After Wisdom Tooth Removal

The after-effects of oral surgery are different for different people, so not all of these instructions may apply. At the least, you must control any bleeding, keep eating, limit the amount of pain, and do proper oral hygiene/wound care. Please follow these guidelines or call our office at any time for assistance.

Day of Surgery

On the day of your procedure you should do things that will help you achieve complication-free healing.

Control of Bleeding

Bleeding after surgery may continue for several hours. Bite down firmly, putting pressure on the gauze packs that have been placed over the surgical area(s), making sure that they remain in place. Do not change them for the first hour unless the bleeding is not being controlled. If active bleeding persists after one hour, place enough new gauze (may require 2 or 3 pieces) over the surgical site to put pressure at the site for another 30-60 minutes. These changes should produce a gradual reduction in bleeding. The gauze may be changed as needed and may be dampened and/or fluffed for more comfortable positioning.

Occasional bleeding or oozing is normal. It is likely for bleeding to continue for a few hours after simple extractions and for several (6-10) hours after more complex surgery (such as the removal of impacted teeth). Placing fresh gauze over the surgical areas and biting down firmly for 30-60 minutes should result in a steady decrease in bleeding.

Keeping the head in a raised position (with the use of a recliner or several pillows) will also help reduce bleeding and swelling.

Bleeding should never be severe. If it is, it usually means that the gauze packs are being clenched between your teeth instead of them putting pressure on the surgical areas. Try repositioning fresh packs. If bleeding persists or becomes heavy you may instead use a tea bag (soaked in hot water, squeezed damp-dry and wrapped in a moist gauze) for 20 or 30 minutes. If bleeding remains uncontrolled, please call our office at 603-298-7557.

Immediate Post-operative Care

Do not disturb the surgical area on the day of surgery. Rinsing should be avoided on the first day and do not probe the area with any objects or your fingers. You may brush your teeth gently.

Swelling

Often there is swelling when you have oral surgery. It will usually peak around 48 hours and may take 7-10 days to end. You can reduce swelling by using a cold pack or an ice bag wrapped in a towel and applied firmly to the face or cheek next to the surgical area. This should be applied 20 minutes on and 20 minutes off during the first 12 to 24 hours after surgery. Do not apply cold packs after the first 24 hours as this may prolong swelling. If you have been prescribed medicine to control swelling, be sure to take it as directed.

Fever

A slight fever is common the first few days after surgery (temperature to 100.5F). If you have a higher fever or if fever persists, please call our office.

Operating a Motor Vehicle

Please do not operate any machinery or a motor vehicle for 24 hours after sedation, or at any time if you are taking narcotic pain medicine (such as Percocet, Endocet, Roxicet, Oxycodone, Vicodin, Hydrocodone, Tylenol with Codeine).

Smoking and Drinking

You should not smoke following surgery for at least 48 hours. Smoking may disrupt the healing process. Do not consume any alcohol for 24 hours after intravenous (I.V.) sedation, or while taking any prescription pain medicine.

Pain

Unfortunately, most oral surgery has some degree of discomfort. If you have no allergy to non-steroidal anti-inflammatory drugs like ibuprofen (Motrin, Advil) naproxen (Naprosyn) or ketorolac (Toradol), we recommend taking this type of medicine before the local anesthetic wears off. If pain is more severe, a narcotic pain medicine may be needed. As there is no interaction between the prescribed narcotic pain medicine and ibuprofen or ketorolac (Toradol), these medications can be taken at the same time if needed. Be aware that narcotic pain medicine may cause an upset stomach, which may include nausea, vomiting or constipation.

Also, these medicines should not be taken if you must operate any machinery or a motor vehicle. Pain medicines affect different people in different ways. Remember that the most severe discomfort is usually a day or two after the extraction. After that, your need for medication should decrease and it is usual to take some form of pain reliever (Tylenol, Advil) for several days. Discomfort after the first couple of days is normal. This may persist for seven to ten days. If the pain is worsening after the third or fourth day following the procedure, please notify the office.

Nausea

Nausea, a common event after surgery, is sometimes caused by stronger pain medicines or certain anesthetic drugs. If you eat a small amount of soft food before taking a pill, and then take the pill with a large amount of water, this may reduce the nausea caused by pain medications. If nausea occurs, try drinking clear fluids and use less pain medication. And, call us if you do not feel better or if repeated vomiting is a problem. Cola drinks that have been stirred to lessen their carbonation may help with nausea.

Diet

On the day of surgery, you should avoid hot foods as they will extend bleeding. Cold soft foods (such as ice cream, milk shakes, Instant Breakfast, puddings and yogurt) are ideal. For the first few days we recommend soft foods (such as soup, pasta, eggs, and mashed potatoes). Over the next several days you can start to eat solid foods at your own speed. It is important not to skip meals! If you eat regularly, you will feel better, gain strength, have less discomfort and heal faster. Avoid foods like nuts, sunflower seeds, popcorn, etc., which may get lodged in the socket areas. If you are diabetic, keep your normal eating habits as much as possible and follow our instructions or those from your physician about your insulin schedule.

Exercise and Activity

Keep physical activities to a minimum immediately following surgery. If you do exercise, throbbing or bleeding may occur. If this happens, you should discontinue exercising. Be aware that your normal nourishment intake is probably reduced. Exercise may weaken you. And, if you do get light headed, stop exercising.

Sutures

Sutures (or “stitches”) may be used to return and hold tissue to its proper place and to help control bleeding. Sutures may be one of two types - those that dissolve and those that do not dissolve. When a suture dissolves, anywhere from several hours to a couple of weeks after surgery, it will come apart and you may remove it from your mouth. If you were given a suture that does not dissolve, it will be removed at your post-operative visit at the office.

Instructions for the Second and Third Days

Mouth Rinses

Keeping your mouth clean after surgery is important to reduce the risk of infection. Following the first day of surgery, use one-quarter teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking 5 minutes to use the entire glassful. Repeat as often as you like, and not fewer than two or three times a day and always after eating for the next 5 days. We may prescribe an antibiotic rinse such as chlorhexadine (Perioguard or Peridex) for certain procedures. This rinse should be used in the morning and at bedtime after your regular mouth care. Do not eat, do not drink, and do not rinse your mouth after using the antibiotic rinse for 30 minutes.

Brushing

Begin your normal mouth and teeth cleaning routine on the second day after surgery. Soreness and swelling may not allow very active brushing of all areas, but please make every effort to clean your teeth as much as you can without exceeding your comfort level.

Dry Sockets

Normal healing after tooth extraction should be as follows: The first and second days of surgery are the most uncomfortable and there may be some amount of swelling and stiffness. From the third day on, there should be slow and steady improvement for the rest of your post-operative recovery. If a dry socket happens (which is the loss of the blood clot from the empty socket), usually on the 3rd to 5th day, there is a noticeable, distinct, constant increase in throbbing pain in the jaw, often spreading out toward the ear and forward along the jaw to cause other teeth to ache. If you do not see steady improvement after the first few days after surgery, don’t suffer needlessly. Call the office and report symptoms so that you can be seen as soon as possible.

Open Sockets

Sockets from tooth extractions may remain open for several weeks after surgery. Rinsing after eating is very important. At our post-operative check-up, you may be given a small irrigation syringe to help keep food out. This can be used with plain lukewarm water to rinse out your open socket.

Sharp Edges

If you feel sharp edges in the surgical areas with your tongue, it is probably the bony walls of the socket that originally supported the teeth. Occasionally small slivers or pieces of bone may emerge during the first week or two after surgery. They are not pieces of tooth and, if necessary, we will remove them. Please call the office if you are concerned.

Sinus Precautions

Some procedures in the back part of the upper jaw may involve entry into the sinus cavity. If you are advised of this, please follow these precautions for 10 days after surgery. Do not blow your nose forcefully or sneeze holding your nose. Flying in pressurized aircraft and scuba diving will also increase sinus pressure and should be avoided. Decongestants such as Drixoral, Dimetapp, or Sudafed will help reduce pressure in the sinuses. You may also be given a prescription for antibiotics. Please take these as directed.

Retainers

Retainers may be worn after surgery when it is comfortable for you. We recommend leaving them out at least for the first few days after surgery.

It is our desire that your recovery be as smooth and as pleasant as possible. Following these instructions will help make your recovery more comfortable, but if you have any questions about your progress, please call the office where you had your surgery. Please try and call during office hours whenever possible; however a 24-hour answering service is available for after hours contact with a doctor.

Emergency Contact: Phone 603-298-7557 and ask for the doctor on call.