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 30-45 minutes. After this time, the gauze pad should be removed and discarded. If the bleeding or oozing still persists, insert another gauze pad and bite firmly for another 30 minutes. You may have to do this several times.
  • Unless otherwise instructed, take your first dose of ibuprofen (Motrin or Advil) 400 mg (2 tablets) before the local anesthesia wears off to decrease the initial pain. If you feel it is necessary, you may take the prescribed pain medication.
  • If it is necessary to take a prescription medication for pain, you may take it in conjunction with the ibuprofen or staggered with the ibuprofen.
  • 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.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.

Pain

The following dosages are for adults, if the patient is less than 100 lbs, please ask the doctor for appropriate pain medication dosages.

For moderate pain, ibuprofen (Motrin or Advil) 400mg (2 tablets) should be taken every three to four hours on a regular schedule. By taking this pain medication regularly and keeping the blood levels constant, the medication can work better and often less prescription narcotic pain medicine is necessary.

If you cannot take ibuprofen, you can take two, regular strength (325mg) acetaminophen (Tylenol), or one extra strength (500mg) every three to four hours, keeping in mind that no more than 4 grams may be take in 48 hours. The prescription medication may have some of this medication in it as well and should be taken into account.

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. You may take the prescription medicine it in conjunction with the ibuprofen or staggered with the ibuprofen.

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.

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 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag (regular tea, not herbal) for 30 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.

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 bodys 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 two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. In some cases you will be provided with ice packs. Two plastic bags 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 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.

Diet

Drink liquids after intravenous anesthesia. Do not use straws when drinking 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 site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. 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 five to six 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.

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.

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.

Oral Hygiene

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 five to six times a day with a cup of warm water mixed with a teaspoon of salt especially after eating.

REMEMBER: A clean wound heals better and faster.

Activity

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

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 postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

Antibiotics are not routinely prescribed, but 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 or other unfavorable reaction. Call the office if you have any questions.

Nausea & 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 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.

Other Complications

  • 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 two to three days following surgery. Call the office if this occurs.
  • 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 please be careful.
  • A 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 suddenly stand up. Before standing up, you should sit for one minute and 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.
  • 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 two to three 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 that will resolve in time.

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 from your mouth and discard it. If the sutures are not the dissolvable type, they will be removed approximately one week after surgery. 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 its really nothing to worry about.

There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue over the next month. In the meantime, 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. Aslanian and Bergen or your family dentist.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office. Please try to call during office hours, however a 24-hour answering service is available for after hours contact with a doctor.  The afterhours telephone number is Greenwich Office Phone Number 203-661-4231.