Post-Operative Instructions: 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 20 minutes after you are discharged from our office. After this time, the gauze pad should be removed and discarded. Refer to the section on bleeding for further instructions. Place ice packs to the areas of your face where surgery was performed. Restrict your activities the day of surgery and resume normal activity when you feel comfortable.

For the first 72 hours, do not:

• Disturb the site
• Use straws
• Drink anything with carbonation
• Vigorously rinse, swish, or spit
• Smoke

BLEEDING

Some bleeding is expected after tooth extractions. It’s important for a blood clot to form to stop the bleeding and begin the healing process. That’s why we ask you to bite on a cold, damp gauze pad for 30 minutes after the appointment. If the bleeding or oozing persists, you will need to moisten the gauze with ice-cold water, squeeze out the excess water, and bite down with firm pressure for 20-30 minutes. If bleeding continues, moisten a tea bag with ice-cold water and bite down for 20-30 minutes. The tannic acid in the tea bag helps to form a clot by contracting the blood vessels. A small amount of bleeding can continue intermittently for a couple of days especially if the area is stimulated by movement. After the blood clot forms, it is important not to disturb or dislodge the clot, as it aids in healing.

SWELLING

Swelling is also a normal part of post-operative healing and can increase for 2-3 days following any surgery, slowly resolving after this. You may apply an ice pack to the area for 20 minutes at a time for the first 24 hours; this will help minimize pain and swelling during this time. After 24 hours, you may switch to warm, moist heat.

MEDICATIONS

If you have been sedated for your procedure, you may not drive for 24 hours. If you have been prescribed a narcotic pain medication, you also cannot drive while taking this. If an antibiotic mouth rinse is prescribed, do not begin using until the day after your procedure to avoid stimulating further bleeding. If an antibiotic was prescribed, make sure to take as directed and until completely gone to help prevent infection.

PAIN

You should begin taking pain medicine as soon as you feel the local anesthetic start wearing off. For mild to moderate pain, ibuprofen (Advil® or Motrin®) may be taken. Ibuprofen bought over the counter comes in 200mg tablets: 3 tablets may be taken every 6 hours as needed for pain. You may alternate with 2 Extra Strength Tylenol® as needed (example: 12 PM—Ibuprofen, 3 PM—Tylenol, 6 PM—Ibuprofen, 9 PM—Tylenol). For severe pain, the prescribed pain medicine should be taken as directed with food. Tylenol may be in the prescribed pain medication; therefore, do not take Extra Strength Tylenol when taking prescribed pain medication. Do not take any of the above medications if you are allergic or have been instructed by your doctor not to do so.

For children, use over-the-counter Children’s Tylenol® or ibuprofen as directed per instructions on the bottle as needed for pain.

DIET

Hydration and nutrition are important for healing following surgery. You may be more comfortable with a soft diet initially, but you can eat what you like. You are only limited by your discomfort. Stick to cold and/or soft foods and liquids while you are numb. Remember to always eat prior to taking any pain medication to avoid nausea. Return to a normal diet as soon as possible unless otherwise directed.

ORAL HYGIENE

Good oral hygiene is essential for healing. Continue brushing and flossing your teeth, avoiding the surgical site(s) initially; remember, no vigorous swishing or spitting for 72 hrs.

An irrigating syringe will be given to you on the day of surgery. Start using an irrigating syringe to lower extractions sites 72 hours (3 days) after surgery. You will fill the syringe with warm water or Peridex® (if prescribed), insert the tip gently into the opening at the lower extraction site, and flush out any trapped food or debris after every meal and as needed. You will need to do this until there is no longer an opening to trap food.

ACTIVITY

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing and/or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking in normal nourishment, which may weaken you and further limit your ability to exercise. Limit any vigorous exercise for 24 hours after surgery, as this will increase blood pressure and may cause more bleeding from the extraction sites.

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 sensation, so be careful. Call our office if you have any questions.
• 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.
• Slight elevation of temperature immediately following surgery is not uncommon. Remember to drink plenty of fluids. Contact our office for temperatures over 101 degrees.
• You should be careful going from the lying down position to standing. Standing suddenly can cause you to get light headed. Taking pain medications may cause you to be lightheaded and dizzy as well.
• Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots: they are the bony walls that once supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by the doctor.
• A sore throat may develop; the muscles of the throat are neat extraction sites. Swelling in the throat muscles can cause pain. This is normal and should subside in 2-3 days.
• Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth following surgery. This is a normal post-operative event which will resolve in time. Warm, moist heat may help.

FINALLY

• Sutures may have been placed; if so, they will dissolve on their own in 7-10 days. Sometimes they become dislodged—this is no cause for alarm. Just remove the loose suture from your mouth and discard it.
• The pain and swelling should subside more and more each day following the first 3-4 post-operative days. If your pain or swelling worsens or unusual symptoms occur, call our office.
• There will be an opening where the tooth was removed. The opening will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean, especially after meals with warm water rinses, a toothbrush, or your irrigating syringe.
• 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, our doctors, or your family dentist.
• A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms include severe pain at the surgical site unrelieved by pain medications and may even radiate to your ear. This usually occurs 2-3 days following surgery. Call our office if this occurs.