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 to 45 minutes. After this time, the gauze pad should be removed and discarded.
- Vigorous mouth rinsing or touching the wound area following surgery should be avoided for the first 24 hours. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
- Take the prescribed pain medications preferably before the numbness in the area has dissipated completely and definitely it should be taken as soon as you begin to feel discomfort with slight numbness still present. Pain medications usually take 45 minutes to 1 hour to take full effect so if there is still considerable pain then another tablet is usually advised. If after the second tablet is taken and there is still pain after 45 minutes then a call to the office is advised to discuss dosing or changes to the medication.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable. Strenuous physical activity should be avoided for 4 days post operatively. Light work outs can start 3 days post operatively depending on the surgery and activity.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Most common causes of bleeding is caused by excessive changes of the gauze pads either too frequently such as every 30 minutes or less and too many changes of the such as more than 3-4 times for one site. Spitting, rinsing the mouth or using straws to drink with in the first 24 hours will also cause increased bleeding. Excessive bleeding may also be caused by a poorly formed clot called a ‘liver clot” because it looks like liver and usually protrudes above the socket. This liver clot bleeding may be controlled by wiping any loose, old clots from your mouth with moist gauze, then placing a moistened gauze pad over the area and biting firmly for 45 minutes. Repeat the gauze change if necessary and hold in place for 1 hour to 1 ½ hour period. 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.
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 placed on the sites 20 minutes on and 20 minutes off while you are awake. After 24 hours, ice has no beneficial effect and can actually cause more soreness, stiffness and keep the swelling from dissipating as fast as it would normally. If swelling or jaw stiffness has persisted for several days with no increase in size of the swelling or decrease in opening of the mouth, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat alternating with cold compresses but ending with heat in the cycle to the sides of the face is beneficial in reducing the size of the swelling and stiffness of the jaws. If there is increased swelling after the third day of surgery along with increased pain then you need to notify the doctor of this issue especially if there is a fever above 100 degrees Fahrenheit taken orally or by temporal artery monitors.
For moderate pain for patients over the age of 12 years, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every six hours or Ibuprofen; (Motrin or Advil) two to four 200 mg tablets may be taken every 6-8 hours with food. Burning stomach or patients with an ulcerative disease or kidney disease will need to avoid or reduce the dose of Ibuprofen significantly. For dull ache and throbbing pain in the postoperative period, Ibuprofen or the other NSAIDs class of drugs seem to be more beneficial than Tylenol and the narcotic medications.
For severe pain, take the tablets prescribed as directed. These will usually be narcotic drugs such as, Ultracet, Vicodin, Percocet, Dilaudid or Tylenol with codeine. The prescribed narcotic pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid taking with alcoholic beverages and do not take with sleeping pills or sedative pills as these combinations can cause a dangerous over-sedation condition which would be life-threatening. Pain or discomfort following surgery should subside more and more every day, especially after the third day. If pain persists or increases whereupon you are taking more medications than the first 2 days and cannot sleep well, it will likely require attention and you should call the office.
After general anesthetic or I.V. sedation, clear liquids should be initially taken for the first 8-12 hours but do not use straws for the first 24 hours rather you can drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. The diet for the second half of the day after surgery which is about 12 to 24 hours later you should stay on full liquids such as yogurt, pudding, ice cream, milkshakes and protein drinks, cream soups or plain porridge soup.
After 24 hours, you may eat anything soft but avoid spicy foods. The spices tend to irritate the wounds up to 2 weeks postoperatively. 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 to three minutes before standing. Immediately after surgery and also after the first dose of narcotic pain medication, someone should be nearby when you start to walk around to help you if you become faint or to prevent you from falling/stumbling/tripping.
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 4-6 times a day especially after eating your meals with a cup of warm water mixed with a teaspoon of salt. You can also drink water with your meals with slight swishing the day after surgery to also help keep the sites cleaner. At follow up you will be provided instructions on how to use a Monoject syringe to help irrigate the sites directly with warm water to help keep the sites clean while the sockets heal in with tissue. If you have one of these or are provided one before surgery I do not recommend using the syringe before the second day after surgery.
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 alternated with cold compresses applied to the area may speed up the removal of the discoloration.
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Missing one dose time is usually not a problem if you have been on it for a couple days but take the next dose as soon as possible and in this case doubling the next dose usually is not necessary. Missing more than 24 consecutive hours of antibiotics within the first 3 days of dosing schedule can be a problem and a call to the doctor is recommended to discuss the situation. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Rash, itching or swelling with use could indicate an allergic reaction and you must alert the doctor of these findings immediately. Swelling of the neck and face other than at the surgical site accompanied with difficulty in breathing is a life-threatening allergic problem and calling 911 and/or going to the nearest emergency room is advised. Other problems that antibiotics could cause that you may need to advise your doctor of is a sudden development of diarrhea as this could signify a antibiotic-induced colitis of the bowels that may need treatment.
Call the office if you have any questions.
Nausea and Vomiting
In the event of nausea and/or vomiting following surgery take the medications noted on the packed for nausea provided at discharge from the office for this purpose. If you do not have them for some reason, call the office. You should then sip either plain water or ginger ale to take the medications and keep hydrated. You should sip slowly over a fifteen-minute period. When nausea subsides you can begin taking thicker foods and the prescribed pain medicine starting with half the initial dose or with an alternative pain medication if that is prescribed after discussing the situation with the office.
- 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. Chun if you have any questions.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature is over 100 degrees Fahrenheit or 37.8 degrees Celsius via oral or temporal artery monitors, 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 sometimes postoperatively it is sometimes difficult to take fluids so you may be dehydrated. Taking pain medications can also make you dizzy. Anyone of these factors could cause you to get light headed when you stand up suddenly and possibly faint. Before standing up, you should sit upright for one to three minutes before standing and attempting to walk.
- Occasionally, patients may feel hard or sharp projections in the mouth with their tongue. They are not roots; they are the bony walls which supported the tooth. These projections called bone spurs usually smooth out spontaneously by themselves. If not, they can be removed by Dr. Chun.
- 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 1-2 days. Immediately postoperatively, this usually indicates suboptimal dosing (under medicating) of the prescribed pain medications.
- 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 usually resolve in time by itself without treatment. However, if there is tightness or limited opening of 2 vertical finger breadths persisting more than four to five days after surgery, then intermittent hot and cold compresses applied to sides of the jaw, anti-inflammatory drugs such as Ibuprofen combined with mouth opening stretch exercises to regain the normal range of motion (3 vertical finger breadths) may be advised at your follow-up appointment.
Sutures are placed in the area of surgery to minimize post-operative bleeding and to help to heal. Sometimes they become dislodged; this is no cause for alarm and they will fall out by themselves usually within the next 24 hours. If they are very loose and dangling, you can just remove the suture from your mouth and discard it. The sutures will be removed approximately one week after surgery but many will be gone by that time or mostly dissolved and easily removed. The removal of sutures requires no anesthesia or needles. It takes usually less than a minute to remove sutures, there is minimal to 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 of the face worsens after the third day from surgery or unusual symptoms occur call the office to discuss the situation and obtain instructions.
There will be a concavity or pocket where the tooth was removed. The concavity will gradually over the next two months to fill in with the new tissue. In the meantime, the area should be kept clean especially after meals with salt water rinses for 1-2 weeks, the Monoject syringe provided at follow-up for four to six weeks and your 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. Chun or your family dentist.
Brushing your teeth is advised by the second day after surgery – just be gentle at the surgical sites and you may want to avoid the extraction sites by not brushing them directly for 3-4 days with the toothbrush. You can begin with a gentle whisk with a soft brush over the sites usually by the fourth day.
A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of increased pain at the surgical site and even pain referred to the ear or temples or front teeth on the side of the pain may occur 2-3 days following surgery. It would be difficult to sleep through the night on the pain medications even taking the medications on the first day of surgery. If these symptoms are occurring, call the office if this occurs so it can be treated.
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.