After Wisdom Tooth Removal
Immediately following surgery
- Bite down firmly on the gauze to slow down the bleeding and leave in place for 30 minutes. After this time the gauze should be discarded. If still bleeding fold up two more gauze and place all the way to the back of the teeth area and bite down again for another 30 minutes and repeat if needed. Do not talk as this will not allow biting down on the gauze efficiently.
- As you can swallow a pill take 3 over the counter tablets of ibuprofen if not contraindicated by your physician or package insert. Patients taking blood thinners or history of gastritis, stomach ulcers, severe asthmatics, or those allergic to NSAIDS should avoid ibuprofen, aleve, and other similar drugs. Ibuprofen can block pain molecules and prevent inflammation. The narcotic medication especially when taken immediately after a sedation may induce nausea and vomiting. However, if you feel the numbness is already starting to wear off and are already beginning to hurt you may want to go ahead and take the pain medicine soon.
- The local anesthesia or numbing medicine used will begin wear off about a couple of hours however, this time begins after it was given, which may have been an hour prior to discharge. Take the prescribed medicine as soon as you feel the numbness wearing off and/or discomfort.
- If you feel you need to get something in your stomach so you will not get sick, consume something liquid until the bleeding stops. Preferably not dairy. A smoothie is a great option.
- Avoid vigorous mouth rinsing or touching the wound today as this may dislodge the clot. Gentle warm salt water rinses may be used to clean the mouth of dried blood.
- Place ice packs on the sides of your face where the surgery was performed. Refer to the section on swelling for explanation.
- Restrict your activities the day of surgery and be aware that the sedation and medications we prescribe may make you dizzy. You should have someone with you after surgery to assist you if needed.
- If you have any questions, please read below and/or call our office. In order, to get a response you must leave a message with your name and phone number and follow the prompts.
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 wiping any old large protruding clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Remember you want to leave a clot in the socket but don’t need a large clot growing out of the socket. Repeat firm biting on the gauze if necessary. If bleeding continues, bite on a moistened tea bag for thirty 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, get your pain under control, sit upright, and avoid exercise. If bleeding does not subside, call our office for further instructions or seek medical attention.
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 later that day or 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 48-72 hours, ice has no beneficial effect on swelling. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Forty-eight hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. If swelling subsides then increases again this then could be a sign of infection or inflammation. If your swelling is associated with a temperature >100.4 F, firm warm redness of the neck, difficulty swallowing, or difficulty breathing, please call our office and /or seek medical attention.
For mild to moderate pain, one or two tablets of over the counter Tylenol or Extra Strength Tylenol may be taken every four to six hours or Ibuprofen, (Motrin or Advil – contraindicated in patients with gastritis, stomach ulcers and blood thinners- see package insert for details and other contraindications)) two-four 200 mg tablets may be taken every 4-8 hours. A maximum dose of Tylenol is 3000 mg in a 24 hour period and Ibuprofen is 3200 mg in a 24 hour period. Remember most pain medicine formulations have Tylenol in them (usually 325 mg per whole pill). Consult your family doctor, pharmacist, and/or the package insert if you think you may not be able to take certain over the counter medications.
For moderate pain, 600 mg of ibuprofen and 500 mg of Tylenol (acetaminophen).
For severe pain, take the 400-600 mg of ibuprofen and 5-10 mg of the hydrocodone or oxycodone pain meds prescribed. Usually, 1/2 of a pain pill (5mg of hydrocodone or oxycondone) and 400mg of Ibuprofen will keep most pain away during the recovery. You can alternate the prescribed pain medication with Ibuprofen taking one or the other every two hours. If you have any questions regarding this regimen please call our office.
The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Be careful going up or down stairs. Avoid alcoholic beverages. Avoid strenuous exercise until off of pain meds. Pain or discomfort following surgery should subside more and more every day. If severe pain persists or worsens after 3 days, it may require attention and you should call the office. This may be a sign of dry socket.
After general anesthetic or I.V. sedation, clear liquids should be initially taken. Do not use straws for the first 24-48 hours. Drink from a glass. The sucking motion can cause more bleeding. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Stick to soft foods such as soups, grits, creamed veggies or beans, eggs, flaky fish, pasta, smoothies, shakes, etc…. Your food intake will be limited for the first few days. Try to take at least 5-6 glasses of liquid 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. 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.
Keep the mouth clean
No vigorous 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 3 times a day (after each meal) by placing the curved plastic syringe just into the socket or under the gum and flushing out the food particles as the assistant showed you or your caregiver after surgery. This will create turbulence and wash out any food that is trapped under the gum. Use a mixture of 8 oz of warm clean water and 1/2 teaspoon of salt. Discard this each day and keep the syringe clean and store in a clean place. If you lose it come by the office and pick up another one as soon as possible. Note: no matter how difficult it is to open, how uncomfortable it is, or how hard it is to see back there, you must rinse out these sockets in order to help prevent a dry socket. Use the Peridex rinse two times a day after brushing starting the night of surgery or the next day. This is only used as a mouthwash and not used to irrigate the sockets. It will not hurt to rinse the sockets with Peridex but it is not necessary.
In some cases, discoloration of the skin (bruising) 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 are not routinely prescribed for teeth extractions. 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. Most of you will be given an antibiotic rinse called peridex and this should be used twice daily after brushing teeth. Take 15-30 ml and swish and spit after 1 min. Use this for one week unless directed by your doctor. Prolonged use can stain the teeth and tongue brown. This stain if present can be removed with brushing and/or your hygienist.
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 can take the prescribed nausea medication if not an oral route. You should then try ice chips first, then sip on sprite with the bubbles stirred out 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 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 Drs. Dupree, Chandler, & Kelley if you have any questions.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists or is greater than 100.4, notify the office. Tylenol or ibuprofen can be taken to reduce the fever as long it is not contraindicated by your history.
- 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 Drs. Dupree, Chandler, & Kelley.
- 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. If you are ever concerned or have questions please call our office and let us know.
- Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a common post-operative event which will resolve in time. Again, if you are concerned or have questions please call our office or seek medical advice.
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 form your mouth and discard it. Sutures will fall out on their own. If they have not fallen out in a week or two you can call for an appointment to have them removed.
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 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: Drs. Dupree, Chandler, & Kelley or your family dentist.