Wisdom Teeth Removal

Post Op

Instructions

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. In particular your diet and hygiene affect your healing tremendously

Immediately Following Surgery

Surgery

The gauze pad placed over the surgical area should be kept in place for an hour. After this time, the gauze pad should be removed and discarded. If active bleeding is still present from the surgical site(s), fold up a new piece of gauze tightly and bite down on it for another hour. Be sure the gauze is placing pressure on the surgical site and avoid checking for bleeding before the hour is up. Failure to do this will result in prolonged bleeding. Remember that blood mixed with saliva will appear to be more bleeding than is actually present. You will be given extra gauze when you go home. Should you run out of gauze, a moistened tea bag may be substituted.
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. Avoid rinsing, swishing or spitting for 48 hours after surgery.
Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished. Be sure to drink some juice, soup broth or similar liquid with your pain medication to prevent nausea. Take pain medications as advised - Two Advil (ibuprofen) 400mg and 1 Tylenol (Acetaminophen) 500mg four times daily - you can take your narcotic pain medication as needed between these doses or before bed if necessary
Restrict your activities the day of surgery and the next day. 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. Apply ice for about 20 minutes of each hour while the patient is awake during the first 48 hours after surgery. After 48 hours use heat instead.

Bleeding

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 sixty minutes. Repeat if necessary and be sure the gauze is putting pressure over the surgical site. If bleeding continues, bite on a moistened tea bag for sixty 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, or 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 for 20 minutes of each hour 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 to the sides of the face is beneficial in reducing the size of the swelling.

pain

Pain

For moderate pain, one Tylenol (Acetaminophen) Extra Strength may be taken every four hours with Motrin or Advil (ibuprofen) two-three 200 mg tablets may be taken every 4-6 hours. For severe pain, take the tablets prescribed as directed, which may be a narcotic between those doses or at bedtime. 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

Diet

After 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 form 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. 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.

mouth

Keep the mouth clean

No rinsing of any kind should be performed until 48 hours following surgery. You can brush your teeth the day after surgery using warm water on the toothbrush, but do not rinse, swish or spit. Two days 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. You may also be given a plastic syringe to help irrigate out food debris from the surgical sites. Do not begin using the syringe until 48 hours after surgery.

dlt

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.

RX

Antibiotics

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

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. Taking your pain medication on an empty stomach can cause nausea.

Other Complications

Complication

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. An elevated temperature above 100.5 F is considered to be a 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. If not, they can be removed by our doctors
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 carmex or lip balm.
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

Finally

Sutures may be 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 sutures are usually dissolvable and require no 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 hole where the tooth was removed. The hole will gradually close over the next month and fill in with 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: Drs. Zeller and Baker or your family dentist.
Brushing your teeth is okay after 24 hours- just be gentle at the surgical sites, use only warm water on your toothbrush and avoid rinsing, swishing or spitting for 48 hours.
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.