Surgical Instructions

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

  • The gauze pad placed by the surgical assistant over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be carefully removed and discarded.
  • Vigorous mouth rinsing 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 as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
  • Restrict your activities the day of surgery and the following day.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
IF YOU HAVE HAD IV SEDTION OR GENERAL ANESTHESIA DO NOT DRIVE FOR 16 HOURS.
 

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. We ask you to bite firmly on the gauze pad placed by the surgical assistant and once home, the pad can be gently removed.  Excessive bleeding may be controlled by 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. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed for thirty minutes on and thirty minutes off while you are awake for the first 24 hours.
 
After 24 hours, it may be helpful to apply moist heat to the swollen area.  Use caution with heating pads as some may burn facial skin. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. 

Pain

It is best to take the initial dose of pain medication before the anesthesia wears off.  Don't be afraid to use the medication as it is designed to make those first days after surgery more comfortable.  When taking oral medication, drink at least 1/2 cup of water or juice to aid in absorption and reduce stomach irritation.  To help reduce swelling and for moderate pain, take one 600mg tablet of Motrin (ibuprofen) every 4 hours as needed.
 
For severe pain, take the medication prescribed by your Doctor as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages.
 
Pain or discomfort following surgery  usually peaks by the third day following surgery and then slowly gets bettter each day there after. If pain persists, it may require attention and you should call the office.

Diet

Immediately following procedure it is important that you drink plenty of fluids and not use a straw.  Water and juices are good choices.  Soft foods such as ice cream, pudding, gelatin, soups and applesauce should be eaten at meal times, if possible.  If swallowing is difficult, meals may have to be eaten five to six times daily in small portions. 
 
After 24 hours add more solid foods such as pancakes, eggs, mashed potatoes, soft pasta, anything you can cut easily with a fork, to your diet.  It is best to avoid crunchy, hard foods like popcorn, nuts and chips for one week following surgery.

Oral Hygiene

The day of surgery avoid rinsing or spitting as this may dislodge the blood clot and delay healing.
 
The day after surgery resume brushing your teeth.  Use the pink sponges (toothettes), provided by the surgical assistant, moistened with warm water to gently clean the surgery areas for the first week.  They can be used several times and then discarded.  The day after surgery you should also begin rinsing every four to six hours, especially after meals, with a warm salt water solution (dissolve 1/2 teaspoon of salt with 1/2 cup of warm water).  Continue warm salt rinses for one week.

ACTIVITY

Immediately following procedure reduce your activity as much as possible. Too much chewing or talking will contribute to greater swelling.  It is best to nap with your head elevated on several pillows.  Rest is importhant to start you on a good recovery.
 
After 24 hours and the few days following surgery, you may increase your activity as tolerated, but avoid bending and heavy exercise through the first week.

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

Immediately following procedure it is not uncommon to experience nausea or vomiting.  Medications, anesthetics, diet changes and swallowed blood cn easily upset your stomach.  A small bland meal or clear carbonated beverage may coat your stomach and help alleviate your discomfort.
 
 
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. Rodenburg, Youssef, MacMenamin, French and Brown 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 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 Drs. Rodenburg, Youssef, MacMenamin, French and Brown.
  • 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 (Trimus) 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 may have been placed in the area of surgery to minimize post-operative bleeding and to help healing. The sutures are dissolvable and will eventually fall out as your mouth heals.  Sutures that become dislodged are no cause for alarm. Just remove the suture form your mouth and discard it. Any remaining sutures will be removed at your one week follow up appointment.  The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it's really nothing to worry about.

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 persons best able to effectively help you: Drs. Rodenburg, Youssef, MacMenamin, French and Brown or your family dentist.

Brushing your teeth is okay - just be gentle at the surgical sites.  Use the toothettes the first week after surgery.

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.

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.