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 with firm biting pressure. 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 within one hour of being discharged from the office. This will usually coincide with the effects of the local anesthetic wearing 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.
Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting firmly on a moistened gauze pad placed directly on the bleeding wound for 30-45 minutes. This may be repeated as needed. If bleeding continues, bite on a moistened black tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. If bleeding continues after 3-4 gauze changes please call for further instructions. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. Do not disturb the wound. After the blood clot forms, it is important not to dislodge the clot as it aids healing. Do not spit, rinse vigorously, suck on straws, smoke or drink alcohol for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process and will promote bleeding.
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 the second post-operative day. However, the swelling may be minimized by the immediate use of ice packs and sleeping with the head in an elevated position. 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 applied to the surgical site for 20 minutes and then removed for 20 minutes. This should be done continuously while you are awake. After 48 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. Forty-eight hours following surgery, the application of moist heat is beneficial in reducing the size of the swelling and jaw muscle stiffness. On the day of surgery begin aggressive oral stretching manual massage to the sides of the face. This will help with muscle tightness and reestablishing a normal oral opening. If possible sleep with your head elevated at a 30-degree angle for the first two days following surgery. In general, patients who use ice and sleep with their heads elevated experience less swelling, have less post-operative pain and recover more quickly from surgery.
Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. To optimize your comfort you should take the first pain pill before the numbing medication has worn off. Remember that the most severe pain is usually within six hours after the local anesthetic wears off; after that your need for medicine should lessen. For moderate pain, take a dose (400-600mg) of Ibuprofen (Advil or Motrin) every 4-6 hours as needed for pain. Do not exceed the maximum daily dosage suggested on the bottle. Do not take Ibuprofen if you are intolerant of this medication or have a history of stomach ulcers or kidney disease. For severe pain, the prescribed medication should be taken as directed. It is best to take pain medication with a small snack or following a meal to avoid stomach upset. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not operate a motor vehicle or machinery (lawn mower, etc.) while taking the pain medication. Do not drink alcoholic beverages. Notify the clinic if you are experiencing pain that is not improving 3-5 days after surgery. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it. Prescription pain medication has the potential to be addictive. Only take the medication to control significant post operative pain. If you have medication remaining after your pain has resolved please take any unused medication to the police station and they will dispose of the medication responsibly for you. Never leave unused medication in your medicine cabinet at home.
We recommend the following protocol for optimum pain management: Take each medication with a small snack and full glass of liquid.
Immediately Following Surgery: 1 Prescription Pain Pill
3 Hours Later: Ibuprofen dosage
3 Hours Later: 1 Prescription Pain Pill
3 Hours Later: Ibuprofen dosage
NOTE: The dosage of the prescription pain medication can be increased to 1.5 to 2 pills if needed for pain management.
After general anesthetic or I.V. sedation, liquids should be initially taken until the effects of the oral numbing medication has worn off. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. Until the local anesthesia (numbness) goes away you should mainly eat food that can be swallowed without a lot of chewing (pudding, yogurt, mashed potatoes, ice cream, etc.). 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 1-2 liters 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 and faint. If you are lying down following surgery, make sure you sit for one minute before standing.
It is not uncommon to have some sensitivity in your remaining teeth following removal of your third molars. Some patients even report a sensation that their teeth have shifted position. Your teeth will not change position in the immediate postoperative period. If you have an orthodontic retainer please resume wearing your retainer within one week of surgery.
Keeping your mouth as clean as possible following surgery is essential to good healing and one of the best ways to avoid infection. Begin brushing and flossing your teeth the night of surgery, avoiding the surgery site. The night of surgery, use the prescribed medicated mouth rinse before bed. The day after surgery, the medicated mouth rinse should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 60 seconds then gently spit it out. Please continue to use the medicated mouth rinse until we see you for your follow-up visit in one week. You can dip a Q-tip in the medicated rinse and wipe gently over the surgery site to keep plaque from accumulating on the sutures or teeth surrounding the area. Be gentle initially when cleaning the surgical areas. 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. Try to avoid over the counter mouth rinses that contain alcohol.
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
Nausea is not uncommon after surgery. Sometimes pain medications are the cause. Nausea can be reduced by preceding each pain pill with a small amount of soft food, and taking the pill with a large volume of water. 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 a carbonated beverage, gatorade or tea. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. To help avoid nausea and vomiting do not take pain medication on an empty stomach.
DO NOT SMOKE for a minimum of 4 weeks following surgery. The heat and toxic chemicals in cigarette smoke are harmful to the healing of wounds and increases the likelihood of infection and dry socket.
Normal healing after tooth extraction should be as follows: The first two days after surgery are generally the most uncomfortable and there is usually some swelling. Swelling will peak on the second day, this is normal. After the third day you should be more comfortable, swelling should start to go down, tenderness will subside, and a more substantial diet can be resumed. The remainder of the post-operative course should be gradual, steady improvement. If you don’t see continued improvement, please call our office. If you are given a plastic irrigating syringe, DO NOT use it for the first five days. Then use it daily according to the instructions until you are certain the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket. This is usually for 6-8 weeks following surgery.
Because of the close relationship between upper back teeth and the sinus, a communication between the sinus and mouth sometimes results from surgery. If we informed you at the conclusion of your procedure that this complication occurred please read the following instructions. Do not blow your nose for at least 14 days after surgery, even though your sinus may feel “stuffy” or there may be some nasal drainage. Slight bleeding from the nose is not uncommon for several days after surgery. When sneezing during the first two weeks, sneeze with the mouth open to avoid applying pressure to the sinuses. Please take all medications as prescribed. Do not smoke for four weeks. Eat only soft foods for several days, always trying to chew on the opposite side of your mouth. Please keep our office advised of any changes in your condition, especially if drainage or pain increases. Sinus exposures often heal slowly and with difficulty, therefore, it is important that you keep all future appointments until this complication has resolved.
You may have been prescribed an antibiotic if there were signs of active infection at the time of tooth removal. Be sure to take the prescribed antibiotics as directed to help prevent further spread of the infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and notify our office. Otherwise, please finish your entire course of antibiotic. Antibiotics can sometimes cause an upset stomach. If this is the case, it is advisable to take acidophilus or pro-biotic tablets along with your antibiotic. Call our office if you have any questions.
Women taking oral contraceptives: Antibiotics that you have received for your surgery may make your oral contraceptive less effective. You should use an alternate form of birth control until your normal menstrual cycle.
- 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 Drs. Foley and Foley 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 and you may be dehydrated. Taking pain medications can make you dizzy. You could get light headed and faint 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 Drs. Foley and Foley.
- 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 or the lip balm that was provided to you in your post surgery care pack.
- 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. It is recommended to massage the muscles on the side of the face and perform oral stretching exercises. This will decrease the muscle stiffness.
Sutures are 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. The sutures will dissolve and will not require removal.
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, over the next 6-8 weeks 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.
Every surgical case is unique, co not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Drs. Foley and Foley or your family dentist.
Keeping your mouth clean while you heal from surgery is important to help prevent infections and dry sockets. Begin brushing your teeth the day of surgery- just be gentle when brushing around the surgical sites.
A dry socket occurs 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 3-5 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.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have any questions or concerns about your progress please call the office Boulder Office Phone Number 303-444-2255. We are available 24 hours a day.
Thank you for trusting us with your oral and maxillofacial surgery needs.