After Wisdom Teeth Extraction

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 pad placed over the surgical area should be kept in place for at leaset a half 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 pain medications as soon as you begin to feel discomfort. Often we recommend you begin the non-narcotic pain medication or anti-inflammatory medication prior to the numbing medicine wearing off.  If you were prescribed a narcotic you should only take it when you begin to feel discomfort.  It takes one hour to work.  Do not drive a car, work, or operate heavy machinery while on the narcotic medication. 

• 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 intermittently for the first six to eight hours after surgery.  If you have swelling due to infection, do not use ice, use warm compresses . Refer to the section on Swelling for an 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 45 minutes. Do not open and close the mouth, and do not talk excessively at this time.  Do not remove the gauze if it becomes saturated, you may add more gauze to it if needed.  Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 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.

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 two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be used intermittently while you are awake. After 6-8 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.

Pain

Please take only pain medications as instructed by the doctor. 

For severe pain, take the tablets prescribed 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.

Diet

Drink liquids after general anesthesia or IV sedation. Do not use straws when drinking 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 site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. 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 five to six 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.

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 for one minute before standing.

Keep The Mouth Clean

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing several times a day especially after meals and before bed.  You may mix a teaspoon of salt with two cups of warm water.

Discoloration (bruising)

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 postoperative occurrence, but will not occur for most people.  It will follow gravity and after several days may move down the body towards the chest.  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 other unfavorable reaction. Call the office if you have any questions.  Itching and nausea are symptoms often caused by narcotic pain medications. 

Nausea & 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 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.  If an antinausea medications is necessary please contact the office.

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 could bite it and not feel the sensation. So be careful. Call Dr. Ditty or Dr. Pancko if you have any questions.  Often you are expected to have numbness for 8 hours after surgery. 

• A slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office.  Most pain medications will reduce the fever.  Please contact the office for temperatures above 101.5.

• You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It is often difficult to take fluids afterwards.  Taking pain medications can make you dizzy. Because of these reasons, you could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and then get up.

• Occasionally, patients may feel hard projections in the mouth with their tongue. They are usually not pieces of teeth; they are the bony walls, which supported the tooth, or fragments of bone that will come out like splinters.  These projections usually smooth out spontaneously. If not, they can be removed by Dr. Ditty or Dr. Pancko.

• If the corners of your mouth are stretched, they may dry out and crack. Your lips may 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 two to three 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 that will resolve in time.

Finally

Sutures (stitches) 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 are almost always dissolvable.  Some are designed to fall out in as early as one day.  Others may last up to three weeks. 

The pain and swelling should subside more and more each day following the third day after surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call the office for instructions. There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue 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 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. Ditty, Dr. Pancko, or your family dentist.

Brushing your teeth is okay – just be gentle at the surgical sites.  Bleeding intermittently for several days is normal and is a healthy sign, as long as it is not excessive or severe.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of severe pain at the surgical site and even pain to the ear may occur two to three days following surgery. Call the office if this occurs.

If you are involved in regular exercise, please start only slowly after the pain at the sites have resolved and you are no longer taking pain medications.