Post-Operative Instructions: Wisdom Teeth Removal

The removal of wisdom 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 30 minutes to one hour. After this time, the gauze pad should be removed and discarded. If active bleeding (bright red blood visualized in the mouth) continues, replace the gauze and continue applying pressure by biting together, changing the gauze as needed. Refer to the section on bleeding for an explanation.

Vigorous mouth rinsing, sucking through a straw, spitting hard, 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 before 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 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 gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes to one hour. 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 postoperatively. However, the swelling may be minimized by the immediate use of ice packs. Two ice packs or baggies filled with ice should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously 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. If swelling begins to increase after the third post-operative day, please contact your doctor immediately. 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, 1 or 2 Regular Strength Tylenol® (325mg) may be taken every 6 hours (no more than 2600 mg in a 24-hour period). Ibuprofen (Advil® or Motrin®) may be taken instead of Tylenol®. Ibuprofen bought over the counter comes in 200 mg tablets: 3–4 tablets may be taken every 4–6 hours as needed for pain (no more than 3200 mg in a 24-hour period). Do not take any of the above medication if you are allergic or have been instructed by your doctor not to take it. This may include patients with liver or kidney disease.

For severe pain, take the tablets prescribed as directed. (Please note: if this prescription has Tylenol® [APAP] in it, see the above paragraph.) The prescribed pain medicine may make you groggy and may 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

After IV 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 by chewing away from the surgical sites. High-calorie, high-protein intake is very important. Refer to the section on suggested diet instructions at the end of the 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, endure less discomfort, and heal faster if you continue to eat. What you eat is a comfort issue, not a healing issue. You may advance your diet back to normal as tolerated.

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 1 minute before standing.


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 rinse gently. The day after surgery you should begin rinsing at least 5–6 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt. DO NOT rinse with peroxide, even if diluted.


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 postoperatively. Moist heat applied to the area may speed up the removal of the discoloration.


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

There are three main causes for nausea or vomiting: 1) sensitivity to the medication, 2) taking the medication on an empty stomach, or 3) swallowing blood. 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 tea or flat ginger ale. You should sip slowly over a 15-minute period. When nausea subsides, you can begin taking solid foods and the prescribed medicine.


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 Drs. Aiken and Shessel to inform them of this numbness or if you have any questions.

Slight elevation of temperature immediately following surgery is not uncommon. 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 were not able to eat or drink before 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 that supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Drs. Aiken and Shessel.

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 that will resolve in time.


Finally

Sutures may be 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 usually dissolve within one week of surgery. If the removal of sutures is required, no anesthesia or needles are 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 the office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually fill in with the new tissue over the next month. In the meantime, the area should be kept clean, especially after meals, with saltwater rinses or a toothbrush. Starting 5 days after the surgery, the Monoject syringe provided should be used to direct water into the lower extraction sockets to remove any food and debris following meals.

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: Drs. Aiken and Shessel or your family dentist.

Brushing your teeth is okay — just be gentle at the surgical sites.

A dry socket is when the blood clot dissolves or gets dislodged prematurely from the tooth socket, leaving exposed bone in the socket. Symptoms of pain at the surgical site and even pain to the ear may occur 3–4 days following surgery. Call the office if this occurs. A medicated packing can be placed to relieve the discomfort. Ibuprofen tends to be more effective than the narcotic pain medication.

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.

Click here for a printable pdf version of these instructions.

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