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 pads placed over the surgical areas should be changed for fresh gauze pads every 30-40 minutes and may need to be kept in place for up to 2-3 hours following surgery or until the bleeding has stopped or been reduced to a very slow ooze.  
  • Vigorous mouth rinsing or touching the surgical areas 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 instructed by Dr. Smith.  
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable enough to do so.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for a more detailed 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 thirty minutes.  Repeat if necessary.  If bleeding persists, biting on a moistened tea bag wrapped in a fresh piece of gauze for 30-40 minutes should stop or slow the bleeding sufficiently enough to remove the packs.  To reduce the risk of recurrent or persisting bleeding, sit in an upright position and avoid physical activity.  If bleeding does not subside, call for further instructions.

Swelling

Swelling of the face or cheeks following third molar surgery is an expected condition.  This is a temporary state and will usually be more apparent and peak 2-3 days following surgery.  Complete prevention of swelling is not usually possible but the swelling can be minimized by resting and sleeping in a slightly elevated position with the head being positioned above the heart and with the use of ice packs.  It is recommended that you keep your head elevated, including during naps and when sleeping at night for the first 72 hours following surgery.  Ice packs, cold packs or packages of frozen peas can be applied to the face adjacent to the surgical sites for the first 12-24 hours following surgery and can be applied for 20 minutes at a time every hour or so.  After 24 hours ice packs will have little or no benefit on swelling.  If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is an expected temporary condition following 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 and may also provide some relief from residual pain and soreness.

Pain

Dr. Smith will instruct you on the use of any over-the-counter or prescribed medications that he recommends following your surgery.  This, along with following the post-operative instructions given to you after surgery should provide effective prevention or relief of pain following surgery.  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 general anesthetic or I.V. sedation, drinking lots of non-carbonated liquids is extremely important.  Do not drink from a straw for the first 3-4 days following your surgery. Your food intake will be limited for the first few days so you should compensate for this by increasing your fluid intake.   At least 5-6 eight ounce glasses of non-carbonated liquids should be taken daily. Resume eating as soon following surgery as possible.  You should begin with foods that require no chewing such as yogurt, mashed potatoes or pudding and then advance to soft foods that require only gentle chewing as you are able to tolerate.  You should resume a normal diet with foods that require regular chewing as soon as your swelling and pain have reduced to a point that it is comfortable to do so. 

Keep the mouth clean

You should begin very gentle rinsing with warm salt water (1/4 tsp of salt in a cup of warm water) 3-4 times per day beginning the afternoon or evening of surgery once the bleeding has slowed to the point that you are able to take the gauze packs out.  You are encouraged to brush your teeth the evening of surgery as well, taking care to be very gentle as you approach the surgical sites.  Be very gentle with the rinses you do after brushing and with the warm salt water for the first 3-4 days following surgery.  Avoid vigorous swishing or forceful spitting in the sink during this period of time as it is important not to dislodge the organized blood clots in the extraction sockets.  You will be given an irrigating syringe for use in keeping the extraction sockets clean of food debris during healing.  Do not begin use of the irrigating syringe until the 5th day following surgery.  Beginning on postoperative day 5 it will be very important to use vigorous oral rinses and the irrigating syringe to keep the surgical sockets clean, especially following eating, in order to aid in healing and reduce the risk of infection.  

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 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. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. 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 sip on water, tea or ginger ale until you feel better.  You should sip slowly over a fifteen-minute period.  When the nausea subsides you can begin slowly taking solid foods and, if needed, another attempt at taking the prescribed medication.   Persisting postoperative nausea is uncommon but if you are not able to improve the symptoms with the above measures, call our office for further guidance.   

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 and due to the local anesthetic that was administered during your surgery.  You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be very careful when attempting to chew even soft foods while the tongue and/or lip is still numb.  
  • Slight elevation of temperature immediately following surgery is not uncommon. If a temperature above 101 degrees persists, notify the office. 
  • You should be careful going from the lying down position to standing. Effects of the general anesthesia as well as possible dehydration following surgery can cause light-headedness and possible dizziness.  Taking pain medications can also contribute to this effect.  To protect against this, make certain you are drinking lots of non-carbonated fluids following surgery and go very slowly when changing from a lying position to standing up, taking a minute or two to sit before rising to stand.  
  • Occasionally, patients may feel hard projections or small, hard particles in the mouth with their tongue. These are not roots, but rather the bony walls which supported the tooth that are in the process of healing. These projections usually smooth out on their own over time but, if not can be removed or reduced by Dr. Smith.
  • 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 usually subside in 2-3 days along with the swelling.
  • 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 as the swelling reduces. 

Finally

– 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 form your mouth and discard it. The site will continue to heal normally. 

– The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unexpected symptoms occur call our office for guidance.

– There will be a socket where the tooth was removed. The socket 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 or surgeries are exactly alike.  Be careful in comparing your experience with those of others and in accepting well-intended advice from others about what your experience during and after surgery should be like.  Discuss any questions or problems you may have following your surgery with the persons best able to effectively help you: Dr. Smith or your family dentist.

– 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 in the period 3-5 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.