After Wisdom Tooth Removal

Home Instructions After Wisdom Teeth Extraction

The removal of impacted wisdom teeth is an invasive 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

• Keep the gauze pad on the surgical area for 30 minutes, then discard the gauze pad.
• Avoid vigorously rinsing your mouth and/or touching the wound area following surgery. This can cause bleeding when the blood clot is dislodged. 
• Take the prescribed pain medications before the numbness wears off.
• Restrict your activities the day of surgery and resume normal activity when you feel comfortable – typically 3-10 days.
• Place ice packs on the sides of your face where surgery was performed. Refer to the section on swelling for a more thorough explanation.

Bleeding

Following surgery, slight bleeding, oozing, or redness in the saliva is expected. 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 moistened green or black tea bag for thirty minutes. The tannic acid in the tea helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit with your back propped up, 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 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 that we provide. The ice packs should be left in place while you are awake. After 48 hours, ice has minimal effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Three days following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

You should begin taking pain medication prior to the local anesthetic wearing off.

• NSAIDs:
  • NSAIDs (Ibuprofen, Aleve, Motrin, Aspirin, Naproxen, Advil, Lodine, Etodolac, etc) are additive. We recommend using only one type of these medications such as Lodine (Etodolac) OR  Ibuprofen (Motrin).
    • Ibuprofen:
      • Over the counter comes in 200 mg tablets. Taking three or four 200 mg over-the-counter tablets has equivalent pain and inflammation control as a prescription 600 mg or 800 mg tablets.
      • Do not exceed 3200 mg daily for an adult
      • Take two tablets (400 mg) every 4 hours OR three tablets (600 mg) every 6 hours OR four tablets (800 mg) every 8 hours. 
    • Lodine
      • Typically prescribed at 400 mg
      • Take 1 tab every 8 hours
  • Ask you doctor prior to taking these medications if you are on a blood thinner.
• Tylenol (acetaminophen)
  • This is a different medication class than NSAIDs. It is safe and more effective to take in tylenol in addition to NSAIDs.
  • Comes in strengths of 325 mg, 500 mg, or 650 mg.
  • Max dose of 3000 mg daily for an adult. Be aware that many other medications such as Dayquil, decongestants, antihistamines, and some narcotics also have Tylenol (acetaminophen) added to them.
  • You may take three 325 mg tablets (975 mg) every 8 hours, or two 500 mg tablets (1000 mg) every 8 hours, or one 650 mg tablet every 6 hours.
  • Discuss with your physician prior to taking Tylenol if you have a history of hepatitis, alcohol abuse, cirrhosis, or other liver disease

It is safe and advisable to take both Tylenol and NSAIDs. Maximum pain relief and fewer side effects occur when the medications are staggered. Consult our practice for individuals under 18. 

For procedures that  cause more severe pain, a narcotic may be prescribed. This narcotic should be taken in addition to an NSAID (such as Ibuprofen or Lodine) and Tylenol (acetaminophen). If you are taking a narcotic, do not drive an automobile, work around machinery, or drink 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.

ANTIBIOTICS

Post-operative antibiotics are not prescribed or indicated after routine tooth extraction or when the infection was localized around the tooth. If antibiotics were prescribed, take them as directed to help prevent or treat an infection. Antibiotics are prescribed in certain medically compromised patients and cases of bone grafting, active purulent drainage, and facial swelling. 

An antimicrobial mouth rinse (Peridex/Chlorhexidine) is frequently prescribed in the above situations as well as procedures requiring incisions and bone removal.

ORAL HYGIENE

Good oral hygiene is essential to good healing. No rinsing of any kind should be performed until the day following surgery. An antimicrobial mouthwash (Peridex/Chlorhexidine) may be prescribed. If it was prescribed, begin use the day following surgery after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt water rinses (one teaspoon of salt in a cup of warm water) may be used 4-5 times a day if desired for patient comfort; however, salt water rinses do not lower your infection rate or speed up healing. Gently brush your teeth around the surgical areas.

ACTIVITY

Keep physical activities to a minimum for the first 3-5 days immediately following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking in normal nourishment. This may weaken you and further limit your ability to exercise.

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.

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.

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 zofran was prescribed, it may be taken to improve nausea. 

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 Drs. Cudney or Ingoldsby 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 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 Drs. Cudney or Ingoldsby.
• 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.

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. Quickly dissolving sutures after wisdom teeth do not need to be removed and will dissolve on their own within 3-10 days.

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 several months. 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: Drs. Cudney or Ingoldsby or your family dentist.

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

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain near the ear may occur 3-5 days following surgery. Call the office if this occurs.

Infections are rare. The majority of infections after wisdom tooth removal occur 3-6 weeks after surgery and typically require antibiotics and a minor surgery to clean the site.

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.