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.

Any patient receiving general anesthesia for the removal of wisdom teeth must be accompanied by an adult who will remain in our office throughout the entire procedure, and be responsible for driving the patient to a pharmacy to have prescriptions filled, and then home where the following events should take place:

Immediately following Surgery:

Get something cold and soft to eat (like ice cream or a milkshake).  If you have a milkshake, remember to eat it with a spoon-NO STRAWS.  The sucking motion can cause more bleeding by dislodging a blood clot.
Have your prescriptions filled at a pharmacy.  AFTER EATING, begin taking medications.  Usually, there will be 4 medications for those of you who have impacted or-partially impacted wisdom teeth.  These medications include antibiotics, anti-swelling pills, pain relievers, and a prescription-strength mouth rinse.

Note: Start taking the oral medications (pills) right away, but begin using the mouth rinse on the day after surgery.

The surgical areas in your mouth will be numb for several hours, but it is recommended that 1 pain pill be given before numbness has subsided.  Remember, the patient may not be in discomfort (due to numbness form the local anesthetic), but if the pain medication has already been taken, the transition from a “numb” mouth to an “awake” mouth will be much easier.  In addition to pain control, there is usually an anti-nausea ingredient added to the pain medication that is quite helpful.  Take 1 pain pill every 4-6 hours on the day of your surgery (always with food).  Pain medications will cause sleepiness.  (Obviously no driving after taking a pain pill)  Depending on the amount of discomfort on the day after surgery, Tylenol (acetaminophen) or Motrin/Advil (ibuprofen) may be all that is needed.  Avoid taking aspirin for about 3 days unless instructed otherwise.  Take all prescriptions as directed.  If the instructions on the bottle are not perfectly clear to you, call our office at 512-258-1636 and ask to speak with a surgical assistant.

Note: The anesthetic makes your mouth and throat areas numb.  Although the soft tissues surrounding these areas are numb, the muscles involved in swallowing still work.  After eating and trying to swallow pills, if you find it impossible to swallow, simply rest for a while (30 minutes or so) and try again.  If you are still not successful, try opening up the capsules, mashing up the pills, and placing them on top of 1 spoonful of ice cream or pudding, and swallow.  For some reason, creamy things are sometimes easier to swallow than water and pills.  Good luck!  Keep in mind that no matter what, you’re probably going to drool, so have plenty of napkins around and a grubby shirt on.

After eating and successfully taking the first round of medications, most of you will want a nap.  You will most likely still be “groggy” from the general anesthesia, and the pain pill will cause drowsiness as well.  It’s fine to rest and relax (sleep), but start using ice packs to help prevent swelling.  Place ice packs on the outside of cheeks.  You can get creative to figure out a good way to hold ice packs against your cheeks while sleeping.  Some people choose to place ice bags on their cheek and wrap an ace bandage under the chin and over the head to keep the bags in place while sleeping.  If you don’t have an ace bandage, a long sock or even pantyhose will work.  You may choose to simply hold the ice packs on your cheeks and alternate sides every 20 minutes or so. Remember that the majority of swelling won’t be seen until 2 to 3 days after surgery, so what you do now (ice today and exercise tomorrow) will make your recovery much more pleasant.  After 36 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.

Cold soft foods (ice cream, pudding, and applesauce, etc.) should be eaten as long as numbness is present.  Remember to eat any time you take a pill!  Even though the pain pill may be an anti-nausea ingredient, you will have to eat a little something before taking any of the prescription medication unless instructed otherwise.  After numbness is gone, you may have warm foods such as soup, eggs, mashed potatoes, and macaroni and cheese.  Avoid rice and foods with seeds which are the perfect size to become lodged in the extraction sockets, as well as hard, crunchy foods such as chips, nuts, and popcorn.

A certain amount of bleeding is expected after extractions.  Slight bleeding, oozing, or redness in the saliva is not uncommon.  After leaving and getting your prescriptions filled, go get something to eat (ice cream, milkshake, or other soft, cold food).  Remove all gauze before eating!  After eating and taking medications, replace the gauze with fresh gauze (which is provided for you at your surgical appointment) and bite down firmly on the gauze for about 45 minutes to an hour, and then check it to see if you are oozing.  Repeat as necessary.  If bleeding continues, bite on a moistened tea bag for 30 minutes.  The tannic acid in the tea bag helps form a clot by contracting bleeding vessels.  This could continue for only a few hours, or it could continue for as long as 2 days.  A tinge of blood when brushing and rinsing is normal up to about 3-4 days after surgery.

• Feel free to relax on the day of your surgery, but get going the next day.  Exercise speeds up the healing process and resolves swelling much more quickly.
• The sutures (stitches) will dissolve by themselves in a week or two.
• Remember to follow the directions on all prescriptions and to CALL IF YOU HAVE ANY QUESTIONS.

Pain

For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol (acetaminophen) may be taken every 3-4 hours or Ibuprofen (Advil or Motrin) may be taken instead of Tylenol.  Ibuprofen, bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. 

For severe pain, take the tablets prescribed for pain 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.

Keeping your mouth clean

Good oral hygiene is very important to promote healing.  Brush AT LEAST 2 times per day (starting the day after surgery) and use the prescription mouth rinse.  The prescription mouth rinse should only be used 2 times a day (morning and bedtime), but warm salt water rinses may be done in addition if desired.  Avoid vigorous mouth rinsing and touching the wound area; this may initiate bleeding by causing the blood clot that has formed to become dislodged.  Do not use hydrogen peroxide.  Do not use a Waterpik near surgical areas.

Discoloration and 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 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.

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 clear, carbonated beverages like ginger ale that has been allowed to go flat.  You should sip slowly over a fifteen-minute period.  When the nausea subsides you can begin taking solid foods and the prescribed medicine.

Other Complications

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm.  As stated before surgery, this is usually of a temporary nature.  You should be aware that if your lip or tongue is numb you could bite it and not feel it, so be careful.
• Slight elevation of temperature immediately following surgery is not uncommon.  If the temperature persists, notify the office.  Tylenol or Motrin/Advil should be taken to reduce the fever.
• You should be careful going from the lying down position to standing,   because you were not able to eat or drink prior to surgery, and it is difficult to take fluids, and 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.
• 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 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.

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing.  Sometimes they can become dislodged; this is no cause for alarm.  Just remove the suture from your mouth and discard it.  The sutures will dissolve approximately one to two weeks after surgery.

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 our 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 with salt water rinses or a toothbrush.

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 2-3 days following surgery.  Call the office if this occurs.