After Wisdom Tooth Removal

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 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. 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 on the side 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. In order to stop bleeding, the pressure from the gauze must be placed directly over the surgical area.  Chewing on the gauze only stimulates saliva flow, increases the risk of more bleeding, and risks injury to the “numb” oral structures. If bleeding continues, gently wipe away any formed clot over the surgical site and 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, please call the office for further instructions.

Swelling

Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. Swelling and mild bruising is normally expected and is usually proportional to the surgery involved.  This is the body’s normal reaction to surgery and eventual repair. Many times the swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. A bag 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 the first 24 to 36 hours, ice has little beneficial effect to reduce swelling. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm, as this is a normal reaction to surgery.

Pain

For severe pain, take the prescribed pain medication tablets as directed. The prescribed pain medicine might make you feel groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery is usually at its worst 24 – 48 hours after surgery, after that it should subside more and more every day. If pain persists or worsens, it may require attention and you should contact the office for further instruction.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Drink from a glass and do not use a straw, as the sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. 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 5-6 glasses of liquid should be taken daily (avoid ice tea). 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 vigorous rinsing 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 at least 5-6 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt.

Discoloration

As mentioned earlier some discoloration (bruising) is common. 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 occur 2-3 days post-operatively. Bruising can take 14 days to resolve. Avoid sun exposure until the discoloration has resolved.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent or treat infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Please contact the office if you have any questions.

Nausea and Vomiting

Nausea and vomiting are common side effect of IV sedation, general anesthesia, and many narcotic oral pain medications.  In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour, including the prescribed pain medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. Once the nausea subsides, you can begin taking solid foods and restart the prescribed pain medicine. If the nausea and vomiting do not resolve, please contact our 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 them and not feel the sensation.  If you experience this altered sensation please contact our office.  Appropriate care can be initiated, if indicated, at that time.
• Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office.
• Many patients feel dizzy following surgery. You should be careful going from the lying down position to standing. Remember, many times you were not able to eat or drink prior to surgery. It also can be difficult to take fluids. The prescribed pain medications may also make you feel dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
• Occasionally, patients may feel hard projections in the mouth with their tongue.  The rough surface is not the roots of the tooth.  They are usually the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Drs. Spinazze, Zak, Spinazze, Spina or Perkinson
• If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with over the counter lip balm.
• Sore throats and pain when swallowing are not uncommon. Since muscles are swollen, the normal act of swallowing can become painful. This pain will usually subside in 2-3 days.
• Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for several days following surgery. This is a normal post-operative event which will resolve in time.

Finally

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes the sutures disintegrate early or are dislodged. This is no cause for alarm, simply remove the suture from your mouth and discard it. The sutures will dissolve or be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. The procedure takes only a minute or so, and there is minimal discomfort associated with this procedure.

There will be a hole or opening  where the tooth was removed.   In the coming months the cavity will gradually fill in with the new tissue. 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. Dennis Spinazze, Dr. Zak, Dr. Russell Spinazze, Dr. Spina, Dr. Perkinson, 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 2-7 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.