After Wisdom Tooth Removal

Please read these instructions carefully. Very often the after-effects of oral surgery are quite minimal, so not all these instructions may apply. Common sense will often dictate what you should do.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, call the office. Please try to call during office hours. However, if you must call after hours, instructions for contacting the doctor will be provided in the message. Calling during office hours will afford a faster response.

DAY OF SURGERY

FIRST FEW HOURS

Bite down firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour. If active bleeding persists after one hour, place enough new gauze to obtain pressure over the surgical site for another 45-60 minutes. The gauze may be changed as necessary, just remember that steady pressure is essential to control bleeding. Intermittent bleeding or oozing is normal.

STEADY BLEEDING

Bleeding should never be severe. If it is, it usually means that the packs are being clenched between your teeth rather than exerting pressure on the surgical areas. Try repositioning with fresh packs. If bleeding persists or becomes heavy, you may substitute a tea bag (soaked in warm water, squeezed damp-dry and wrapped in a moist gauze for 45-60 minutes. If uncontrollable bleeding continues, please call our office.

WOUND CARE

Do not disturb the surgical area today. Do NOT rinse, brush or probe that area with any objects or your fingers. DO NOT SMOKE for at least 4 DAYS, since it is very detrimental to healing.

SWELLING

Often there is some swelling associated with oral surgery. You can minimize this by using a cold pack or ice bag wrapped in a towel and applied firmly to your face or cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 12 to 24 hours after surgery. Swelling will usually increase through the second and third post operative days. It is not until the fourth post-operative day that the swelling will begin to subside.

PAIN

Unfortunately, most oral surgery is accompanied by some degree of discomfort. Many times an over-the-counter pain medication provides adequate pain relief.

Please be warned that some narcotic pain medications have an addictive or habit forming potential. To limit your risk to this you may alternate the narcotic pain medication with plain, over-the-counter Tylenol (Acetaminophen).  Do not however take both the narcotic pain medication and Tylenol together as the narcotic pain medication may already contain the active ingredient in Tylenol which may cause an unsafe overdose of Tylenol. 

Your doctor will decide whether or not you will actually require a prescription pain medication. In any case, taking the first pill before the anesthetic has worn off will manage your discomfort better. Effect of pain medicines vary widely among individuals. Taking the medication around-the-clock will reduce your post operative discomfort. Please remember if you have been prescribed a narcotic pain medication you may not drive, operate heavy machinery or care for young children for several hours after taking this medication.

OTHER SYMPTOMS YOU MAY EXPERIENCE

…All of which are normal: You may have a slight earache; you may develop a sore throat; your other teeth may ache. Bruising in the area of an extraction may occur. There will be a space or hole where the tooth was removed; this will gradually fill in.

NAUSEA

An upset stomach is common following oral surgery. General anesthesia, pain medications (especially narcotic medications) and swallowing blood all contribute to nausea. Usually this nausea does not last long. Try to keep down clear liquids first, then advance to more solid foods as tolerated. If the nausea becomes severe or persists for more than 24 hours, please let us know.

DIET

Eat any nourishing food that can be taken with comfort. Temperature of the food doesn’t matter, but avoid extremely hot foods. It is sometimes advisable, but not required, to confine the first day’s intake to bland liquids or pureed foods (creamed soups, puddings, yogurt, milkshakes, etc.) Do not drink through a straw.

Avoid foods like nuts, sunflower seeds, popcorn, etc, that may get lodged in the socket areas. Over the next several days you can progress to solid foods at your own pace. It is important not to skip meals! If you take nourishment regularly, you will feel better, gain strength, have less discomfort and heal faster. If you are diabetic, maintain your normal eating habits as much as possible and follow instructions from us or your physician regarding your insulin schedule.

INSTRUCTIONS FOR SECOND AND THIRD DAYS

MOUTH RINSE

Keeping your mouth clean after surgery is essential. Use one-half teaspoon of salt dissolved in an 8-ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily for the next five days. DO NOT use hydrogen peroxide or any other available commercial oral rinse unless directed by your doctor.

BRUSHING

Begin your normal oral hygiene routine the day after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.

SHARP EDGES

If you feel sharp edges in the surgical areas with your tongue, it is probably the bony walls which originally supported the teeth. These usually smooth out during the healing process.

ADDITIONAL NOTES ABOUT WISDOM TEETH EXTRACTIONS

SWELLING

Usually peaks 3 days post-surgery. Use of ice-packs on the outside of the jaw (20-minutes on / 20-minutes off) on the day of surgery will help minimize the swelling.

PAIN

For most people, post-operative soreness is greatest on the evening of the surgery and the first post-operative day. You have likely been given a prescription for a synthetic-type of narcotic. If you are able to take Ibuprofen (Motrin or Advil), alternating this medications with the prescribed medication may provide the best pain relief. For example: If the first dose of the prescribed narcotic-type medication is taken at 10:00 am, and you will be taking this every six hours, then at 1:00 pm you may take 200 mg to 600 mg of Ibuprofen (1-3 pills of the over-the-counter formulation). At 4:00 pm you may take another of the narcotic-type medication. You may continue this alternation as needed. Make sure you have something in your stomach when taking these medications.

DRY SOCKETS

Normal healing after tooth extractions should be as follows. The day of surgery is usually tolerable. The first day after surgery is usually the most uncomfortable day.

The second and third days after surgery, you will usually be far more comfortable and although still swollen, you can usually begin a more substantial diet. From the fourth day after surgery, GRADUAL, STEADY IMPROVEMENT should make up the remainder of your post-operative course. If a DRY SOCKET occurs (loss of blood clot from socket, usually on the 3rd to 5th day after surgery), there is a noticeable, distinct, persistent throbbing pain in the jaw, often radiating toward the ear and forward along the jaw to cause other teeth to ache. If you don’t see steady improvement during the first few days after surgery, don’t suffer needlessly. Call the office and report symptoms.

LIMITED OPENING

Most people experience a decreased ability to open their mouth, especially following the removal of the lower wisdom teeth. Normal range of motion usually returns within 7-9 days.

ORTHODONTIC CARE

If you wear an orthodontic retainer, it may be reinserted when it is most comfortable to do so.

SMOKING

If you smoke, try not to smoke for as long as possible after your surgery. Smoking makes it very difficult for your body to heal itself and makes it more likely for you to develop a dry socket or an infection.