Care and Conditions After Wisdom Tooth Removal

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain, infection and swelling can be minimized if the post-operative instructions are followed carefully.


Immediately Following Surgery:

  • The gauze pad placed over the surgical area should be kept in place for a half hour to forty-five minutes. After this time, the gauze pad should be removed and discarded if the bleeding has subsided. If the bleeding is still apparent, then the gauze pad should be folded and replaced for another half-hour to forty-five minutes until bleeding subsides.
  • 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 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 folded gauze pad over the area and biting firmly for thirty to forty-five minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes or place a gauze pad in strong tea solution, then remove the excess tea solution, and place the folded gauze pad on the bleeding site and place biting pressure for thirty to forty-five minutes and repeat if necessary. 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 the office 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 2-5 days after surgery. 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 continuously, in a 20 minutes on and 20 minutes off type of pattern, 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

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four to six hours or you may use two (2 x 200 = 400mg) to four (4 x 200 = 800 mg) of Ibuprofen (marketed as Motrin or Advil) every 4 to 6 hours. The maximum dose of Ibuprofen for the normal adult is 3200 mg per 24 hours.

For severe pain, take the pain medication prescribed by Dr. Freimuth. Always take the pain medication as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes, therefore do not drive an automobile or work around machinery. Avoid alcoholic beverages while taking pain medications, because the effects can be additive. Pain or discomfort following surgery should continue to decrease each day after surgery. If pain persists or is not controlled by the pain medication, you should call the office for additional instructions.

Diet

After a general anesthetic or I.V. sedation, you should start your dietary intake with clear liquids and increase to a normal diet as tolerated. Do not use straws. Drink from a glass. The sucking motion from a straw can cause more bleeding by dislodging the blood clot. Your diet may include soft foods. You should try chewing away from the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. 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.

Dizziness

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. This is not an uncommon condition after oral surgery and anesthesia. You should be careful going from the lying down position to standing. It is common to become dehydrated because you were not able to eat or drink prior to surgery and it is difficult to take fluids after oral surgery. Taking pain medications can also make you dizzy. You become light headed when you stand up suddenly. Do not stand up suddenly, but sit up on the side of the bed for one minute and then stand up slowly.

Keep your 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. You can rinse with a cup of warm water mixed with a teaspoon of salt or use any special mouth rinse (Peridex or Listerine) as instructed by Dr. Freimuth.

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 2-5 days after surgery. 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, diarrhea or other unfavorable reactions. Women please note that some antibiotics may interfere with the effectiveness of birth control pills. 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. If the nausea and vomiting continues despite all efforts, then call the office for further instructions.


Other conditions that may occur, but are generally considered normal:

  • 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. The local anesthetic can cause numbness for most of the first day of surgery. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful.
  • Slight elevation of temperature for the first 24 to 48 hours following surgery is not uncommon. If the temperature persists after 48 hours, notify the office. Tylenol or ibuprofen should be taken as directed to reduce the fever.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are usually the bony walls which supported the tooth. These projections usually smooth out spontaneously, if not, they can be removed at a later time.
  • If the corners of your mouth are stretched, they may become dry and crack. Your lips should be kept moist with an ointment such as Vaseline or Chapstick.
  • Sore throats and pain when swallowing are not uncommon. The sore throat and pain is caused by swollen muscles after surgery. The normal act of swallowing can then become painful. This pain will subside in 2-3 days.
  • Stiffness (Trimus) 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 over the next few days.


Finally:

  • 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 form your mouth and discard it. The remaining sutures will dissolve over the next week after surgery. The remaining sutures or remnants will be removed at your post operative visit. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.
  • 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 the office for instructions.
  • There will be a cavity where the tooth was removed. The cavity will gradually heal over the next few weeks and fill in with new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses, irrigation with a monoject syringe, or a toothbrush.
  • Your case is individual, no two mouths are alike, therefore do not accept well intended advice from friends. Discuss your problem or concerns with Dr. Freimuth, his staff or your family dentist.
  • Brushing your teeth is okay - just be gentle and use a soft tooth brush around 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 after oral surgery, therefore exercise may weaken you. If you get light headed, stop exercising.