After Wisdom Tooth Removal

post-operative care for Third Molars

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. After this time, the gauze pad should be removed and discarded. If bleeding persists, dampen a new gauze pad and replace in same area.
  • 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.
  • Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
  • Restrict your activities the day of surgery and 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 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 first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary.
  • If bleeding continues, bite on a warm, moistened tea bag for thirty minutes; tea has an ingredient that helps to promote blood clotting.
  • To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling

  • 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 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 left on continuously while you are awake. After 48 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.
  • 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.

PAIN

  • Some degree of discomfort and pain may arise as the numbness wears off. At the first sign of pain or discomfort, take the tablets prescribed as directed, or you may substitute 2-4 Advil. Repeat these dosages every 6-8 hours if needed.
  • If the Advil or Ibuprofen  are not strong enough for the pain you are having, you may then switch to the prescribed severe pain medication but only in small doses and only after eating some food. Any pain medication can cause nausea and vomiting; it is very important to eat a small amount of food before taking these medications.
  • 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. Pain or discomfort following surgery should subside more each day. If pain persists, it may require attention and you should call the office.

Diet

  • DO NOT USE A STRAW for several days. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot.
  • You should begin drinking clear carbonated beverages such as ginger ale, Sprite, or 7-Up. Once your stomach has settled, you can advance to other fluids including water, tea, sodas, broth, soups, and juices. 
  • Avoid hot liquids until the numbness has worn off and the bleeding has stopped. 
  • You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important.
  • 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.
  • You can also try Ensure, Instant Breakfast added with milk, and yogurt to supply added nutrition.
  • DO NOT DRINK ALCOHOLIC BEVERAGES WHILE TAKING PRESCRIPTION PAIN MEDICATION.

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 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.

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 other unfavorable reaction. 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 coke, 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. If this persists, please call the office.

Medications

  • If you take birth control pills, you should be aware that the pills may not be effective while you are taking antibiotics.
  • You may take any of your regularly scheduled medications (for diabetes, high blood pressure, etc) on your regular schedule unless your doctor has advises otherwise.

SMOKING

  • DO NOT SMOKE until the sockets are completely healed. Smoking can loosen the formed blood clots, which will lead to a painful dry socket and can disrupt the healing process.

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 the sensation. So be careful. 
  • 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 support the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Campbell.
  • 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 time.

Finally

  • DO NOT drive any motorized vehicles for 24 hours following surgery if you have had IV sedation (being “put to sleep”) or if you are taking prescription pain medications.
  • Sutures are placed 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. 
  • 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.
  • Do not blow your nose.
  • Do not sneeze through the nose only; you must sneeze with your mouth open.
  • 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. Campbell or General Dentist.
  • Avoid swimming or strenuous exercise for at least one week.