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. After this time, the gauze pad should be removed, discarded, and replaced until bleeding stops.
  • 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 2 hours of leaving the office (to avoid getting behind the occurrence of discomfort).
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable, unless other instructions have been given by Dr. Grantham regarding activity restrictions.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

Bleeding

Some bleeding is normal, sometimes up to 24 hours.  Bite down on your gauze (we will give you extra gauze) for 45 minutes at a time, and then replace as needed.  When the bleeding is minimal, take the gauze out.  Chewing on it can start the bleeding again.  The old trick of using a tea bag to control bleeding-still works! A moist tea bag can be placed directly at extraction site, biting firmly for 1 hour.   The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. However, heavy bleeding (that you can’t seem to control) should be reported to the office. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. Opening too wide, brushing, etc may cause additional oozing from the extraction site. 

Swelling

Some swelling is to be expected, and this may increase for up to 72 hours.  With really difficult wisdom teeth, for example, you may have considerable swelling. Ice packs, applied immediately after the surgery, will help.  Ice cubes in a zip-lock bag, applied on and off for 20 minutes at a time, seems to help- and feels good! Place a wash cloth between your skin and the bag, however.  You may experience bruising over the surgical site- or even in distant areas, such as under the chin. This is not uncommon, and it will go away. You may experience tightness of the jaw muscles, too. After several days, this may respond to mild heat. Apply Vaseline or lip balm if your lips tend to crack or are sore from mild stretching. A slight elevation of temperature can be seen for 24-48 hours.

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours.

For severe pain, take the tablets prescribed 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.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. 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. 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.

* Eat something soft, cold and preferably with a milk base (unless you cannot tolerate milk products) approximately 20 minutes before taking prescribed pain medication. This will help with nausea.

* 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 (gentle soaks- not vigorously) 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 are sometimes 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 our office 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 over time. If not, they can be removed by Dr. Grantham.
  • 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 sometimes placed at the area of surgery to minimize post-operative bleeding and to help healing. We routinely use dissolvable sutures which will dissolve in approximately 5-7 days.  If silk sutures are used, a return appointment will be given to remove them approximately one week after surgery.  Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. 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 my office for instructions.

There will be a cavity where the tooth was removed. The cavity 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. Grantham or your family dentist.

Brushing your teeth is okay – just be gentle at the surgical sites.

Everyone is concerned about a dry socket, and they do occur, especially after difficult wisdom tooth surgery. If the clot is lost after the 2nd to 4th day, you may experience pain in the site and into the ear. It does not respond too well to pain medications. PLEASE call-we can help a lot.

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.