After Wisdom Tooth Removal

Home Instructions After Wisdom Teeth Extraction

The removal of impacted wisdom teeth is a serious 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 pad placed over the surgical site and held in place with firm pressure for 1 hour. Change the gauze pad every hour until the bleeding has stopped.
• Vigorous mouth rinsing and/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 pain medication (ibuprofen, Tylenol, prescription Motrin) as soon as you are able to keep fluids down. As the local anesthetic wears off, you may continue with these pain medications or add any stronger prescription medication (hydrocodone/APAP, etc.) if needed.
• 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 a more thorough explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is to be expected. Depending on the medications you take and how well you are keeping the gauze pads in place, the bleeding may stop in a few hours or may last a day or more. Excessive bleeding may be caused by what is called a “liver clot” and can be controlled by first rinsing or wiping the clot from your mouth, then placing a gauze pad over the area and biting firmly for 1 hour. Repeat as needed. If bleeding continues, you may try a moistened black tea bag. First rinse the tea bag with warm water and gently squeeze out the excess water. Then place the tea bag over the surgical site, place a gauze pad over the tea bag and apply pressure for 1 hour. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels. To minimize further bleeding, sit upright, relax and avoid any activity that may elevate your blood pressure like exercise. If bleeding does not subside, 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 and eventual repair. 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. Two 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 15 minutes of each hour 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.

Swelling can be the cause of most post-operative pain, so controlling or eliminating it is very important. If you were given oral steroids to take after your surgery these will also help to minimize post-operative swelling. Usually, you will take 6 pills the first day, 5 pills the second day, and so on until they are gone. It is important to take this medication with food, so if you are not eating anything solid (applesauce, mashed potatoes, pudding) the first day then wait until the second day to start the steroids.

Pain

For mild to moderate pain, two Tylenol or Extra Strength Tylenol may be taken every 6 hours. If you prefer, you may take an anti-inflammatory (prescription Motrin, over-the-counter ibuprofen, Advil, Aleve, etc.) as directed on the bottle. If one of these medications is not controlling your discomfort, you may take both by alternating every 3 hours between Tylenol and Motrin. Be sure not to take more than eight Tylenol, or four Motrin in any 24 hour period.

For severe pain, you should stop taking Tylenol and start taking the prescribed medication as directed. Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. 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 or gets worse, it may require attention and you should call the office.

Diet

After general anesthetic or IV sedation you should start with non-dairy liquids until you are able to keep them down and the effects of the anesthesia have begun to wear off. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. After that, you may eat anything you wish by chewing away from the surgical sites. You should avoid any hot foods until the local anesthetic has worn off. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. If your food intake is 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 any meals. 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 up for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. The day after surgery you should rinse after every time you eat anything, with a teaspoon of salt mixed into one cup of warm water. In addition, if you were given a prescription mouthwash (Peridex, PerioGard, Chlorhexidine) you should resume using that twice daily the day after surgery.

Discoloration

In some cases, discoloration of the skin (bruising) 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. 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 may be given to help prevent or treat infection. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. If the antibiotic is causing an upset stomach or diarrhea you may try eating yogurt after each dose of the medication or try adding a daily probiotic to relieve these symptoms. Call the office if you have any questions.

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 water or ginger ale.Make sure that the gauze pads are properly placed because swallowing any blood can cause nausea. When the nausea subsides you can begin taking solid foods and the prescribed medicine. If nausea and vomiting does not subside after 12 hours call our office.

Other Complications

• If 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. If your lip or tongue is numb be careful not to bite it since you will not feel the sensation. Dr. Stastny will evaluate any numbness and explain any further details at your post-operative appointment. Call Dr. Stastny 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 could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting 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 Dr. Stastny.
• 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 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 be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is usually no discomfort associated with this procedure.

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.

There may be a void or hole 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, with salt water rinses or a toothbrush.

Your case is unique, no two mouths are alike. Discuss any problems with the trained experts best able to effectively help you: Dr. Stastny 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 sudden, severe pain at the surgical site or entire side of the face may occur 3 days following surgery. Call the office if this occurs.

It is important to avoid any exercise or strenuous activity for 3 days after surgery. 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.

If you have additional questions please go the Downloadable Instructions page or call our office Blue Ash Oral & Maxillofacial Surgery Office Phone Number (513) 984-2100.