After Wisdom Teeth/Tooth Removal

The removal of teeth is a true surgical procedure.  Post-operative care is very important.  Unnecessary pain and the complications of infection and swelling may be minimized if the instructions are followed carefully.  Sometimes the after effects of surgery are quite minimal, so not all these instructions may apply.  Common sense will often dictate what you should do.  However, when in doubt, follow these guidelines or call our office any time for clarification.

Immediately Following Surgery:

  • The gauze pad placed over the surgical area should be kept in place for 30 minutes and changed at regular intervals until the bleeding subsides. Usually within 45 minutes to an hour, the bleeding will subside to a trickle.  After the subsidence of bleeding, you can quit using the gauze.
  • Vigorous mouth rinsing 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.  Gentle rinsing is encouraged BEGINNING THE DAY AFTER SURGERY.  Warm water rinses are fine or ½ teaspoon of salt in 8 oz of warm water can also be used.
  • Take the prescribed pain medications as soon as you begin to feel discomfort.  This will usually coincide with the local anesthetic becoming diminished.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.  It is not unusual to require 7 to 10 days before you are feeling back to normal, before you can resume strenuous physical activity, and normal eating patterns.
  • Place ice packs to the sides of your face where surgery was performed.  Refer to the section on swelling for further 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 one minute before standing.  Stand up slowly to provide time to steady yourself.  If you feel dizzy when you sit or stand, you should lie back down immediately to minimize the possibility of fainting.

Bleeding

A certain amount of bleeding is to be expected following surgery.  Slight bleeding, oozing, or redness in the saliva is not uncommon up to 72 hours after surgery.  Excessive bleeding may be controlled by first wiping any old clots from your mouth if present, then placing a gauze pad over the area and biting firmly for 30 minutes.  If the gauze needs to be changed, the new gauze should be moistened with cold water, with excess squeezed out until the gauze is slightly damp, then placed in the mouth.  Dry gauze will absorb any forming clot and will stimulate bleeding.  As the bleeding subsides, each change of the gauze should be whiter and less red.  If bleeding continues, bite on a moistened 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.  Avoid bending over and lifting anything greater than 3 pounds.  Smoking, forceful spitting, and use of a straw can cause the bleeding to start again and they can also cause dry socket.  Do not hesitate to call our office if you have any concerns about bleeding.

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, ice packs, or small bags of frozen corn or peas should be applied to the sides of the face where surgery was performed.  The ice packs should be used for 20 minutes on, 20 minutes off for the 1st 48 hours following surgery while awake.  After the 48 hours, either ice or heat is permitted.  Drinking plenty of cold fluids with crushed ice is also advantageous.  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 moist heat to the sides of the face is beneficial in reducing the size of the swelling.  Please note that it is important to keep your head elevated for 2-3 days following surgery to minimize swelling.  A reclining chair works well to keep your head elevated.

Pain

For mild pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours.  For moderate pain, take the Ibuprofen 800mg as prescribed.  As a substitution for the prescription ibuprofen, you can use over the counter ibuprofen (Motrin or Advil) by taking two to four 200 mg tablets every 3-4 hours. You should not take more than 2400 mg of ibuprofen in any one 24 hour period which equates to three 800 mg tablets or 12 of the 200 mg tablets.

For severe pain, take the narcotic pain medication as directed.  This 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 as they will enhance the effect of the narcotic.  This is a dangerous combination.  Pain or discomfort following surgery should begin to subside after the first three or four days.  If pain persists, it may require attention and you should call the office.  Some patients will develop significant pain 3 to 7 days post operatively and this may indicate a dry socket which is described below.  Do not routinely take Tylenol with prescription pain medications.  Many prescription pain medications already contain Tylenol.

Diet

After general anesthesia or I.V. sedation, clear 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 but try to avoid chewing directly over the surgical sites.  High calorie, high protein intake is very important.  Nourishment should be taken regularly.  You should prevent dehydration by drinking 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.  Keeping well hydrated also prevents nausea and vomiting.  Try not to miss a single meal.  You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.  We recommend caloric supplements such as Ensure or an equivalent product.  Two to three cans per day will help keep your strength and promote healing.  Blenderizing the Ensure type products over ice usually makes them tastier, and the ice is usually soothing to the tissues.  Remember to remove the gauze before eating.  It is also advisable to avoid very hot foods for the first 24 hours.  Avoid foods such as nuts, popcorn, sunflower seeds and any other food where particles can get into the socket (such as pretzels, potato chips, corn chips) for 2 weeks.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery.  You can brush your teeth the night of surgery but do not rinse with any force.  Gently place the water in your mouth and let it swirl around and drip out into the sink.  Do not spit as this may dislodge the blood clot that has formed and could result in a dry socket.  The day after surgery you should begin rinsing gently at least 5-6 times a day especially after eating with eight ounces of warm water mixed with one-half teaspoon of salt.  The important thing is to keep the surgical areas as clean as possible.  If salt water is not available, warm water is very acceptable.  You may also use diluted mouthwash in at least a 4:1 dilution.  Following one week, vigorous rinsing should be done to keep the surgical sites very clean.  The use of a WaterPik is generally avoided in the surgical area for several weeks.

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.  In some patients, this is a normal occurrence, which may occur 2-3 days post-operatively.  Moist heat applied to the area may speed up the removal of the discoloration.  In younger patients, bruising is rare and sometimes is represented as a slight yellow discoloration.  In older patients, especially the elderly, bruising can be quite significant and is represented as black and blue discoloration.  This can cover a larger area sometimes even involving the neck and upper part of the chest.  Bruising of this degree can take approximately two weeks to resolve.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed.  Antibiotics will be given when there is a clinical reason for their use such as if there is an infection already present.  Discontinue antibiotic use in the event of a rash or other unfavorable reaction, and notify the office of the reaction.  We invite you to call the office if you have any questions or concerns.  Sometimes taking antibiotics with yogurt can help prevent diarrhea.  If you take birth control pills, the birth control may become ineffective; use back up form of birth control.

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 flat coke, tea, or ginger ale.  You can also purchase coke syrup over the counter which can have a soothing effect on the stomach.  You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. Please call if the nausea does not subside within 3 hours.  There are medications we can call in to your pharmacy that work very well to control nausea and vomiting.

Additional Information:

  • 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 although in some instances, it can be permanent.  You should be aware that if your lip or tongue is numb, you could bite it causing injury, and not feel the sensation.  Therefore, be careful. Call Dr. Hammond 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.
  • Occasionally, patients may feel something sharp in the mouth with their tongue.  These are not roots. They are the bony walls which supported the tooth.  These projections usually smooth out over time.  If not, they can be smoothed or removed by Dr. Hammond.
  • If the corners of your mouth are stretched, they may dry 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, and 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.  In some patients, this is a normal post-operative event.  Do not force your mouth open.  Massage the muscles and apply heat, and usually this will resolve in time.
  • In an upper tooth, especially in the back of the mouth, there is a possibility of the sinus communicating with the extraction socket.  If this occurs, it usually feels like air is “passing through the area.”  It is important that you notify us of this finding as it may need attention with surgery and/or antibiotics.
  • 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 dissolve on their own 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 our office for instructions.
  • Sometimes there will be an opening in the gum where the tooth was removed.  This opening will gradually fill in with 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.   A syringe will be given at your 1 week appointment.  This will allow better access to clean the site.
  • Your case is individual as no two mouths are alike.  Do not accept well intended advice from friends. Discuss your questions and concerns with either Dr. Hammond or a member of their staff.
  • 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 3-7 days following surgery.  With a dry socket, patients usually notice a significant increase in their level of discomfort.  Pain can radiate from the surgical site to the ear or front teeth.  The pain can awaken patients from their sleep.  If the prescription pain medications fail to relieve the pain, call the office.  Treatment involves gently irrigating the socket and gently placing a medicated dressing.  Most patients get relief within thirty minutes.
  • If you are involved in regular exercise, be aware that your normal nourishment intake is reduced.  Exercise may weaken you.  We recommend that you take at least a week off from any vigorous physical activity.  When you do resume your exercise regimen, start with a light to moderate workout and gradually increase your regimen over several sessions.  Stop exercising if you get light headed.
  • If you are having a denture or partial placed at the time of surgery you should leave it in place for at least 24 hours after the surgery.  The denture or partial denture tends to act as a Band-Aid.  After that time, you need to remove it and rinse your mouth gently and clean the denture off with water.  If the denture is left out for long periods of time it may allow swelling to occur which may prevent the reinsertion of the denture/partial.  You will need to make an appointment with your general dentist within a few days of surgery to make any needed adjustments to your denture/partial.
  • If necessary, an appointment will be made at the front desk for 1 week to check the extraction sites.  If you did not receive an appointment and feel you would like to be seen, please don’t hesitate to call our office and we will be happy to see you.
  • If you have any questions regarding the condition, it is best to call the office during our regular office hours.  A follow-up visit is provided as a courtesy at no charge.  If you have a true emergency, Dr. Hammond or his assistant can be reached 24 hours a day 7 days a week.  During the day call the office number.  At night, call Dr. Hammond on his cell phone.  If there is no answer, leave a message and Dr. Hammond will call you back as soon as possible.