After Wisdom Tooth Removal

The removal of impacted wisdom 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

All Surgery requires a period of time to heal and complications can occur. By following these instructions possible complications can be reduced.

1. To reduce your chances of infection and continued bleeding:
   1. Do not drink anything hot today
   2. 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.
   3. Do not use a straw for 72 hours following your surgery.
   4. Do not smoke for 72 hours after your surgery.
2. 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.
3. Get your prescription(s) filled immediately. Take your pain medication before the local anesthesia (numbness) wears off.
4. 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.
5. 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.
6. If you received IV medication, no driving for 24 hours.
7. 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.
8. Bruising and soreness are normal.
9. A dry socket (loss of the blood clot) may occur on or after the 3^rd day after surgery. This can cause localized pain. Please call our office if you feel like the pain is increasing after the 3^rd day
10. Beginning on day 6 after surgery use the curved tip syringe to flush lower extraction sockets.
11. Please call us with any questions or concerns that you may have.

• 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. Replace the gauze pad if bleeding persists.
• 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. Usually this occurs between 4 and 6 hours after the initiation of the procedure.
• 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

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. If bleeding continues, 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, call for further instructions.

Swelling

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 body’s 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 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies 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 intermittently (20 minutes on, 20 minutes off) while you are awake. 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.

Pain

Medication for pain management

Classes of Medications

• Analgesics

• 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.

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.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws, instead, drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form 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. 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 rinsing of any kind 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

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.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. 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.

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 coke, tea or ginger ale. 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 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 Dr. Morgan if you have any questions.
• 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 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 over weeks to months. If not, they can be removed by Dr. Morgan.
• 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.

Finally

Sutures are placed 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 form your mouth and discard it. The sutures will be dissolve approximately one week after surgery. The part of the suture that is under the gums will dissolve and the visible part becomes loose and falls off.

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 my office for instructions.

There will be a depression where the tooth was removed. The depression will gradually over the next month fill in with the new tissue. In the mean time, 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. Morgan 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 2-3 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.