Post Wisdom Teeth Surgery

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 45-60 minutes. After this time, the gauze pad should be removed and discarded. Vigorous mouth rinsing, spitting 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. Begin taking the prescribed pain medications before the local anesthesia wears off. Restrict your activities the day of surgery and resume normal activity as directed by your oral surgeon. 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 45-60 minutes. Repeat if necessary.

If bleeding continues, bite on a moistened tea bag for 45-60 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 do not become excited.

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. 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 used (20 minutes on and 20 minutes off) intermittently for the first 48 hours 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. 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. A wet wash clot placed in the microwave for approximately 30 seconds works well. Check to make certain it is not too hot for your skin. Do not use a heating pad as this could make the swelling worse.

Pain

If you received a prescription for a pain medication or antibiotic, it best to begin taking the medication before the local anesthesia wears off. Be sure to take the entire course of antibiotics as directed. Take the pain medication as needed after the surgery.


	For moderate pain, take Ibuprofen, (Motrin or Advil) two-four 200mg tablets may be taken every 6-8 hours. For severe pain, take the prescription medication(s) as directed.

The prescription 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 taken initially. 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 so you should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily.

The day of surgery your fluids can include beverages (not diet drinks), jello, soup, ice cream, yogurt, milkshakes, fruit juices.

If you are comfortable on the day of surgery you may start a soft diet: eggs of any type, French toast, pancakes, mashed potatoes, pasta, meat loaf, ground meats, canned fruits and vegetables; anything you can mash with a fork. Advance to your normal diet as you are able to tolerate.

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 day following surgery. The day after surgery you should begin rinsing with a 8 oz of water mixed with 1/2 tsp of salt at least 5-6 times a day, especially after eating. Do not rinse your mouth vigorously or use mouthwash for one week. Mouthwash is 16-18% alcohol and when it is used as a rinse it can dissolve the clot in the socket and cause further bleeding.

Resume brushing the day after surgery; twice a day with a soft-bristled toothbrush. Avoid the extraction site. You can brush gently in the extraction area as soon as it is comfortable.

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.

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, sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. Call our office if nausea and/or vomiting persists for 2-3 hours.

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. Call our office if numbness persists over 24 hours. Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists over 24 hours, notify the office. Tylenol or ibuprofen should be taken to reduce the fever. You should be careful going from a lying down position to standing up to avoid becoming lightheaded. Taking pain medications can also make you dizzy. Before standing up, you should sit for one minute, then stand 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 over a period of weeks. If not, they can be removed by the oral surgeon. 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 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


	Dissolvable sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. They will dissolve anywhere from 2-10 days. The pain should subside more and more each day following surgery. If your post-operative pain worsens or unusual symptoms occur, call our office for instructions. There will be a hollow area where the tooth was removed. The hollow area will gradually fill in with the new tissue over the next month. 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: your oral surgeon 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 to the ear may occur 2-5 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.