After Wisdom Tooth Removal

The removal of impacted teeth is a significant surgical procedure. Post-operative care is very important. Post-operative discomfort and the complications of infection and swelling can be minimized if instructions are followed carefully.

Immediately Following Surgery

• The gauze pad placed over the surgical area should be kept in place for one hour. After this time, the gauze pad should be 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 dose of ibuprofen before discomfort begins and continue every four hours for the first day. We often will give the first dose in our office to patients who can tolerate ibuprofen.
• Restrict your activities the day of surgery even if you feel fine and resume normal activity the following day or when you feel comfortable.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for 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 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 spitting. 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. The peak swelling may be minimized by early use of ice packs in the first day before swelling is apparent. “Zip Lock” bags filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice pack should be applied at least 10 minutes each hour for the first few hours. For more difficult cases your doctor may advise additional time. After 36 hours ice has no beneficial effect. Remember the swelling peak will occur on the third day (72 hours) and begin to subside by the fifth day. After the third day, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. Daily opening exercises to keep the jaw muscles stretched out is also advised from the first post operative day until two weeks later. No harm will come from stretching the mouth open wide during the initial healing period. Stretching will often help prevent discomfort and lead to more rapid healing. The best results from stretching are achieved following the application of moist heat and jaw muscle massage. Stretch to three finger widths and hold for 10 seconds 4-6 times each day.

Pain

Mild to moderate pain, two to three 200mg Ibuprofen, (Motrin or Advil) tablets may be taken every 4-6 hours if you are not allergic and stomach can tolerate these medications. It is always best to take ibuprofen with food even if not sensitive. Alternatively, Naproxen (Aleve) 275-550mg every 6-8 hours or Tylenol 650mg-1000mg may be used.

Moderate to severe pain is best treated adding the prescribed narcotic pain medication to your routine ibuprofen dosing. This pain medicine may make you groggy and will slow down your reflexes. Do not drive an automobile, work around machinery, care for children or consume alcoholic beverages while taking narcotic pain medications. The prescription narcotic medication often has a Tylenol base so there is no need to mix with Tylenol. Patients with liver, kidney or stomach illness should consult with their physician prior to the use of any pain medications.

Pain or discomfort may peak on the third day but should then progressively improve with each day. Muscle cramping is often the cause of jaw pain on day 3-5. If pain persists or worsens after the third day, it may require attention and you should call the office.

Diet

After I.V. sedation with local anesthesia, liquids should be initially taken until the local anesthetic effects are gone. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. Start with yogurt, apple sauce, jello or pudding consistency and progress to foods that easily break with a fork. High calorie, high protein intake is very important for the first week after surgery. Fluid intake is also very important to prevent dehydration. It is common your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. You will feel better, have more strength, less discomfort and heal faster if you continue to eat and drink from the first day.

Please refrain from eating popcorn or nuts for a few weeks after surgery.

Oral Hygiene

No rinsing of any kind should be performed until the day following surgery. You can begin to brush your teeth the night of surgery but rinse very gently. The first week after surgery brush first then rinse very gentle. Try not to rinse into the extraction sockets this may dislodge the protective clots and lead to a “Dry Socket”. The second week you may rinse the sockets lightly and by the third week there is no problem from rinsing. Warm water mixed with a teaspoon of salt or plain water will do fine. The best cleaning method is twice each day after brushing to mechanically wipe the top of the surgical site and adjacent tooth at the gumline with a Q-tip saturated with a 50/50 mixture of water and 3% Hydrogen Peroxide. This will mechanically and chemically remove plaque bacteria and food debris without rinsing. The cleaner the gumline on the back of the second molar tooth the faster you will heal.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to the breakdown of blood spreading beneath the tissues. This is occasionally 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

Antibiotics are not routinely used following third molar removal unless there is a pre-existing infection or whn surgical anatomy is difficult. Occasionally we will use antibiotics in a high risk patient to prevent infection. Routine antibiotics are useful in the post-operative period when a documented infection is found or early symptom first appear.

If you have been placed on antibiotics, take the tablets or liquid as directed. Get plenty of rest and maintain good fluid intake. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and call the office.

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. Pepcid A/C or similar acid blocker may reduce nausea especially when taken the night before surgery.

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 may bite it and not feel the sensation. So be careful. Call our office should 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.
• 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, Chap-stick or Neo-sporin ointment.
• 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. To help prevent this and the pain that accompanies this, daily mouth opening stretch exercise will hasten recovery.

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 form your mouth and discard it. Most often self dissolving sutures are used. On the occasion non dissolving sutures are used they will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles.

The progressive improvement of post operative discomfort and stiffness is expected after the third day. The most common complaint is a dull ache in the cheeks and is usually due to a lack of massage and stretch exercise necessary to keep the chewing muscle relaxed. If your post-operative pain or swelling worsens despite proper exercise, or unusual symptoms occur call our office for instructions.

There will sometimes be a cavity where the tooth was removed. The cavity will gradually fill in with the new tissue over the next few months. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush. The area can be rinsed vigorously only after the second week.

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: Dr. Rissolo is always available to help you.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain may develop at the surgical site or radiate down the jaw and up to the ear. Most often socket pain starts 3 -5 days following surgery and is self limiting by day fourteen. Dry sockets are not dangerous. They most often occur in patients who smoke or are on birth control. Call the office if this occurs. A simple clean out and socket dressing can help alleviate these symptoms.

If you are involved in regular exercise, be aware that your normal dietary intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.