After Extraction of Wisdom Teeth

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. The information below follows the same instruction listed on the “Wisdom Teeth After Surgery” card provided to you before leaving our office. Below we discuss day by day instructions for the first week after surgery, common concerns patients bring up and symptoms that may occur after surgery, and potential risks, or problems that may occur after wisdom tooth removal.

General Tips for the first week Following Your Surgery:

• Keep your head elevated (even while sleeping) and relax for the first few days! Watch movies, drink milkshakes, and take pain medicine if needed.
• DO NOT use straws
• DO NOT spit (even when cleaning your mouth)
• DO NOT drink alcohol or smoke
• DO NOT eat hard, crunchy, spicy or hot food

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The First Week After Wisdom Teeth Removal

Day 1: The Day of Surgery

• After leaving our office get a smoothie to take with pain medication and antibiotics. Taking medicine on an empty stomach will most likely cause nausea and it is important to have the pain medicine working fully when the numbness wears off.
  • Take the gauze out of your mouth when eating or drinking (remember NO straws) and replace with new gauze directly after.
  • Continue with a liquid diet for today. (ice cream, cool soup broth, yogurt, milkshakes).
• Keep the gauze in place and avoid talking and touching the area. Change gauze every 30 minutes. Gauze is to be used until the bleeding stops, which is usually a few hours after surgery. If bleeding doesn’t stop use a moist tea bag. The wound(s) will continue to ooze for a few days.
• A blood clot will form within the tooth socket which is good and helps prevent dry socket. DO NOT rinse, brush or touch areas with finger or tongue.
• To stay ahead of pain take 600 mg Ibuprofen every 6 hours (even if you don’t think you need it). If the pain has increased and your doctor has prescribed a narcotic, you may take it with Ibuprofen. DO NOT take narcotics with Tylenol as it is already contained within the narcotic.
• To help prevent swelling, ice the area 30 minutes on and 30 minutes off. Place ice pack back in the freezer when not in use.

Day 2

Same as Day 1 except:

• Transition to soft food (mashed potatoes, oatmeal, applesauce, soft pasta, fish, eggs) Make sure they are cooled down.
• Start brushing teeth GENTLY and avoid surgical site. Remember not to spit, but let liquid fall out of your mouth into the sink.

Day 3-6

• Continue soft food diet but progress to more substantial food as tolerated.
• Swelling will be at its greatest on days 3 and 4.
• Stop using the ice pack and start using warm compress for comfort and healing.
• On day 3 start rinsing out the extraction site(s). Use the syringe and the prescribed antibiotic mouthwash (Peridex) or warm salt water. Continue to use the rinse for 7-10 days.

How to use the syringe:

• First make sure the plunger is pressed down to the bottom of the barrel of the syringe. Then, place the tip in the liquid that you want to measure. Draw back on the plunger and the liquid will flow into the syringe.
• Stand in front of a mirror and gently pull back your cheek to see the surgery site. With the prescribed mouthwash or warm salt water in the syringe, place the tip near the surgery site (without touching it) and push the plunger slowly to release the liquid out to rinse.
• Avoid swishing the saltwater rinse in your mouth or spitting it out. Gently move your head to move the rinse around your mouth or use your tongue to help move the saline solution around.
• After rinsing, lean over the sink and open your mouth to let the rinse fall out. Don’t spit.
• This should be done after meals and at bedtime as long as debris accumulates in the area.
• Stitches can start to dissolve as early as day 3.

Common Concerns After the Removal of Wisdom Teeth

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 moistened (not hot) 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, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions. You should cover your pillowcase with something so that you don’t get any blood on it. Also, see the section on sleeping for more instructions on how to properly sleep after surgery.

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 3-4 days postoperatively. However, the swelling may be minimized by the immediate use of ice packs. The cold causes the blood vessels in the area to constrict and therefore reduce the amount of swelling. Two baggies filled with ice or ice packs should be applied to the sides of the face where surgery was performed. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm, as 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. The heat causes the blood vessels to dilate, which enables them to carry away the fluids that cause the swelling more efficiently.

Sleeping

Because wisdom teeth extraction is often done while the patient is heavily medicated or under anesthesia, you’re likely going to be tired and in need of sleep after the surgery.

It is normal to wonder how to sleep after wisdom teeth removal. As you head to bed, make sure to take all gauze out of your mouth before you fall asleep. Leaving gauze in your mouth is extremely dangerous and can be a choking hazard.

After everything has been removed from your mouth, take any prescribed medications and drink cool water if you are able to do so. You can put an ice pack on your face to decrease pain and reduce swelling, but do not sleep on the ice pack. Don’t brush your teeth or use mouthwash. This will put you in a world of pain and potentially have other consequences.

When you’re ready for bed, stack a few pillows up and sleep with your head elevated and inclined. This is a comfortable way to help your body rest easy as well as reduce the facial swelling you may be experiencing. Don’t crash on your couch where a surface like leather or suede could have your head slipping and sliding.

Statistics indicate that sleeping with your head elevated is ideal for the first two days. Do not sleep on your side. Instead, let gravity work in your favor for a few days so you can heal quickly

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours.

For severe pain, take the tablets prescribed as directed. 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 and more every day. If pain persists, it may require attention and you should call the office.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. 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. 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. 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 rinsing of any kind should be performed until the 3 days following surgery. You can brush your teeth the 2 night of surgery but rinse gently.

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 postoperatively. Moist heat applied to the area may speed up the removal of the discoloration.

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 nausea subsides you can begin taking solid foods and the prescribed medicine.

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 that supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Coviello, Dr. Starley or Dr. Waise
• 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 that will resolve in time.

Additional Advice After Wisdom Tooth Removal

• 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. The sutures will be removed approximately one week after surgery.
• 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 meantime, 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. Coviello, Dr. Starley, or your family dentist.
• 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 to the ear may occur 2-3 days following surgery. Call the office if this occurs.
• If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get lightheaded, stop exercising.

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What Problems May Occur After the Extraction of Wisdom Teeth?

As with any medical procedure, there can be complications or an unanticipated result. Though rare some complications that patients may experience after wisdom tooth extraction include:

• damage to the sensory nerve that supplies sensation to the lips and tongue
• sinus communication
• dry sockets
• infections

After the procedure, our assistants will review your post-operative instructions with your escort. We ask that you follow these instructions closely, as they will make you most comfortable following your procedure. If you were sedated, you will be comfortable and drowsy when you leave the office. Most patients prefer to go home and rest with no other physical or scholastic activities planned for a few days. With any medical procedure, there can be unexpected results. These can include delayed healing, infection and post-operative numbness or tingling in your lip, chin, or tongue. Dr. Coviello, Dr. Starley or Dr. Waise will review relevant post-operative events with you and answer any questions during your office visit.