After Wisdom Tooth Removal

The removal of impacted teeth is a serious surgical procedure. Postoperative 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 10 minutes and changing every 10 minutes for up to 1-2 hours.  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 as soon as you begin to feel discomfort. This will usually coincide with the local anaesthetic becoming diminished.
• Restrict your activities 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.  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 about 30 minutes.  The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels.  To minimize further bleeding, sit upright, avoid excersize and do not become excited.  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 two or three days postoperatively.  However, the swelling may be minimized by the immediate use of ice packs for 36 hours.

Ice packs or two plastic bags filled with ice should be applied to the sides of the face where surgery was performed.  The ice packs should be left on continuously 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.  Four days following surgery the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

Adults:

Ibuprofen (“Advil”, Motrin”) is an extremely useful medication for control of postoperative discomfort after minor oral surgery. For adults and teenagers, two over-the-counter 200mg Ibuprofen tablets (400mg) can be taken every five hours for 2 to 4 days postoperatively on a scheduled basis. In between the doses of Ibuprofen, other analgesics such as Tylenol with Codeine may be taken if these have been prescribed.  This way one can maintain a level of anti-inflammatory medication in the blood to help with swelling and discomfort while Tylenol with Codeine or regular Tylenol will help with any “break through discomfort”.

Ibuprofen should not be taken on an empty stomach and may be taken with any types of food or drink.  The best way to take Ibuprofen is to swallow with 8 ounces of water and remain upright for 30 minutes to minimize the amount of time that the medication is sitting in the stomach.  Before taking any over-the-counter preparations you should be careful to read the instructions on the medication and make sure there are no other reasons why you shouldn’t be taking these medications such as patients who have severe asthma, taking blood thinners, etc.

Children:

For children, all of the above applies except that children may take one Ibuprofen (200mg) every five hours for 2 to 4 days postoperatively on a scheduled basis.  If you have a child under six years, the surgeon will advise you regarding the doses of medications.

Diet

Drink liquids after general anaesthesia or IV sedation.  Do not use straws when drinking 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 site(s).  High calorie, high protein intake is very important. Try to maintain a normal diet. You should prevent dehydration by taking fluids regularly. Your food intake may be limited for the first few days.  You should compensate for this by increasing your fluid intake. At least five to six 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 unless advised otherwise.  You can brush your teeth the night of surgery but rinse gently.  The day after surgery you should begin rinsing at least five to six times a day with a cup of warm water mixed with a teaspoon of salt, especially after eating.

Discolouration

In some cases, discolouration 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 postoperative occurrence which may occur two to three days postoperatively.  Moist heat applied to the area may speed up the removal of 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 unfavourable reaction and call the office. 

Nausea & 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 medicines. You should then sip on a clear fluids like ginger ale, and  sip slowly over a 15-minute period.  When the nausea subsides, you can begin taking solid foods and the prescribed medicine. Gravol may be taken either orally as a pill or liquid, or rectally provided that your health history allows this.

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. 
• A 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.
• You should be careful going from the lying down position to standing. You were unable to eat or drink prior to surgery, and taking pain medications can make you dizzy. You could get lightheaded if you stand up suddenly, so you should sit for one minute before you get up.
• Occasionally, patients may feel hard projections in the mouth with their tongue.  They are not roots, but the bony walls which support the tooth. These projections usually smooth out spontaneously.  If not, they can be removed by the surgeon.
• If the corners of your mouth are stretched, they may dry and crack.  Your lips should be kept lubricated 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  two to three days.
• Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal postoperative event that will resolve in time.

Finally

Sutures may be placed in the area of surgery to minimize postoperative bleeding etc.  Sometimes they become dislodged.  This is no cause for alarm. Just remove the suture from your mouth and discard it.

The pain and swelling should subside more and more each day following surgery. If your postoperative 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 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.

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: your surgeon or your family dentist. 

Brushing your teeth is okay – 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 two to three 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.

Please consider referring to downloadable forms section and print this information off before your appointment to allow extra preparation.