AFTER WISDOM TOOTH REMOVAL
The removal of wisdom teeth is and should be thought of as a surgical procedure. Post-operative care is critical. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully. The consultation appointment is extremely important in establishing expectations and ensures patients can make the appropriate arrangements for aftercare.
IMMEDIATELY FOLLOWING SURGERY
- The gauze pad placed over the surgical area should be kept in place for a half hour. 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 prescribed.
- 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 explanation.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Having a red-tint to your saliva for 24 hours is considered normal. 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 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, avoid exercise and do not become excited or sit upright. If bleeding does not subside, call for further instructions.
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 2–3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs, 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 little effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
Soreness accompanies this procedure. Pain medications will be prescribed to help one remain as comfortable as possible through the healing cycle. Ibuprofen (Motrin®/Advil®) is the most effective pain medication for these procedures and can also help control swelling. Most patients are prescribed 600mg of ibuprofen, which can be taken 4 times daily. A specific regimen will be tailored for each patient, taking into account their medical histories and other medications.
For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention, and you should call the office.
After general anesthetic or IV sedation, liquids should be taken initially. 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 from the surgical sites. High-calorie, high-protein intake is essential and should be taken regularly. You should prevent dehydration by drinking fluids regularly. Your 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, feel less discomfort, and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for 1 minute before standing.
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. The day after surgery, you should begin rinsing at least 5–6 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt.
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. This is a normal post-operative occurrence, which may occur 2–3 days postoperatively. Moist heat applied to the area may speed up the removal of the discoloration.
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 coke, tea, or ginger ale. You should sip slowly over a 15-minute period. When nausea subsides, you can begin taking solid foods and the prescribed medicine.
- If numbness of the lip, chin, or tongue occurs, there is no cause for alarm. As stated before surgery, this is usually temporary. 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 Dr. Koshgerian or Dr. Shelton 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.
- You should be careful about going from the lying down position to standing. You were not able to eat or drink before surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get lightheaded when you stand up suddenly. Before standing up, you should sit for 1 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 that supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Koshgerian or Dr. Shelton.
- 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 ordinary 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 following surgery. This is a normal post-operative event that will resolve in time.
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 sutures will dissolve approximately 1 week after surgery. Sometimes, 1 or 2 of the stitches loosen up and fall out earlier; this does not require treatment, and the area should still go on to heal uneventfully.
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 the office for instructions.
There will be a cavity where the tooth was removed. The cavity will gradually fill in with the 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 2 mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Koshgerian, Dr. Shelton, 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 5–10 days following surgery. Call the office if this happens.
If you are involved in regular exercise, be aware that your usual nourishment intake is reduced. Exercise may weaken you. If you get lightheaded, stop exercising.