After Wisdom Tooth Removal
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The removal of impacted teeth is a significant surgical procedure. Post-operative care is very important. Unnecessary pain and swelling and risk for infection can be minimized if the instructions are followed carefully.
Immediately Following Surgery
- The gauze pads placed over the surgical areas should be kept in place for 30-60 minutes. After this time, the gauze pads should be removed and discarded.
- Vigorous mouth rinsing, spitting 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. This may also cause a “dry socket”, dislodge sutures or introduce bacteria into the wound.
- Take the prescribed pain medications when you begin to feel discomfort. This will usually coincide with the local anesthetic wearing off.
- Restrict your activities the day of surgery and resume normal activity in 2-3 days and only when you feel comfortable. Lying down with your back and head elevated is appropriate.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for an explanation.
- DO NOT SMOKE! Do not use straws for several days.
- DO NOT drive, operate machinery or any other potentially dangerous items, or be solely responsible for child care for 24 hours after IV anesthesia (or at any time when taking prescription pain medication).
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing or redness in the saliva is not uncommon. Blood is like food coloring and a small amount will turn the saliva pink or red, possibly for several days. Do not spit as this may stimulate bleeding. Excessive bleeding (blood visibly welling up at the surgery site) may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad (folded to about one-inch square) 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. We are in the office until 4:30 p.m. – if possible, please call before this if you think there may be a problem.
If blood clots are present in the mouth as may occur after sleeping, wipe them gently away and treat any bleeding as previously described.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks and sides of the face is not uncommon. Swelling also depends on the location of the teeth and the patient’s anatomy. 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. Swelling may be minimized by the immediate use of ice packs. Two ice packs or baggies filled with ice and wrapped in a towel should be applied to the sides of the face where surgery was performed. The ice packs should be used for fifteen minutes at a time with short breaks 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 may be beneficial in reducing the size of the swelling.
The following information is for healthy adult size patients only with normal liver and kidney function and who are not taking other medications. Please ask your doctor about dosing for children. You may begin taking pain medication as soon as you feel the local anesthetic wearing off. For mild to moderate pain, Ibuprofen (Advil or Motrin) may be taken. Ibuprofen, bought over-the-counter comes in 200 mg tablets: 2-3 tablets may be taken every 6-8 hours as needed for pain. Taking this medication every 6-8 hours for two days or more will greatly enhance the effects of the medication. Patients who do this tend to have less pain than those who do not. Tylenol may be taken instead of Ibuprofen, but be aware that your prescription pain medication may contain Tylenol also. For severe pain, the prescribed medication should be taken as directed on the bottle, in addition to Ibuprofen or instead of regular Tylenol, unless otherwise directed. The prescribed pain medicine will make you groggy and will slow down your reflexes, alertness, and concentration. Do not drive a vehicle, work around machinery or other dangerous areas such as a hot stove, and do not be responsible for child care. DO NOT drink alcoholic beverages. For most patients, pain or discomfort following surgery will subside each day after the 3rd day. If pain persists, it may require attention and you should call the office. DO NOT take any of the above medication if you are allergic, have had a reaction to, or have been instructed by any doctor not to take it.
The maximum dose of Ibuprofen is 800 mg every six hours and 3200 mg in 24 hours.
The maximum dose of Tylenol is 1000 mg every six hours and 3000 mg in 24 hours.
After general anesthesia or I.V. sedation, liquids should be taken initially, ideally water, until you are confident that nausea or vomiting will not be a problem. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. Soup, apple sauce, pudding, jello, ice cream/milkshake are easy items to start out with. High calorie, high protein intake is important. Nourishment should be taken regularly. You should prevent dehydration by drinking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. Avoid carbonated beverages for the first few days. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
Keep the mouth clean
No rinsing of any kind should be performed until the day following surgery. If desired, you can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing with a cup of warm water mixed with a 1/4 teaspoon of salt. Do this 4-5 times a day, especially after eating. See the last section for instructions on the use of the monoject syringe provided for lower extraction site care.
In some cases, discoloration or bruising of the skin will appear. 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 become visible 2-3 days post-operatively. Moist heat applied to the area may speed up the resolution of the discoloration.
If you have been prescribed antibiotics, take your prescription as directed. Antibiotics may be prescribed 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 or if you develop multiple unformed (watery) bowel movements.
Nausea and Vomiting
Nausea and vomiting can occur due to a combination of altered diet, reaction to anesthesia, and medications (especially prescription pain medications). In the event of nausea and/or vomiting following surgery, do not take anything by mouth, if possible, for about 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 food and the prescribed medicine. Nausea due to medications is less likely if you have some food in your stomach. You may call our office if the nausea and/or vomiting persists.
A “dry socket” can occur when the blood clot gets dislodged from the tooth socket. Symptoms of increasing pain at the surgical site will occur, generally where a lower molar or wisdom tooth was removed. This phenomenon can be noted 4-5 days following surgery and the pain is typically not very responsive to your prescription pain medication. Call the office if this occurs. Treatment involves placement of a palliative dressing at the surgical site which requires removal and replacement several times during the healing process. Smoking is the biggest risk factor for a dry socket. Other risk factors include impacted teeth, poor oral hygiene, infection, female gender, and birth control medications, as well as plain old bad luck.
Occasionally, an allergic reaction can occur to one of your medications. Allergic reactions usually consist of itching, rash, or hives. If such a reaction occurs, you should stop taking the medications and call our office. Over-the-counter Benadryl may help alleviate these symptoms, but also will cause drowsiness. If a severe reaction such as swelling of the face or neck or difficulty breathing occurs, contact your nearest hospital emergency department and/or call 911 immediately.
- If numbness of the lip, chin, or tongue persists the day after surgery, 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. Numbness from the local anesthetic used during the procedure may last for 8-10 hours. If numbness is persistent, please contact us and you will be seen for a follow-up assessment approximately one week following your surgery.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen may be taken to reduce a fever.
- You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery and it may be difficult to take fluids following surgery. Taking pain medications can make you dizzy. You could get lightheaded if you stand up suddenly. Before standing up, you should sit upright for one minute then get up.
- Occasionally, patients may feel a hard projection in the mouth with their tongue during the healing phase. This is generally part of the bone wall that surrounded the tooth. These projections usually resolve spontaneously. If not, it can be removed by your oral surgeon. Please call if you have questions.
- 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 following surgery. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in a few days.
- Stiffness of the jaw muscles may cause difficulty opening your mouth for a few days or more following surgery. This is a normal post-operative event that will resolve in time. Gentle, repeated opening of the mouth wide enough to accommodate at least two fingers placed vertically between your front teeth will help this, as will warm compresses. Headaches may also occur.
Sutures are often placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged soon after surgery and this is no cause for alarm. Just remove the suture from your mouth and discard it. Usually, sutures are used that will dissolve and come out on their own in 4-8 days.
The pain and swelling may maximize 2-3 days following surgery should subside each day following that. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions.
Often, there will be a hole where the tooth was removed which may not appear for several days. The hole will gradually fill in from the bottom up over the next few weeks. In the meantime, the area should be kept clean especially after meals. When lower teeth are removed, a plastic syringe will be provided that may be used to gently irrigate the hole(s) starting 5-6 days following surgery. Irrigate the area with lukewarm tap water by carefully placing the tip of the syringe directly into the hole. Upper extraction sites typically only require gentle rinsing of the mouth; a syringe is not needed.
Your case is individual since no two mouths are alike. Well-intended advice from family or friends may be inappropriate. Please call our office if you have questions.
Brushing your teeth is okay – just be gentle at the surgical sites.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get lightheaded, stop exercising. Strenuous activity, exercise, or work is discouraged for one week following removal of wisdom teeth, as this may precipitate pain or dry socket.
Remember, your jaw will be slightly weakened for up to six months following surgical removal of lower wisdom teeth. It could be more prone to fracture and caution should be used when participating in activities where an impact to the jaw is possible.
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