After Wisdom Tooth Removal

The removal of impacted 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 area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
  • 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 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.
  • 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

Immediately after oral surgery, damp gauze pads will be applied over the surgical sites.  These should be left in place, with moderate biting pressure for one half hour, then removed.  If bright red oozing continues, 2-3 gauze pads should be dampened and folded twice and reinserted.   These pads should be placed directly OVER the extraction site.   Proper gauze placement should “cover” the extraction site and produce a clot down in the extraction site.   You may experience a red tinged appearance to the saliva lasting up to 24 hours.  However, if bright red, coagulated “jelly-like” clots are constantly forming several hours after surgery and do not decrease with time, please call the office.  

Swelling

Swelling and possible bruising will occur.  Swelling will reach its peak 2-3 days after surgery, then gradually will decrease.   Elevating the upper body and ice packs the first day may minimize swelling.   Apply ice for twenty minutes and remove for twenty minutes, then repeat.  Muscle stiffness may also develop, which may limit opening.   Moist heat applied to the face after the first day may improve this condition.

Discomfort/Medication

If throbbing or aching pain develops 2 to 3 days after extractions, and does not respond to pain medications, please contact the office; a “dry-socket” (disintegration of the blood clot) may be present.  Medicated dressings may be placed to control the pain.   There is no additional charge for dry-socket treatments.  If symptoms develop during non-office hours, “Red Cross Toothache Drops” (oil of cloves) or Anbesol drops (topical anesthetic) dripped into the socket after irrigation with water, provide some relief.  DO NOT use cotton pellets.  

Usually, ibuprofen 200-600 mg every 4 hours is very effective in controlling post-operative pain and swelling.  Side effects are minimal and it can be safely used while driving or working.   For difficult oral surgical procedures, narcotic pain medications may be prescribed to control discomfort.   The narcotic medication is best utilized between the scheduled dosages of ibuprofen, minimizing the total amount of narcotic required.  Do not operate cars or dangerous machinery if narcotic pain medications are used.   Driving is not allowed until the next day if intravenous sedation has been utilized.   it is recommended you be monitored at home after surgery.  If you are a woman on oral birth control medication, you must consider the fact that antibiotics, if prescribed, might make oral birth control less effective.   

Diet

Drink plenty of fluids the day of surgery.  A soft diet may be resumed once the gauze is removed and the local anesthetic has worn off.   Patients are encouraged to resume a normal diet the following day.   This too may help with muscle stiffness.

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 begin rinsing at least 5-6 times a day, especially after eating, with a teaspoon of salt mixed into one cup of warm water. 

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. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. 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 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.

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. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. Call Drs. Fountain, Madion and Olsen 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 which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Fountain, Dr. Madion and Dr. Olsen.
  • 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 for a few days following surgery. This is a normal post-operative event which will resolve in time.

Finally

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. 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 will be a void 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. Fountain, Dr. Madion and Dr. Olsen 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 pain at the surgical site and even pain near 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.