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 instructions are followed carefully.
Immediately Following Wisdom Tooth Surgery:
- The gauze pack placed over the surgical site should be kept in place and replaced as needed for bleeding.
- Take the prescribed pain medications as directed and start taking in fluids.
- If liquids are well tolerated, the diet can be advanced to soft cool to room temperature foods.
- Avoid chewing foods until after tongue sensation has returned.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
Bleeding will occur after surgery, and it is not uncommon to ooze blood for 24-48 hours after surgery. Keep in mind that oral bleeding represents a little blood and a lot of saliva.
Placing a gauze pack over the area and biting firmly will control bleeding. If oozing is still active, replace gauze as needed.
If bleeding continues or begins again, sit upright or in a recliner, avoid physical activity, use ice packs on the sides of the face where surgery was performed and bite gauze for 1 hour or on a moistened tea bag for 30 minutes.
The tannic acid in the tea bag helps to form a clot by constricting bleeding vessels.
DO NOT RINSE, SPIT, OR DRINK THROUGH A STRAW – This will cause suction and could result in bleeding. If you wish to clear blood from your mouth, let it drip into the sink, but do not rinse or spit.
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Discomfort is common after any surgical procedure. Take the pain medication as prescribed by your surgeon.
For mild to moderate pain you may switch to your choice of over-the-counter pain medication. If your post-operative pain or swelling worsens beyond the third day after surgery or unusual symptoms occur, please call our office.
NOTE: Tylenol should not be taken concurrently with the prescription pain medication as this typically already has Tylenol as an ingredient and could result in overdosage.
Swelling is a normal occurrence after surgery and will not reach its maximum until 2-3 days after surgery.
However, the swelling may be minimized by the immediate use of ice packs. A zipper-lock bag filled with ice, or ice pack should be applied to the sides of the face where surgery was performed.
If continuous use is uncomfortable, then use it for 20 minutes on and 20 minutes off. Apply the ice continuously as much as possible for the first 36 hours.
Suggested way to apply ice:
- Fill two zipper lock bags with crushed ice
- Cut a pair of pantyhose at the thigh, and slide both bags halfway down the leg (to about the knee)
- Tie ends of pantyhose on top of the patients head and adjust ice to the side of the face
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.
Under most circumstances, the sutures will dissolve approximately one week after surgery.
Should you require the removal of sutures, this procedure requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure.
On the day of surgery, we recommend cool liquids and soft cool foods. You may eat anything soft by chewing away from the surgical sites.
You should prevent dehydration by taking fluids regularly. Try not to miss a meal.
Please avoid popcorn, nuts and seeds for 6 weeks after your extractions.
Discoloration or bruising
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to bruising beneath the tissues.
This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Beginning 36-hours after surgery, moist heat applied to the area may speed up the removal of the discoloration.
Antibiotics may be prescribed to help prevent infection. If you have been placed on antibiotics, take the tablets or liquid as directed.
Discontinue antibiotic use in the event of a rash or other unfavorable reaction, and call the office.
Female Patients: Antibiotics and other medications may interfere with the effectiveness of oral contraceptives. An additional form of birth control should be utilized for one complete cycle of birth control pills after the course of antibiotics or other medication is complete.
Nausea and Vomiting
Nausea and vomiting can occur as a result of:
- swallowed blood
- or anesthesia.
Post-operative nausea is usually self-limiting and sipping on FLAT cola (Pepsi or Coke) often helps. Soda crackers may also be used with cola.
If nausea persists, stop taking the pain medication and substitute an over-the-counter pain medication for the next dose. If nausea is persistent, call our office.
Smoking, chewing or dipping will retard healing, cause increased discomfort and increase the chance of dry sockets.
We strongly advise you to discontinue these habits during your healing phase.
Keep the mouth clean. You can brush your teeth the night of surgery, but be gentle around the surgical sites.
If there is no bleeding, salt-water rinses may begin 24 hours after surgery. (Mix 1 tablespoon of salt with 8 ounces of warm water.)
Swish gently and allow the water to drip into the sink. Rinses should be done 2 to 3 times per day, especially after eating.
Activities after surgery should be couch or bed rest for the first day. Bending, lifting, or strenuous activity will cause increased bleeding, swelling, or other problems.
You should be careful going from the lying down position to standing. You could get light-headed when you stand up suddenly.
If you are involved in regular exercise, be aware that your normal fluid and caloric intake is reduced. Exercise in the post-operative period may also result in increased bleeding, swelling, and discomfort. Exercise should be avoided for 3-4 days following surgery.
- 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 your surgeon if you have any questions.
- 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, your surgeon can remove them.
- 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 should subside in 2-3 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, which will resolve in time.
- A dry socket may occur 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 3-5 days following surgery. Call the office if this occurs. Smoking cigarettes has been shown to greatly increase the occurrence of dry socket.
Irrigation of wisdom tooth sockets
It is common and inevitable that food and other debris will begin to accumulate in your extraction sites. This is even more common on the lower extraction sites. We have provided a curved-tip irrigation syringe that you should begin using on DAY 5-7 as instructed by your surgeon, after your surgery to aid in the removal of debris. We recommend you use either a lukewarm saline solution or tapwater to irrigate your sockets as follows:
- With the plunger pressed all the way down into the syringe, place the tip of the syringe in a clean cup containing saline or tapwater.
- Pull up on the plunger to fill the syringe. In rare instances, if you find it difficult to draw through the tip, you may cut a small amount of the tip off with clean scissors to enlarge the opening.
- While standing in front of a mirror or with the assistance of another person, open your mouth and pull your cheek out with your finger, a toothbrush, or a tongue depressor. Pulling the cheek outwards will allow you to see the extraction site and may open the incision up a bit to facilitate insertion of the syringe.
- Advance the tip of the syringe just inside the socket and flush it with the water in the syringe.
- Spit and repeat until fluid comes out clear.
- Repeat on the other side if applicable.
- Sockets should be irrigated at least twice daily, preferably after meals, until sockets have fully healed. In some cases this may take several weeks.
- Do not start irrigating earlier than day 5-7 after your surgery unless instructed to do so by your surgeon.
- It is not uncommon for a small amount of bleeding to occur when first irrigating. Biting on gauze for a few minutes after irrigating generally stops any minor bleeding.
- It is not uncommon for a bad odor or taste to be present. Keep in mind that the socket initially contains a blood clot and several days of food debris. A small amount of listerine mouth rinse mixed with the water in the syringe (half and half) is typically effective in eliminating the odor.
- Keep your syringe in a clean place, ideally with your toothpaste and other oral hygiene products.
Please do not hesitate to call our office if you have any questions!
- There will be a hole (socket) where the tooth was removed. The socket will gradually fill in with the new bone and tissue. In the meantime, the area should be kept clean, especially after meals, with salt-water rinses and/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–your surgeon.