Wisdom Teeth Removal
Post Operative Instructions for Wisdom Teeth Removal
The removal of impacted wisdom teeth and surgical extraction of teeth is quite different from the extraction of erupted teeth. Postoperative problems are not unusual, and extra care must be taken to avoid complications. All of the following are considered normal. It is often advisable to return for a postoperative visit to make certain healing is progressing satisfactorily. If a follow-up visit has been scheduled, please be sure to return for that visit. In the meantime, follow the post operative instructions given to you at the time of wisdom teeth surgery.
Immediately Following Surgery
- The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded. If there is continued active bleeding then replace the gauze and bite down to put pressure on the site for another 30 minutes.
- Avoid vigorous mouth rinsing or touching the wound area following surgery. 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 resume normal activity when you feel comfortable. But do no strenuous activity for 48 hours.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
Other normal post-operative symptoms
- Local anesthesia will cause numbness of the lip, chin, or tongue and there is no cause for alarm. As stated before surgery, this is 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.
- You may have a slight earache.
- Your other teeth may ache temporarily. This is referred pain and is a temporary condition.
- If the corners of the mouth are stretched out they may dry and crack. Your lips should be kept moist with cream or ointment.
- Healing of the surgical site is variable.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. To control bleeding; immediately following procedure keep a steady pressure on the bleeding area by biting firmly on the gauze placed there by your doctor. Pressure helps reduce bleeding and permits formation of a clot in the tooth socket. Gently remove the compress after the local anesthesia has worn off and normal feeling has returned. If there is continued active bleeding then replace the gauze and bite down to put pressure on the site for another 30 minutes.
Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a folded gauze pad over the area and biting firmly for thirty minutes. The gauze acts as a pressure dressing. It is not there to soak up blood. Repeat if necessary. If bleeding continues, bite on a moistened tea bag wrapped in gauze for thirty minutes. (Use black tea, steep in hot water for 1 minute then cool completely prior to use.) The tannic acid in the tea bag helps to form a clot. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.
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. 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. 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.
Swelling peaks on the 2nd or 3rd post-operative day; however, it is normal to have swelling and/or pain up to and beyond day 5.
Slight elevation of temperature immediately following surgery is not uncommon for 24 to 48 hours. If the temperature persists, notify the office. Tylenol or Ibuprofen should be taken to reduce the fever.
Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished. Severity of postoperative pain will depend on the procedure and your physical condition. Take medication for pain 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 should subside more and more every day. If pain persists, it may require attention and you should call the office.
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four hours to a maximum of 4000mg per day. Overdosing with Tylenol can hurt your liver.
(Motrin or Advil) three 200mg tablets may be taken every 6 hours to a maximum of 3200mg per day. Ibuprofen can be taken at the same time or along with Tylenol. Overdosing with Ibuprofen can hurt your kidneys.
Aleve (Naproxyn sodium) and Aspirin
These are in the same class of drugs as ibuprofen so they should not be taken together, an 81mg aspirin once a day is of no concern. Naproxyn’s (Aleve) maximum daily dose is 600mg. (200mg 2 times a day is adequate) Overdosing with naproxyn can hurt your kidneys.
Cool liquids should be initially taken. Do not use straws–drink from a glass. Sucking through a straw creates a vacuum that 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. 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, less discomfort and heal faster if you continue to eat.
Keep the mouth clean
No rinsing should be performed until the day following surgery. But rolling water around the mouth, if necessary, is acceptable. Avoid vigorous mouth rinsing or touching the wound area following surgery. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
You can brush your teeth the night of surgery just be gentle at the surgical sites. Rinse gently, no swishing. The day after surgery you should begin rinsing at least 4 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt.
Do not smoke or drink alcohol for 48 hours following oral surgery. This may cause the disruption of healthy blood clot formation and increase in complications including dry sockets, prolonged healing, wound breakdown and post-operative infections.
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 mean time, the area should be kept clean especially after meals with salt water rinses. A curved tip syringe may be provided for irrigating the socket. Begin using the syringe 72 hours after surgery.
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 post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
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 IV sedation, nausea is often caused by low blood pressure or blood pooling in the extremities. Taking plenty of fluids as soon as possible will help with this early post-op nausea. Do not fight the nausea and or dizziness.
Lie down and put your feet up. Take a deep breath and expand your rib cage. Flex the muscles in your legs. All this will help to bring blood to your heart to be pumped to your brain. Doing this will decrease the nausea. You should be careful going from the lying down position to standing. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute flex your leg muscles, take a deep breath then get up.
If nausea develops later, it may be due to the pain medication. Nausea is a normal side effect of narcotic pain medications. If you have severe nausea or vomiting you may need to stop the pain medications or take an additional anti-nausea medication. Do not take anything by mouth for an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.
Sharp bony edges
Occasionally, patients may feel hard projections sharp areas on the surgical site 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.
“Dry Socket” is a term usually describing 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.
A “Dry Socket” will usually heal on its own. Pain control is the issue. Try using an anti-inflammatory medicine like ibuprofen in addition to the narcotic pain medicine. If unsuccessful, then this can be treated in our office by placing a medicated dressing in the surgical site.
Sutures are placed 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 dissolve approximately one week after surgery.
A sore throat may develop. Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can 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. Use warm moist heat from the 3rd day after the procedure. Also do stretching exercises with your jaw. Try to get to an opening where you can insert 3 stacked fingers between our upper and lower teeth.
No strenuous activity for 2 days. Then you may resume normal activity. 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. Restrict your activities the day of surgery and resume normal activity when you feel comfortable. But do no strenuous activity for 48 hours.
- No Swimming for the first 4 days after surgery.
- Playing musical wind instruments such as trumpets which require high blowing force. You should not resume playing full force for 2 weeks.
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: Our doctors or your family dentist.