After Wisdom Tooth Removal

Postoperative care is very important. Unnecessary pain and the complications of infection, swelling and dry socket can be minimized if the instructions are followed carefully.

Immediately Following Surgery

  • A gauze pad placed over the surgical area should be kept in place for a minimum of an hour.
  • Vigorous mouth rinsing or touching the area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take pain medications before the local anesthetic (“Novocaine”) wears off.
  • 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 explanation.

Bleeding

It is helpful to exert firm pressure over the surgical sites for 1 to 2 hours following surgery. This can be done by biting on gauze packing, which can be changed every 20 to 30 minutes. Biting on a moistened tea bag using the same time interval as above may be helpful for persistent bleeding. It is common to have slow bleeding and blood tinged saliva for 12-24 hours after surgery.

Swelling

Swelling is normally expected after oral surgery and may be minimized by the immediate use of cold packs for the first 12-24 hours. Apply the cold pack to the outside of the face directly over the surgical sites. Do this 20 minutes on and 20 minutes off while awake. The swelling is usually the greatest on the 2nd and 3rd day after surgery, slowly resolving with time. Warm moist heat (a hot water bottle or a warm moist towel) may be used on the outside of the face periodically starting on the 3rd day after surgery and continued until all swelling and/or bruising is gone.

Pain

Use your prescription as directed on the label. You will be comfortable following surgery due to the local anesthetic placed at the surgical sites during the procedure. It is best to start taking the pain medication while still numb. You should begin taking pain medication before you feel the anesthetic wearing off. For moderate pain, ibuprofen or a similar medication may be used. Ibuprofen bought over the counter comes in 200 mg tablets: 2-4 tablets may be taken every 6 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medications if you are allergic, or have been instructed by your doctor not to take them. Many pain medications are opioids such as hydrocodone, codeine, and propoxyphene, and may cause nausea. Take a full 8 ounces of a clear liquid (such as water, 7-up, or ginger ale) when taking the pain medications to minimize nausea. Caution: If you are lying down following surgery, make sure you sit for one minute before standing.

Diet

It is important to maintain an adequate intake of fluids and nutrients for optimum healing. Drink at least 6 large glasses of water or fruit juice daily. A high-calorie, high-protein diet is recommended. Chewing may be a problem, and food choice is therefore limited. If solid foods cannot be taken, supplement a balanced soft diet with 2 or 3 servings of a liquid dietary supplement such as Meritene, Ensure, Sustacal, Nutriment, or Instant Breakfast. These products can be obtained at a grocery store or pharmacy without a prescription. Start with a liquid or soft diet for the first 24-48 hours. Avoid hot or hard foods for 48 hours as these can dissolve or dislodge the clot. Avoid fatty foods, as these may cause nausea. Also, avoid using straws or spitting forcefully, as this may cause premature loss of the blood clot resulting in a “dry socket”. Some food suggestions include: Juices, soups, puddings, custard, gelatin, ice cream, eggs,oatmeal, blended foods, smoothies

Keep the mouth clean

Unless otherwise directed, DO NOT rinse your mouth on the day of surgery. The day following surgery you may resume brushing your teeth, avoiding the surgical sites. If given an irrigation syringe, you may use the syringe with warm water and gently irrigate the sockets beginning NO EARLIER than 5 days after surgery.

Discoloration

In some cases, discoloration of the skin follows surgery. The development of black, blue, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal occurrence, which may occur 2-3 days post-operatively and may take up to two weeks to clear. Moist heat applied to the area may enhance clearance of the discoloration.

Antibiotics

If these were prescribed, please take as directed. Discontinue antibiotic use in the event of a rash or other adverse reaction. Call the office if you have any questions.

Nausea and Vomiting

It is common to experience nausea after surgery and general anesthesia. This can be alleviated by having the patient lie flat or with the head slightly elevated. Anytime the patient gets up, he or she should do so with slow movements and assistance. Ingest only clear liquids to help minimize nausea (such as water, 7-up, ginger ale). Stay on clear liquids until the nausea passes.

Other Complications

DRY SOCKET: If you experience a sudden increase in pain two to four days after surgery, you may have osteitis or ‘dry socket.’ This can be intensely painful and can often be alleviated by using a medicated dressing placed in the socket. Please call our office if you feel you may be experiencing this.

STIFFNESS: Stiffness of the jaw muscles may cause difficulty in opening your mouth. This will usually resolve within a few days.

EARACHE, HEADACHE, OR SORE THROAT: You may experience any of these conditions temporarily as a result of your surgery. Your other teeth may also ache. This is called referred pain and is also a temporary condition.

NUMBNESS: Numbness of the lower lip, chin, and/or tongue on the side of surgery may develop. This is called “paresthesia” and though in rare cases it may be permanent, it is usually a temporary condition that will correct itself within a few days to several months.

FEVER: Your body temperature may be elevated during the first day or two. Be sure to drink plenty of fluids, and get out of bed to walk around at least two to three times a day. If fever persists, call our office.

CHAPPING: If the corners of the mouth are stretched, they may dry and crack. Use a lip balm or other ointment to keep your lips moist.

PHLEBITIS: Occasionally, the vein in your arm used to administer the anesthesia during surgery becomes tender. This indicates an irritation of the vein and usually responds well to applied heat. Should the area become swollen, red, warm and very tender, call our office.

INFECTION: Infrequently, a localized infection may occur in the surgical site in the weeks following surgery. If you have a sensation of increased pain, fever, increased swelling, or stiffness of the jaw after the first 48-72 hours after surgery, call our office.

BONE FRAGMENTS: Occasionally, small sharp fragments of bone may work through the gum tissue during the healing process. This is more common after multiple extractions and is nature’s way of reshaping the ridge. This process of “shedding” slivers of bone may last anywhere from one to four months. Impressions for bridges, partial dentures, or full dentures should be postponed until the ridges are well healed – usually six weeks. Be sure to contact us if you have any concerns about your progress or recovery at (530) 753-0550.

Finally

Sutures are often 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.

There will often be a depression or hole where the tooth was removed. This hole will gradually fill in with the new tissue over the next month to six weeks.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. If you become light headed, stop exercising.