The removal of impacted wisdom teeth is a serious 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.
After Tooth Extraction
The removal of single or multiple teeth can be straightforward or complicated. 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 30 minutes. After this time, the gauze pad should be removed and discarded. Please read the section on bleeding if you should continue to have bleeding after the gauze is removed.
– Vigorous mouth rinsing or touching the wound area following surgery should be avoided. These actions may dislodge the blood clot that is trying to form and cause unnecessary bleeding.
– Take your prescribed pain medications as soon as you get home and before your local anesthetic wears off. Generally, we recommend beginning with Ibuprofen and continue this medication as directed during the first 72 hours.
– Restrict your activities the day of surgery and resume normal activity when you feel comfortable. If you should experience throbbing discomfort your body may be trying to tell you that you’re doing too much.
– Place ice packs on the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
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 several moments before standing.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon for 24 hours or more. Saliva can be swallowed, even if slightly blood tinged. You should not have a significant amount of blood in your mouth. If you do, the excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a moistened gauze pad directly over the area and bite down firmly for 30 minutes. Repeat if necessary. If a lot of uncontrolled bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, sit upright, avoid exercise and remain calm. Do not expectorate (spit) into the sink, this action can increase or prolong bleeding. You should instead use a paper towel to wipe off your tongue as needed. If bleeding does not subside, call the office for further instructions.
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 its eventual repair. The swelling may not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. The swelling (and post-op bleeding) may be minimized by the immediate use of ice packs. Two Ziploc baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. Protect your skin with a dry paper towel. The ice packs should be applied for 20 minutes, then off for 20 minutes during the first 12 – 24 hours. After 36 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 warm moist heat to the sides of the face is beneficial in reducing the amount of swelling.
If not allergic, for moderate pain and swelling you should take Ibuprofen, Motrin or Advil 600mg (three 200mg tablets) every 6 hours, or 800mg (four 200mg tablets) every 8 hours. Do not take Ibuprofen if another physician has instructed you to avoid it, or if you are taking other blood thinners such as Eliquis, Pradaxa, Xarelto, Coumadin or Plavix. If you are over the age of 65 please speak with your doctor about a dose that would be appropriate for you.
For severe pain, take the narcotic pain medication you have been prescribed as directed on the bottle. Narcotic pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile, work around machinery or make important decisions while taking it. Avoid alcoholic beverages. After the third day, your pain and discomfort should subside a little more every day. If pain increases after the third day it may require attention and you should call the office. Taking the narcotic pain medication on an empty stomach may increase your chance of nausea. Try to eat a small amount prior to taking the narcotic medication.
If you have been given a prescription for antibiotics, take the medication as directed by the bottle that the pharmacist gives you. Antibiotics are prescribed to help prevent infection.
If you experience an allergic reaction, such as a red rash, difficulty breathing, diarrhea, or tongue swelling, stop your prescribed antibiotics and pain medication immediately. Begin taking Benadryl 25 mg-50 mg and contact Dr. Ortiz. If you have difficulty breathing or swallowing this may constitute an emergency and you should seek medical attention immediately.
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 clears liquids such as flavored waters, Gatorade,Sprite, Ginger Ale, or Tea. You should sip slowly over a 15 minute period. When the nausea subsides you can begin taking soft foods and the prescribed medicine. If your nausea continues for more than 6 hours, please contact the office.
After IV sedation, liquids should be taken initially, starting with Gatorade before water to help prevent nausea. Do not use straws for the first 72 hours. The sucking motion can cause more bleeding by dislodging the blood clot, so drink straight from a glass. 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. Some examples of ideal cool and smooth foods for the first three days include pudding, applesauce, yogurt, protein shakes, Jell-O, Ensure, Slimfast, and Boost.
You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days so 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 meals. You will feel better, have more strength, experience less discomfort and heal faster if you continue to eat.
Do not rinse or spit on the day of your surgery. This tends to disturb the blood clot, open the wound, prolong bleeding, slow down the healing process and possibly dislodge the membrane. Keeping your mouth clean after surgery is essential to reduce the risk of infection. You should gently brush your teeth the night of surgery. Stay away from the teeth in the area of surgery for at least 48 hours. This is the time most people accidentally expectorate (spit) because they are always used to expectorating while brushing teeth. Again, please do not spit. You can let toothpaste and saliva drool out of your mouth and into the sink or use a paper towel to wipe your tongue off.
The day following your procedure start warm salt water rinses. Use one-half teaspoon of salt dissolved in an 8-ounce glass of warm water and gently rinse with portions of the solution, taking a few minutes to use the entire glassful. Repeat as often as you like, but at least four to five times daily and always after eating for the next five days. We may prescribe an antibiotic rinse (Chlorhexidine, PerioGard, Peridex) for certain procedures. This rinse should be used in the morning and at bedtime after routine mouth care. Frequently, you can use this medication on a cotton-tipped applicator, gently wiping the membrane and surrounding area, to minimize staining of your teeth, discontinue the use of the antibiotic rinse after one week. Do not eat, drink, or rinse your mouth after using the medicated rinse for at least 30 minutes. Using this rinse as an oral rinse more than two times a day can cause staining of your teeth.
REMEMBER: A clean wound heals better and faster.
Discoloration & Bruising
In some cases, discoloration of the skin follows surgery. The development of black, blue, green, or yellow around the lower jaw and neck area is due to blood spreading beneath the tissues and will typically resolve on its own within a few days. You may not notice any discoloration until 2-3 days post-operatively. This is a rare but normal post-operative occurrence. Moist heat applied to the area may speed up the removal of the discoloration.
- 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. Please call the office if your lip or chin is still numb one month after your surgery to schedule a follow up appointment. If your tongue is still numb the day after surgery please call the office for an immediate post-op appointment.
- Slight elevation of temperature immediately following surgery is not uncommon. If your fever persists, notify our office. Tylenol and/or Ibuprofen should be taken to reduce the fever.
- Occasionally, patients may feel hard projections in the mouth with their tongue. These projections are frequently bony projections now noticed after removal of the tooth. These projections usually smooth out on their own over the next several months. If not, they can be removed by Dr. Ortiz.
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, Aquaphor, or other lip balms.
- Sore throat and pain when swallowing are not uncommon. The muscles adjacent to the surgical sites can become inflamed and subsequently give some discomfort during swallowing. This should subside in 2-3 days.
- Stiffness (trismus) of the jaw muscles may cause some difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event, which will resolve typically in several days. You may use a warm, moist compress over the area 6 times a day for 20 minutes. This should feel good, help relax the muscles, and encourage healing.
Sutures are placed in the area of surgery to minimize post-operative bleeding and help to heal. These sutures are frequently dissolving sutures, which will typically fall out in 5-7 days. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. It’s nothing to worry about.
A dry socket can occur when the blood clot becomes dislodged prematurely from the tooth socket. Symptoms of increased pain at the surgical site and even pain around the ear may occur 3-4 days following surgery. Call the office if your surgical pain significantly increases during this time. This condition can easily be treated with medicated packs.
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 or reduce your exertion.
Finally, your case is individual and no two mouths are alike. Try not to accept well-intended advice from friends. We desire that your recovery is as smooth and pleasant as possible. Following these instructions will assist you, but if you have any questions or concerns about your progress, please do not hesitate to call the office.