After Wisdom Tooth Removal

Home Instructions After Wisdom Teeth Extraction

The removal of impacted wisdom teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.

Immediately Following Surgery

  • The gauze pad placed over the surgical area should be kept in place for at least a half hour to 45 minutes. After this time, the gauze pad should be removed and discarded. The gauze will need to be changed every 45 minutes until the bleeding stops, which typically takes 6-8 hours.
  • Vigorous mouth rinsing and/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 either over the counter or the prescribed pain medications BEFORE you begin to feel discomfort. 
  • Restrict your activities the day of surgery and for at least 48 hours after. You can 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 a more thorough 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 bititing on tea bags for 45 minutes with firm pressure or applying pressure manually with thumbs/fingers. Repeat if necessary. The tannic acid in the black tea 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 our 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 or 2 days following surgery. The swelling may be minimized by the immediate use of ice packs. The ice packs should be used on and off 20 minutes at a time, continuously while you are awake. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery and will resolve on its own over time.

Pain

You should begin taking pain medication BEFORE you feel the local anesthetic wearing off.

For moderate pain:
3 tablets of 200mg Ibuprofen (over the counter) every 6 hours. You can alternate with 2 tablets of 500mg Extra Strength Tylenol every 6 hours if needed. Take the Ibuprofen first, then 3 hours later take the Tylenol. 3 hours after the Tylenol, take the next dose of Ibuprofen, and then continue the alternation schedule every 3 hours while awake.

For severe pain:
Narcotic pain medications can be prescribed and the medication should be taken as directed.
Narcotic pain medications do not help with swelling so they should still be alternated with Ibuprofen.
3 tablets of 200mg Ibuprofen (over the counter) or 600mg prescription strength Ibuprofen every 6 hours. You can alternate with 1 table of Norco or similar narcotic pain medication every 6 hours if needed. Take the Ibuprofen first, then 3 hours later take the narcotic. 3 hours after the narcotic, take the next dose of Ibuprofen, and then continue the alternation schedule every 3 hours while awake.

Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. 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.

Sample schedule:
8-9am: Surgery
10:00am: Ibuprofen 600mg
1:00pm: Tylenol 100mg if mild to moderate pain, Norco 5/325mg if severe pain 
4:00pm: Ibuprofen 600mg
7:00pm: Tylenol 100mg if mild to moderate pain, Norco 5/325mg if severe pain 
10:00pm: Ibuprofen 600mg
* Overnight dosing depends on pain control. If pain has been difficult to control, set an alarm for every 3 hours and stay on the schedule as above. If pain has been easy to control, set the next dose of pain medication by the bed with water and plan to take if you wake up in pain during the night. 

Diet

After general anesthetic or IV sedation only liquids should initially be consumed. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. A high calorie, high protein intake is very important. Our staff can provide suggested diet instructions. 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 any meals. 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 up for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. The day after surgery you should begin rinsing at least 2-3 times a day, especially after eating, with a teaspoon of salt mixed into one cup of warm water or a prescribed mouthrinse (Peridex, Chlorhexidine). 

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 will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. 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 juice, 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 reviewed in your consultation, 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. Call Dr. Chance if you have any questions.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists beyond 3-4 days, 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 could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting 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 Dr. Chance.
  • 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.

DRY SOCKET

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. You will not be able to see the blood clot coming out. You will also not be able to see the blood clot in the socket, even when it is present. If you see a socket or hole in your mouth, that is normal, no need to be concerned. 

Symptoms of dry socket include completely uncontrolled pain at the surgical site and even pain near the ear. This usually occurs 2-3 days following surgery. No matter which pain medications are taken (Ibuprofen, Tylenol, narcotics), the pain is not improvement. Call the office if this occurs. A dry socket is not dangerous and the site will still heal, it is just a slower process. 

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. The sutures will typically dissolve 1-2 weeks after surgery. They are not dangerous to swallow. 

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 void where the tooth was removed. The void will fill in with new tissue gradually 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 unique, no two mouths are alike. Discuss any problems with the trained experts best able to effectively help you: Dr. Chance or your family dentist.

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

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.