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Post-Operative Instructions: Wisdom Teeth Removal

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The removal of impacted teeth is a significant 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

  • Bite firmly on gauze for 1 hour. Place fresh gauze for an additional hour if heavy bleeding continues. A slight ooze is normal.
  • 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.

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 30 minutes. Repeat if necessary. If 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, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call 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. The ice packs should be left on 20 minutes on and 20 minutes off while you are awake. 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. 36 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

You should begin taking pain medication before the local anesthetic wears off. Ibuprofen (Motrin®, Advil®) 600 mg (3 regular strength over-the-counter tabs), take every 6 hours around the clock for the first 3 days, then every 6 hours as needed after that. Acetaminophen (Tylenol®) 975 mg (3 regular strength over-the-counter tabs), take every 8 hours around the clock for 3 days, then every 8 hours as needed after that. Note: You may take ibuprofen and acetaminophen together at the same time, or you may alternate them so that you are taking medication every 3 -4 hours.

You may be prescribed a narcotic pain medication. If you are prescribed a narcotic, you may take this with the ibuprofen and acetaminophen. Narcotic pain medications can make you nauseous and drowsy. Therefore, do not drink alcohol, drive a car, or operate machinery while taking narcotic pain medication.

Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.

Pain or discomfort following surgery should subside more and more every day after the third or fourth day. If pain persists, it may require attention, and you should call the office.

Diet

After general anesthetic or IV 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 day following surgery. You can brush your teeth the night of surgery, but rinse gently. The day after surgery you should begin rinsing at least 5–6 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt.

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 may be given to help prevent infection. You should finish the course of antibiotics as directed. 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 water, tea, or ginger ale. You should sip slowly over a 15-minute period. When the 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. Call if you have any questions.
  • Slight elevation of temperature immediately following surgery is not uncommon for the first 48 hours. 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 which support the tooth. These projections usually smooth out spontaneously. If not, they can be removed by your doctor.
  • 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 (trismus) 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

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 in approximately 1 week. 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 the 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. If you were given a syringe, you may use this starting one week after the procedure to help keep the extraction sockets clean

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: Drs. Seeger, Gleason, and Inverso, or your family dentist.

Brushing your teeth is OK—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 3–5 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 light headed, stop exercising.

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