After Wisdom Tooth Removal

Home Instructions After Wisdom Teeth Extraction

The removal of impacted wisdom teeth is an invasive surgical procedure, therefore, post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.

Immediately Following Surgery

• The gauze pad placed over the surgical area should be kept in place for 30-45 minutes. After this time, the gauze pad should be removed, discarded and replaced with a new gauze pad.
• Mouth rinsing, spitting, using a straw and/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.
• Once you can tolerate liquids begin taking the OTC or prescribed pain medication.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for a more thorough explanation.
• For the first 3 post-operative days keep yourself propped up at 30-45 degrees when sleeping, this will help to minimize swelling.
• As with any oral surgery procedure, smoking of any kind, including but not limited to (tobacco, marijuana, vape pens) should be stopped for 7 days after surgery to minimize delayed healing and pain caused by smoking.

Bleeding

A certain amount of bleeding is to be expected following 3rd molar surgery. Slight bleeding, oozing or red tinged saliva is not uncommon. To control bleeding apply continuous pressure for 30-45 minutes immediately after surgery, and refrain from drinking, eating or talking during this time, to generate the initial blood clot. You will be given extra gauze which should be replaced every 30-45 minutes for the first 3-4 hours after surgery or until bleeding stops. If you have bleeding beyond 4 hours use a wet gauze or towel to wipe any dried blood from your lips and mouth followed by biting firmly on the gauze for an additional 30 minutes. If this does not stop the bleeding bite on a moistened black tea bag for 30 more minutes the tannic acid in tea should constrict the vessels and slow or stop the bleeding. If continued or excessive bleeding (blood which fills your mouth in 20-30 seconds) occurs please contact the office or doctor. 

Swelling

Swelling is a normal occurrence following 3rd molar surgery, and will involve the tissues in or around your mouth, cheeks, eyes, jaw, neck and side of your face. Every patient will have a different amount of swelling (edema) that is proportional to their body’s physiologic response to surgery. The swelling usually will not become apparent until the day after surgery, and will reach its maximum 48-72 hours post surgery. However, swelling may be minimized by the immediate use of ice packs applied to the face 15 minutes on and 10 minutes off for the first 6-8 hours after surgery. After 24 hours, ice has no beneficial effect. Swelling will also be reduced by keeping yourself propped up 30-45 degrees while sleeping for the first 3 days after surgery. Swelling will start to subside on post-operative day 3 which is followed by jaw stiffness or limited mouth opening often lasting 1-2 weeks.  To improve jaw stiffness and increase range of motion you may start to massage your cheeks and or apply moist heat to the side of your face beginning post-operative day seven. If swelling is causing difficulty with breathing or swallowing contact the doctor or 911 immediately.

Pain

You should begin taking pain medication soon after your procedure prior to the local anesthetic wearing off. As with any surgical procedure some post-operative discomfort is to be expected, and every person has a different physiologic and psychologic response to pain. OTC pain medication recommended by the doctor is to be taken exactly as directed. For Mild to Moderate pain, take either one or two tablets of Extra Strength 500mg Tylenol (Acetaminophen) OR three to four tablets of 200mg Advil/Motrin (Ibuprofen) every 6-8 hours after surgery not to exceed either 3200mg ibuprofen or 4000mg acetaminophen in a 24 hour period. For Moderate to Severe pain, take acetaminophen and ibuprofen in combination as followed: 600mg Ibuprofen -3hrs- 1000mg acetaminophen -3hrs- 600mg ibuprofen -3hrs- 1000mg acetaminophen continued until pain is controlled at which time you may take less frequently or decrease the dosage. For Severe pain, the prescribed medication (often narcotic) should be taken as directed and usually will be alternated with ibuprofen. DO NOT TAKE OTC ACETAMINOPHEN ALONG WITH ANY PRESCRIBED NARCOTIC.

You may have been prescribed a prescription dose of ibuprofen called Motrin 800 in which case do not take any additional OTC ibuprofen. If you have any questions about the types of or frequency in which to take pain medication please contact the office or doctor.

Do not take any of the above medications if you are allergic to them, or have been instructed by your doctor not to take them. Do not drink alcohol, drive an automobile or work around machinery while taking narcotics. Pain or discomfort should subside more and more every day. If pain persists or is increasing in nature past post-operative day 6, please contact the office or doctor.

Diet

After general anesthetic or IV sedation only clear liquids should initially be consumed. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may begin to transfer into soft cold foods as your stomach tolerates them i.e., jello, pudding, ice cream, yogurt, cottage cheese the day of surgery. Avoid hot liquids and foods for the first 24 hours after surgery resuming warm soft foods the day after i.e., eggs, oatmeal, pancakes, mashed potatoes, well cooked pasta intaking adequate calories is very important to allow healing from surgery. Our staff can provide suggested diet instructions. Refrain from eating crunchy or chewy food (nuts, chips, popcorn, candy, caramel etc.) for 10-14 days. 

ORAL HYGIENE

Good oral hygiene is essential to healing. Do not rinse or brush your teeth the day of surgery. You will begin the prescribed Peridex mouthwash the day after surgery rinsing for 30 seconds morning and night followed by not having anything to eat or drink for 30 minutes. You should also begin brushing your teeth with a soft bristled toothbrush the morning after surgery, including all your posterior teeth, you will not damage the surgical site. Warm salt water rinse (one teaspoon of salt in 8oz of warm water) should be used 3-4 times daily, for the first week after surgery. No OTC mouthwash should be used for the first 10 days after surgery.

Antibiotics

Be sure to take the prescribed antibiotics as directed until all medication is complete which will help to prevent infection. Discontinue antibiotic use in the event of a rash, hives or any other unfavorable reaction and contact the office or doctor for further instruction. If you develop shortness of breathe accompanied by swelling of your throat or difficulty breathing call 911 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 coke, tea, or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. If vomiting is persistent call the office or doctor.

Other Complications

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, 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. Call Dr. Pollaccia 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. Fever can also be associated with not taking good deep breathes or lying in bed, getting up and moving around will often stop a low grade temp.
• You should be careful going from the lying down position to standing. You could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting 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 time or once covered by gum tissue. If sharp areas are still present 3 weeks after surgery Dr. Pollaccia will evaluate and determine if treatment is needed.
• 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 to several weeks 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 removal of sutures requires no anesthesia or needles. The typical time for sutures to begin to breakdown is anywhere form 2-5 days after surgery.

There will be a void where the tooth was removed. The void will fill in with new tissue gradually 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 unique, no two mouths are alike. Address any problems or concerns to Dr. Pollaccia and they often can be easily explained or remedied.

In the first week or two following surgery bruising which may cause (yellow, green, brown or blue) discoloration of your skin is normal and will resolve in time.

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 near the ear may occur 2-3 days following surgery. Call the office or doctor if this occurs.

If you are involved in regular exercise, be aware that as your heart rate increases you may have throbbing or bleeding from the surgical site. Most student athletes can resume activities 3 days after surgery. However, If you become light headed, stop exercising immediately.