area with gentle massage will help to improve mobility.

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. The sutures will become loose and begin to fall out as early as three days after surgery.

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.  Remember, however, that the swelling can peak on the third day.  This is not unusual.

There will be a void where the tooth was removed. The void will fill in with new tissue gradually over the next month. In the meantime, the area should be kept clean, especially after meals and before bed, with salt water rinses (plain tap water is okay after the first week) and a toothbrush. 

Brushing your teeth is okay, just be gentle at the surgical sites until healed.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. If this happens, pain is severe at the surgical site and even near the ear may and may occur 2-3 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.

Your case is unique, no two mouths are alike.  Discuss any problems with the trained experts best able to effectively help you:  Drs. Gissal, Slack, Kanar, or Morse or your family dentist.