After Wisdom Tooth Removal

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 20 minutes. After this time, the gauze pad should be removed and discarded.
  • 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.

  • Take the prescribed pain medications preferably 1hour prior to surgery.

  • Restrict your activities on the day of surgery and resume normal activity when you feel comfortable.

  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for an explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon in the first 24 hours. 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 twenty minutes. Repeat if necessary. 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. 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 3-4 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. We will provide you with a compression face wrap and gel packs to use in the face wrap. The gel packs should be left on continuously while you are awake, even if they are not cold the compression helps reduce swelling. The cold helps reduce pain and the need for extra pain relief. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. From day 4 you should find the swelling has stopped and going down, this is when heat can be helpful to speed resolution. You can microwave the gel packs and use them as hot face packs. Be very careful to test they are not too hot before applying them to your face.

Pain

For moderate pain, two tablets of Paracetamol may be taken every six hours. You will also be prescribed an anti-inflammatory usually celecoxib,  take 1 tablet morning and night. Regular use for the first 3-4 days is recommended, even if you feel no pain, this is likely due to the pain medications working, rather than you having no pain.

For severe or break through pain, take the stronger tablets prescribed as directed, usually Codeine or Tramadol. The prescribed pain medicine may make you groggy and will slow down your reflexes. If so, do not drive an car or work around machinery, avoid alcoholic beverages. Nausea and constipation are common with these medicines and you may need to take additional medication for these side effects. Pain or discomfort following surgery should subside more and more after day 4. 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 form the surgical sites. High calorie, high protein intake is very important.Eat smaller meals more frequently say 6 times per day and drink fluids regularly. Your solid 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.

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 and using the supplied mouthrinse to soak the area. The day after surgery you should begin hot salty mouth soaks at least 5-6 times a day especially after eating. Use hot (cup of tea temperature – but do not burn yourself) water mixed with a teaspoon of salt and hold over the area’s for 30 seconds at each site.

Use the provided Chlorhexidine mouthrinse (Savacol / curasept) morning and night, for it to be effective it must be held and gently swished around the operative site for 1 complete minute (by the clock), use it undiluted.

Discoloration / Bruising

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 (Bruising). 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, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on flat coke (not diet), 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 nausea continues then contact the office.

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 Wayne if you have any questions.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Paracetamol or celecoxib 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 supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Wayne.
  • 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 (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a few 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. They will dissolve over 2-5 days,and do not require removal, sometimes a part dissolved strand can annoy you, if so just pluck the suture from your mouth with tweezers.

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 my office for instructions.

There will be a socket/hole where the tooth was removed. Over the next month the cavity will gradually fill in with new tissue. In the mean time, the area can be kept clean after meals with water rinses or a toothbrush. At your follow up appointment Wayne will give you a curved syringe that you can use to flush the area. Food caught in the area does not cause infection but can give an annoying sensation / taste.

Brushing your teeth is okay – just be gentle at the surgical sites.

A dry socket is when the blood clot gets dissolved prematurely from the tooth socket by particular bacteria. Symptoms of steadily increasing constant pain at the surgical site (usually just one socket, not all them) and even pain to the ear may occur 2-3 days following surgery. Often it becomes intense and wakes you at 3am. If this occurs call the office in the morning as it can quickly be managed and we want to get you pain free as soon as possible.

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.

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: Wayne or your dentist. There are no charges for follow up appointments or post operative problems. For urgent enquiries contact Wayne on his mobile phone or text him.