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.
Post Operative Instructions
PLEASE READ THESE INSTRUCTIONS CAREFULLY. Sometimes the after-effects of oral surgery are quite minimal, so not all of these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office any time for clarification.
DAY OF SURGERY
- FIRST HOUR: Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. DO NOT DISTURB them for the first 30 minutes in order to control the bleeding. If active bleeding persists after 30 minutes, replace with new gauze and bite down gently but firmly for another 30 minutes. The gauze may be dampened and/or fluffed for more comfortable positioning.
- EXERCISE CARE: Do not disturb the surgical area today, except to place/replace gauze. Do NOT suck through a straw for the first 24 hours. DO NOT rinse or spit for the first 24 hours.
- DO NOT SMOKE for at least 48 hours, since it is very detrimental to healing. It is advisable to avoid smoking for at least 7 days following surgery. Smoking is one of the main causes of dry socket.
- STEADY BLEEDING: Bleeding should never be severe. If it is, this usually indicates the pressure packs are being clenched between your teeth rather than on the surgical areas and need to be repositioned. If bleeding persists or becomes heavy you may substitute a tea bag (moisten with cold water, squeeze excess water and wrap in a moist gauze) for one hour. If bleeding remains uncontrollable please call our office.
- SWELLING: Often there is swelling associated with oral surgery. This should peak about the second or third day. You can minimize this by using a cold pack or an ice bag wrapped in a towel and applied firmly to the face or cheek adjacent to the surgical area. This should be applied 30 minutes on and 30 minutes off during the first 48 hours. After the first 48 hours, it is usually best to switch from ice to moist heat to the same areas.
Unfortunately, some oral surgery is accompanied by some degree of
discomfort. You will usually have a prescription for pain medication, and
if you take the first pill before the local anesthetic has worn off, you
will be able to manage any discomfort better. Effects of pain medicines
vary widely among individuals. Remember that the most severe discomfort is
immediately after the local anesthetic wears off, after that your need for
medication should lessen.
You may want to stagger the narcotic medications (Hydrocodone/Codeine) with Motrin, Advil, or Ibuprofen. However, you should not drive or operate machinery while taking prescription pain medications.
- NAUSEA: Nausea can happen after surgery, and it is sometimes caused by stronger pain medications. Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with a large volume of water. Try to keep taking clear fluids and minimize the pain medication, but call us if you do not feel better or if repeated vomiting is a problem. Soft drinks that have less carbonation may help with nausea.
- DIET: Eat any nourishing food that can be taken with comfort once the numbness has gone away, but avoid extremely hot foods. It is advisable to confine the first day’s intake to bland liquids, soft or pureed foods (creamed soups, puddings, yogurt, milkshakes, ice cream, Popsicle’s, etc.). Avoid foods like nuts, sunflower seeds, popcorn, etc., that may get lodged in the socket areas. Over the next several days you can progress to solid foods at your own pace. It is important not to skip meals! If you take nourishment regularly, you will feel better, regain your strength, have less discomfort and heal faster. If you are diabetic, maintain your normal eating habits as much as possible and follow instructions from us or your physician regarding your insulin schedule.
- If you have been given a prescription for antibiotics, take as directed. Be sure and take antibiotics and pain medicine at least ONE HOUR APART, as to not upset your stomach.
INSTRUCTIONS FOR THE SECOND AND THIRD DAYS
- MOUTH RINSES: Keeping your mouth clean after surgery is essential. Begin using the prescription mouth rinse (Peridex or Periogard) as directed. If you did not receive a prescription mouth rinse, use one half teaspoon of salt dissolved in an 8-ounce glass of warm water and gently rinse for 5 minutes. Repeat this as often as you like, but at least two to three times daily for 5 days.
- BRUSHING: Begin your normal oral hygiene routine the day following surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort. Stay away form the surgical areas with your toothbrush.
- DRY SOCKETS: Normal healing after tooth extraction should be as follows: The first three days following surgery are usually uncomfortable and there is some degree of swelling and stiffness. After the third or fourth day you will usually be far more comfortable and, although still swollen, you can usually begin a more substantial diet. GRADUAL and STEADY IMPROVEMENT should mark the remainder of your post-operative course. If a dry socket occurs (loss of the blood clot from the socket, usually on the third to fifth day after surgery) there is a noticeable, distinct, persistent throbbing pain in the jaw, often radiating toward the ear and forward along the jaw to cause other teeth to ache. If you do not see steady improvement after the first few days of surgery, don’t suffer needlessly. Call the office and report your symptoms so you can be seen as soon as possible.
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 where you had your surgery. Calling during office hours will allow you faster access to the Doctor; however, a 24-hour answering service is also available for after hours contact. In the event of an emergency and you are unable to get an answer through our office phone numbers, please call the answering service directly at the number listed below.
After office hours: Emergency direct line to answering service 408-265-9600
- 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. Carroll 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.
- 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 Dr. Carroll.
- 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 (Trimus) 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
Sutures are sometimes placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. The sutures that are used will dissolve on their own. Just remove the suture from your mouth and discard it.
The pain and swelling should start to subside after 3-4 days and improve more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call my office for instructions.
There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the 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: Dr. Carroll or your family dentist.
Brushing your teeth is okay – just be gentle at the surgical sites.