After Wisdom Tooth Removal

Home Instructions After Wisdom Teeth Extraction

The removal of impacted wisdom teeth is a serious surgical procedure. 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 30-40 minutes
Vigorous mouth rinsing 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.
On the 7th day after surgery, begin using the syringe provided to thoroughly irrigate inside the lower surgical sites using warm salt water or the Peridex (Chlorhexidine) mouthrinse, after every meal, until the sites are completely closed (in 4-6 weeks).
Avoid forceful spitting or using straws for the first 7 days
Take the prescribed pain medications (Ibuprofen 600 mg, first) before the numbness wears off. This will allow the medication to work more effectively and to stay ahead of the pain.
Restrict your activities after Resume normal activity after 3-4 days as tolerated.
Place ice packs to the sides of your face where surgery was Refer to the section on Swelling for a more thorough explanation.
DO NOT SMOKE for at least 5 It is detrimental to healing and can contribute to the development of a “dry socket”.

Prescription Information- Below are directions for commonly prescribed medication from your provider. Not all of these medications will pertain to you specifically. Please pick up all of the medications from your pharmacy that are specifically ordered for you. Follow the directions on the medication bottle.

PERIDEX MOUTH RINSE:

Gently rinse your mouth twice daily for 7 days (morning and evening) starting the day after

IBUPROFEN 600mg

Take your first dose 1-2 hours after leaving our office, before the numbness wears off. Then take one tablet every 6 hours regularly for the first 72 This will help you to stay ahead of the pain. After the first 72 hours, it can be taken every 6 hours as needed for mild to moderate pain relief.

TYLENOL (ACETAMINOPHEN – Over-the-counter):

Three hours after the first dose of Ibuprofen, take over-the-counter Tylenol (one extra strength or two regular strength) every 6 hours as needed for mild to moderate pain (so that you are alternating between Tylenol and Ibuprofen every 3 hours)

NORCO (HYDROCODONE):

If regular Tylenol is not adequate, take 1 tablet every 6 hours as needed for moderate to severe pain. If you are taking the Norco, please do not take Tylenol (acetaminophen) at the same time.

ZOFRAN (ONDANSETRON):

Dissolve one tab under tongue 20 minutes before Norco as needed for

Bleeding

A certain amount of bleeding is to be expected for a day or two (2) following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty (30) to sixty (60) minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty (30) to sixty (60) minutes.

The tannic acid in the tea helps to form a clot by contracting bleeding vessels. To minimize further bleeding, sit upright, and avoid exercise. If bleeding does not subside, call our office 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 may 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.

Two (2) bags filled with ice then wrapped with a towel, or ice packs, should be applied to the sides of the face where surgery was performed. For the first 24-48 hours, ice packs should be utilized every 20 minutes (20 minutes on, 20 minutes off) while you are awake. After 48 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. The application of moist heat to the sides of the face is beneficial in reducing jaw stiffness 48 hours following surgery. Taking Ibuprofen as prescribed will help reduce the swelling the in first 2 to 3 days.

Diet

Good nutrition is extremely important for healing. Start off with cool, soft foods after general anesthesia or IV sedation. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. Once you are able, you may eat anything soft by chewing away from the surgical site(s). You may want to confine the first day’s intake to bland liquids or pureed foods (soups, puddings, yogurt, milk shakes, etc.). Avoid foods like nuts, sunflower seeds, popcorn, etc, which may become lodged in the surgical site(s). You should prevent dehydration by taking fluids regularly. At least 5-6 glasses of liquid should be taken daily. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat and drink.

Pain

Unfortunately, most oral surgery is accompanied by some degree of discomfort. You will usually be prescribed with Ibuprofen 600 mg for mild to moderate discomfort (unless you have heart disease, bleeding disorder, are on a blood thinner/anticoagulation medication, or have stomach ulcers). Please take the first dose before the anesthesia wears off for better pain management. You may supplement this with two regular-strength or one extra-strength Tylenol, every four to six hours. An effective pain regimen is to alternate Ibuprofen and Tylenol every 3 hours, thereby taking Ibuprofen every 6 hours and Tylenol every 6 hours. For example, take Ibuprofen at 12:00 pm, Tylenol at 03:00pm, Ibuprofen at 06:00 pm, Tylenol at 09:00 pm, and so on and so forth.

For severe pain, you may be prescribed a narcotic pain medication. If you take this, it will make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Alternating between Ibuprofen 600mg (unless contraindicated, as above) and the narcotic pain medication will help achieve adequate relief. Do not take Tylenol if you are requiring the narcotic, which usually has Tylenol (acetaminophen) in it. A common side effect is constipation and nausea, so please stay well hydrated. Typically, the more severe discomfort is usually experienced within the first 3 days after the surgery. This will usually subside more and more each day after that, and your need for medicine should lessen as well. Sometimes, the pain increases as the swelling increases over the next 2 to 3 days. If significant pain persists for more than 5 days, it may require attention and you should call the office. Do not take any of the above medications if you are allergic, or have been instructed by your doctor not to take it.

Oral Hygiene

Mouth cleanliness is essential to healing. No vigorous rinsing of any kind should be performed for 24 hours after the surgery. You may brush your teeth the night of surgery, but rinse gently. Avoid brushing the gums in the area of surgery for one (1) week. The day after the surgery, you should begin gently rinsing after meals and additionally with an 8oz glass of warm water mixed with one-half teaspoon of salt. Continue this procedure until the gums fill in over the surgical site(s).

Discoloration

In some cases, discoloration (bruising) 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 2-5 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

Antibiotics may be given to help prevent or treat an infection. If you have been placed on antibiotics, take the tablets or liquid as directed. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction Antibiotics make birth control pills ineffective. Women who take birth control pills should use another form of contraception for on complete cycle after the course of antibiotics has been used. Call the office if you have any questions.

Nausea and Vomiting

Nausea may occur after surgery, and is sometimes caused by stronger pain medications. Nausea may be reduced by preceding each tablet with a small amount of food, then taking the tablet with a large volume of water. 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 tea, or ginger ale (after stirring out the carbonation). You should sip slowly over a fifteen-minute period. If you are not on Coumadin/warfarin, you may also try Alka-Seltzer or Pepto Bismol. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. If nausea persists for more than four hours, call the office.

Sutures

Sutures are usually placed in the area of surgery. Sometimes they become dislodged or loose. This is no cause for alarm. Just remove the suture from your mouth and discard it. In most cases, sutures will dissolve unnoticed in about 7-10 days.

Activity

Keep physical activities to a minimum immediately following surgery. Refrain from heavy lifting for 3-5 days. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake may be reduced. Exercise may weaken you. If you get light-headed, stop exercising.

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, It is important to be especially careful when eating because you could bite it and not feel the sensation. Call the office if you have any questions, or if the numbness persists for more than a
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. If a temperature of 101 degrees Fahrenheit persists for longer than 2 days after surgery, notify the

You should be careful going from the lying down position to standing. Since you may not have been able to eat or drink prior to surgery, your body may be low on fluid. Because of this, you could get

light-headed if you stand up suddenly. Taking pain medications can also make you dizzy. Before standing up, you should sit for one minute and get up slowly.

Occasionally, patients may feel hard projections or sharp edges in their mouth with their tongue. They are most likely the bony walls which previously supported the tooth, not roots. These projections usually smooth out spontaneously in a few weeks. If not, they can be removed in our office.

If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with lip balm or an ointment such as Vaseline.

A sore throat and discomfort when swallowing is not uncommon. The muscles of the throat may become swollen, and the normal act of swallowing can then become This should subside in 3-4 days.

Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for several days following surgery. This is a normal post-operative event which will resolve in time. Eating soft foods and applying moist heat to the side of the face will help as well.

Finally

The pain and swelling should subside more and more each day following the third day after surgery. If your post-operative discomfort or swelling worsens after day 4 or unusual symptoms occur, call our office for instructions. There will be a hole or socket where the tooth was removed. The void will gradually fill in with new gum tissue over 2-3 months (and bone tissue underneath over 6 months). In the meantime, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.

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 4-7 days following surgery. Call the office if this occurs. It is our desire that your recovery be a smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, call our office. Please try to call during office hours in order to obtain a quicker result.