After Wisdom Tooth Removal
We at Inland Empire Oral and Maxillofacial Surgeons understand that the removal of impacted teeth is a serious surgical procedure and post-operative care can be a stressful event. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully. The most important element in successful post operative care is common sense. If you have any questions or concerns, please dont be afraid to contact our office. It is much easier to treat a small problem than a large one. Our goal is to make your post-operative course as stress-free as possible.
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 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 before 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 an explanation.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon for up to 24 hours following surgery.
- If given gauze, change it as directed every 30 minutes until the active bleeding has subsided (usually 2-3 hours).
- Make sure you apply good pressure to the gauze.
- You may remove the gauze to begin drinking, but return fresh gauze to the extraction site(s) if bleeding is still present
- 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 30 minutes. 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. Be sure to apply constant pressure. Remain quiet in a seated position for 20 to 30 minutes. Repeat until bleeding is controlled.
- To minimize further bleeding, do not become excited, sit upright, and avoid exercise.
- After these directions have been followed in detail and bleeding does not subside, call for further instructions.
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 bodys 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.
- 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 left on continuously while you are awake. After 24 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. Twenty-four hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
Post operative discomfort is normal after oral surgery procedures. Start taking the pain medication before the local anesthesia or numbness wears off. Please use the following instructions to help control the amount of discomfort that you may have:
For Severe Pain
- For the first 24 72 hours, please take the pain medication as prescribed by your doctor. 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. Be sure to eat something prior to taking pain medication to reduce nausea.
- If your doctor has not prescribed any Motrin/ibuprofen, you may take 400 – 600mg of Motrin/ibuprofen every 6 hours in addition to your prescribed medication.
- 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.
For Moderate Pain
- One or two tablets of Tylenol or Extra Strength Tylenol may be taken every 4 hours or 1 2 tablets of Motrin/ibuprofen may be taken every three to four hours.
- Do not take any additional Tylenol if you are taking a prescription medications
- Do not take any Motrin/ibuprofen if you have any stomach problems such as ulcers
- If you have any questions, please contact your doctor at Rancho Cucamonga Office Phone Number 909-581-7761.
- Drink liquids after general anesthesia or IV sedation. Do not use straws when drinking from a glass for one week. 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.
- Avoid hot liquids or food, spicy foods, and foods with seeds.
- Restrict your diet to liquids and soft foods that are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.
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.
No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the day after surgery but rinse gently. The day after surgery you should begin rinsing at least five to six times a day with a cup of warm water mixed with a teaspoon of salt especially after eating. Continue salt water rinses for 5 days.
REMEMBER: A clean wound heals better and faster.
Keep physical activities to a minimum for one week following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.
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, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
If you have been placed on antibiotics, continue to take them for the indicated length of time. 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. Be aware that some antibiotics can reduce the contraceptive effect of birth control pills. Please contact your gynecologist or pharmacist if you have concerns.
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 given an anti-nausea medication, do not drive or operate have machinery.
Smoking and Alcohol
You should avoid smoking and alcohol for a week following surgery. Smoking before and after surgery my increase your chance of post operative complications such as a dry socket. You may consider asking your primary care physician for a nicotine patch or medication to assist you to stop smoking.
A dry socket occurs in an extraction site where a blood clot dislodges or dissolves about 3 5 days following surgery. Throbbing pain that radiates to the ear and a bad taste are typical symptoms. The exact cause of a dry socket is not known, but smoking, premature rinsing, and oral contraceptives have been implicated in the development of a dry socket. Treatment includes irrigation of any food or debris within the socket and placement of a dressing. If you feel that you may have developed a dry socket, please dont hesitate to call.
- 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 your doctor if you have any questions.
- A 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 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 not roots; they are the bony walls, which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by your doctor.
- 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 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.
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. Most sutures will dissolve on their own over 7 14 days. If the sutures are non-dissolving, 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 no discomfort associated with this procedure. So its really nothing to worry about.
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 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.
Each 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. Dudziak, Dr. Choi, Dr. Hicke, Dr. Zakhary, Dr. Paxman and Dr. Kim 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 to the ear may occur two to three 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.