After Extraction of Wisdom Teeth
In most cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia), or general anesthesia. These options, as well as the surgical risks (i.e., sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding bite down on the gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge your postoperative kit will include postoperative instructions, a prescription for pain medication, antibiotics, and a follow-up appointment in one week for suture removal. If you have any questions, please do not hesitate to call us at Alexandria Office Phone Number 703-751-7841.
Our services are provided in an environment of optimum safety. We utilize modern monitoring equipment and our staff are experienced in anesthesia techniques.
WISDOM TEETH POST OPERATIVE INSTRUCTIONS
All Surgery requires a period of time to heal and complications can occur. By following these instructions possible complications can be reduced.
- To reduce your chances of infection and continued bleeding:
- Do not drink anything hot today
- Do not rinse your mouth or brush your teeth on the day of surgery. Avoid areas where surgery was performed when you resume brushing your teeth.
- Do not use a straw for 72 hours following your surgery.
- Do not smoke for 72 hours after your surgery.
- To control bleeding, firmly bite down on the gauze pads provided to you by our office until the bleeding stops. It is recommended that you change the gauze pads every 30 minutes. Slight oozing is common and is best alleviated by drinking cold liquids.
- Get your prescription(s) filled immediately. Take your pain medication before the local anesthesia (numbness) wears off.
- To help reduce swelling, apply an ice pack at 10 minute intervals (10 minutes on, 10 minutes off). Ice will not help with swelling after 48 hours, but may be continued for comfort.
- Drink extra fluids frequently for the next 48 hours. Soft foods are also recommended for the first 48 hours. You may advance back to a normal diet over one week, as tolerated.
- If you received IV medication, no driving for 24 hours.
- Begin to rinse your mouth 24 hours after your surgery with a warm salt water solution (8oz of water and 1 tsp of salt) or with prescription mouth wash.
- Bruising and soreness are normal.
- A dry socket (loss of the blood clot) may occur on or after the 3rd day after surgery. This can cause localized pain. Please call our office if you feel like the pain is increasing after the 3rd day
- Beginning on day 6 after surgery use the curved tip syringe to flush lower extraction sockets.
- Please call us with any questions or concerns that you may have.
Medication for pain management
Classes of Medications
- Tylenol/Acetaminophen is a common pain reliever with few side effects.
- The usual over-the-counter tablets are 325mg for regular strength, and 500mg for extra strength. The maximum dosage per day is 4000mg/day, the usual post-surgical dose is 1000mg every 6 hours.
- Motrin, Advil, and Ibuprofen are brand names of the same medication. The usual over-the-counter dose is 200mg/tablet. The maximum dosage per day of Naproxen is 1000mg/day, the usual post-surgical dose is 2 tablets twice a day.
- This class of medication is potentially addictive and should only be used when the above medications are insufficient for pain control. These medications are also sedating and should not be taken with alcohol or when driving.
- Vicodin is a combination pill of Hydrocodone (5mg)/Tylenol (325 mg). The usual post-surgical dose is 1-2 tablets every 6 hours, with a maximum dose being limited by the Tylenol in the pill.
- Tylenol and NSAIDS can be combined as needed, alternatively takin 1 dose every 3-4 hours.
- Narcotics and NSAIDS can also be combined as needed, alternatively taking 1 dose every 3-4 hours.
- Tylenol should not be combined with Narcotics as the Narcotic already has Tylenol in the tablet.
Are there any problems after the extraction of wisdom teeth?
As with any medical procedure, there can be complications or an unanticipated result. Some complications that patients undergoing wisdom tooth extraction may experience include:
- damage to the sensory nerve that supplies sensation to the lips and tongue
- sinus communication
- dry sockets
After the procedure, our assistants will review your post-operative instructions with your escort. We ask that you follow these instructions closely, as they will make you most comfortable following your procedure. If you were sedated, you will be comfortable and drowsy when you leave the office. Most patients prefer to go home and rest with no other physical or scholastic activities planned for a few days. With any medical procedure, there can be unexpected results. These can include delayed healing, infection and post-operative numbness or tingling in your lip, chin, or tongue. Dr. Morgan will review relevant post-operative events with you and answer any questions during your office visit.
Damage to Sensory Nerve:
A primary concern is a nerve within the lower jaw bone that supplies feeling to the lower lip, chin, and tongue. This nerve is frequently very close to the roots of the lower wisdom teeth. Having these teeth out between the ages of 12 and 18 usually provides shorter roots so that the nerve is not so close to the roots of these teeth. Occasionally, when the teeth are removed, and especially in older patients, the nerve can become injured. When local anesthesia wears off, you may experience a tingling or numbing sensation in the lower lip, chin, or tongue. Should this occur, it is usually temporary and will resolve gradually over a period of weeks or months. On rare occasions it can result in a permanent alteration of sensation similar to having local anesthesia. We feel that you should be aware of this possibility before consenting to surgery.
The upper wisdom teeth are situated close to your sinuses, and their removal can result in an opening between your mouth and the sinus. Once again, if the teeth are removed at an early age, the root formation is minimal, and this complication is very unlikely. However, if it does occur, it will usually close spontaneously, but we may give you special instructions to follow, such as avoid blowing your nose for two or three days following the surgery. You can wipe your nose, but don’t blow your nose. If you have to sneeze, you should sneeze with an open mouth into a tissue. Pressure should not be created in the sinus area, which may dislodge the healing blood clot. If you sense this condition occurring after the surgery, please contact the office. An additional procedure may RARELY be necessary to close the opening.
Dry sockets continue to be the most common problem people experience following dental surgery. They arise due to premature loss of a blood clot in the empty tooth socket. This seems to occur with greater frequency in people who smoke or are taking birth control pills. While both jaws can be affected, they usually occur in the lower jaw on the third to fifth day. They cause a deep, dull, continuous aching on the affected side(s). Patients may first notice the pain starting in the ear radiating down towards the chin.
The symptoms frequently begin in the middle of the night, and your pain medication regimen may not help. Treatment can involve changing your prescription. Occasionally it is helpful to place a medicated dressing in the empty tooth socket. This will help decrease the pain and protect the socket from food particles. The effectiveness in alleviating the pain lasts for 24-48 hours and may require dressing changes every day or two, for five to seven days. Dressings usually are removed when you have been pain free for 2 to 3 days.
The dressing doesn’t aid in healing. The only reason to place a dressing is for pain control. If medication is controlling the pain, the socket will heal without a dressing. Following removal of the dressing, an irrigation device may be provided to help you to keep food particles from lodging in the extraction site.
Occasionally, post-operative infections occur. This usually requires an office visit and clinical examination. Many times, just placing you on an antibiotic for one week will take care of the infection. If it persists, the area will have to be drained and cleaned. Other temporary problems you may experience in the post-operative period include stiffness of the jaws, chafing around the corners of your lips, facial bruising, and blood oozing from the extraction sites. The post-operative instruction sheet we will provide should answer many of the questions related to these more common concerns. If not, don’t hesitate to call the office at Alexandria Office Phone Number 703-751-7841.