After Wisdom Teeth Extractions/Multiple Teeth Extractions/Extractions

Home Instructions After Wisdom Teeth Extractions

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 a half hour. After this time, the gauze pad should be removed and discarded.
• 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.
• Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic 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 a more thorough 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 thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened black tea bag for thirty minutes. The tannic acid in the black tea 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 our office for further assistance.

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 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 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. 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.

Pain 

Immediately take 600mg of Ibuprofen “Motrin, Advil” along with 500mg Extra Strength Tylenol. Take this combination every 4 hours for the next 3 days. You may adjust this as needed after 3 days depending on your pain level. There is a rescue medication that should only be taken if pain is severe. Supplement this pain pill as needed until the pain can be managed with Ibuprofen/Tylenol combination. Call with any questions regarding pain management.

Diet 

After general anesthetic or IV sedation, only liquids should initially be consumed. Drink from a glass and do not sure straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. A high calorie, high protein intake is very important. Creamed soups, puddings, yogurt, milk shakes, etc. are good examples. Avoid foods like nuts, sunflower seeds, popcorn, etc., that may get lodged in the socket areas. Over the next several days, you can progress to solid foods at your own pace. It is important not to skip meals. If you take nourishment regularly, you will feel better, gain strength, have less discomfort and heal faster. If you are diabetic, maintain your normal eating habits as much as possible and follow instructions from us or your physician regarding your insulin schedule.

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 up for one minute before standing.

Sharp Edges 

If you feel sharp edges in the surgical areas with your tongue, it is probably the bony walls which originally supported the teeth. Occasionally, small slivers of bone may work themselves out 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.

INSTRUCTIONS FOR SECOND AND THIRD DAYS

Oral Hygiene 

No rinsing of any kind should be performed until the day following surgery. The day after surgery, you should begin rinsing at least 5-6 times a day with a teaspoon of salt mixed into one cup of warm water, especially after eating.

Brushing 

Begin your normal hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.

Syringe 

If you were given an irrigating syringe on the day of surgery, start using it the third day after surgery to keep sockets clean. Fill it with warm water and irrigate any open sockets gently, especially after eating.

Dry Sockets 

From the fourth day on gradual, steady improvement should mark the remainder of your postoperative course. If a dry socket occurs (loss of blood clot from socket, usually on the 3rd to 5th day), there is a noticeable distinct, persistent throbbing pain in the jaw, often radiating toward the ear and forward along the jaw to cause other teeth to ache. Call the office and report symptoms so you can be seen as soon as possible.

Discoloration 

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 postoperative occurrence, which may occur 2-3 days post-operatively. 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 any other unfavorable reaction and contact out office immediately. 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 one hour, including prescribed medications. You should then sip on coke, 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.

Other Complications

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, 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. Call Dr. Burkhalter 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.
• 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 is not uncommon. The muscle gets swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days
• Stiffness (Trismus) of the jaw muscles may cause difficulty opening your mouth for a few days 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. 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 post operative pain or swelling worsens or unusual symptoms occur, call our office for instructions.

There will be a void where the tooth was removed. The void will fill in with new tissue gradually 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 unique, no two mouths are alike. Discuss any problems with the trained experts best able to effectively help you: Dr. Burkhalter

Brushing your teeth is okay – just be gentle at 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 near the ear may occur 2-3 days following surgery. Call our office if this occurs.