After Wisdom Tooth Removal

The removal of impacted teeth is a surgical procedure. Post-operative care is very important. Unnecessary pain and swelling and the complications of infection can be minimized if the instructions are followed carefully.

Please read these instructions carefully. They will help you understand the normal reactions following your surgery and help to keep you as comfortable as possible

EARLY CARE AFTER SURGERY

On the Day of surgery, patients tend to do well if they follow this sequence:

  1. Control Bleeding First.
    1. Have the patient sit up and bite hard on the gauze until the bleeding is stopped. Do not spit. Apply ice packs immediately.
  2. Get something in your Stomach.
    1. A milkshake is suggested.
  3. Start Medications.
    1. If you have pain, start taking your pain medicine first and wait one hour to start the antibiotics.
    2. If you have no pain, start taking your antibiotic first and wait to start the pain medicine until pain is just starting to occur.

BLEEDING

Apply a thumb size roll of moistened sterile gauze or a teabag over the wound and bit hard for 1 hour with constant pressure, using 80% of your maximum bite force. Make sure that the bulk of gauze is placed behind the last teeth. This gauze should act as a barrier to prevent a lot of blood from spilling into your mouth. If your mouth tends to fill up with blood, the gauze is not sealing off the area and needs to be adjusted to seal off the area. Another reason for blood filling the mouth is when the gauze is initially placed to seal off the area correctly but the patient only applies intermittent pressure or starts talking, which allows the gauze to move out of position in sealing off the area. It may require 3-4 hours to stop the bleeding even when the techniques described are used properly.

It is best if someone other than the patient can check for bleeding and apply the gauze for the patient. At the end of each hour, remove the gauze and check the wound directly for further bleeding. Do not be afraid to look at the wound directly. It is the best way to check bleeding.

Please ignore bloodstain on the gauze as a sign of bleeding. Instead, it is best to have a second person look at the gum behind the last teeth using a flashlight and a spoon handle for a retractor. Do not be surprised if the patient cannot open very wide. You only need partial opening to see if it is bleeding.

For lower wisdom teeth, Drs. Blecha and Jandali usually sutures the wounds open, so you will see a hole in the gum behind the last tooth. There may be blood in the hole, and some in the adjacent area. If you see blood clots (“jelly clots”) on the adjacent teeth, wipe them off. This may stimulate some bleeding but it is the correct thing to do. These “jelly clots” form when the gauze does not seal off the gum opening and blood seeps outside of the gum and clots on the adjacent teeth. To determine if bleeding is still present, look into the hole for about 20-30 seconds. If the socket “pools up” with blood, place a new pressure gauze to seal off the area and bite constantly on the gauze for another hour. Check the socket an hour later to see if the rate of bleeding has improved, worsened or stayed the same.

With upper wisdom teeth, it may be hard to see the upper socket. If bleeding is occurring with upper wisdom teeth, the person observing the area will see an occasional dripping of blood from behind the last molar teeth. You could also see drops of blood that run down the cheek next to the area.

Thus, if you see blood “dripping down” from the upper wisdom tooth area, or “pooling up” from the lower wisdom tooth socket, you need to place another moistened gauze pad for another hour. During that hour, the patient should not be talking or opening the mouth, as such behavior will cause the gauze to move out of the proper position.

A variable 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. If this creates more bleeding you can then rinse one time with 50% hydrogen peroxide and 50% water. This will make your mouth foam. Rinse out the foam with cool water one time. No further rinsing is suggested. Then, place a gauze pad over the area and bite firmly for one hour at a time, using a constant bite force that is approximately 80% of your maximum bite force. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, sleep with your head elevated and avoid exercise. If bleeding does not subside, call for further instructions.

It is normal to have some minimal bleeding with pink or red saliva during the first 24 hours. Bleeding can occasionally recur during the week after surgery. It will usually stop by itself, but a pressure gauze may be used if it is persistent.

It may be useful to place a towel on your pillow the night of surgery, as minor oozing may occur from the wound at night.

PAIN

If you have impacted teeth, Drs. Blecha and Jandali usually prescribes an anti-inflammatory pain pill, such as Diflunisal or Celebrex, as the main pain medicine. As the local anesthesia wears off and pain develops, please take this medicine first for pain relief. Once you start taking this anti-inflammatory pain pill, continue to take it at prescribed intervals until it is finished or until you have no pain at all. You cannot take Advil or Aleve with Diflunisal or Celebrex as they are in the same family of drugs.

Should you not achieve reasonable pain relief with the anti-inflammatory pain pills, you should still take the anti-inflammatory medicine as prescribed, but add occasional doses of the narcotic pain reliever (Norco, Tylenol with codeine #3) that Drs. Blecha and Jandali also prescribed for supplemental pain relief.

Please remember to

  • Space different medicines at least one hour apart from each other
  • Eat food of some thickness one half hour before taking any medicine
  • Follow the frequency that is prescribed on each bottle
  • Pain medicines take the edge out of strong pain; they do not eliminate all pain sensation.
  • Avoid alcohol with any pain medication or antibiotics
  • You should not drive any vehicle or work if taking narcotic medications. This does not apply with the anti-inflammatory pain pills.

The post-operative pain can vary considerably in different patients. It is often worst in the first 72 hours, but occasionally it can become worse after this period. The overall pattern to one’s pain should be that it tapers off as a general trend over 5-6 days, though the pain can vary some in any one day. Exertional activities, exercise, and a “busy” lifestyle will tend to make the wounds “throb,” so please use common sense and minimize activities that irritate the wounds.

ANTIBIOTICS

If you have been placed on antibiotics you may take the first dose 1 hour after taking the pain pills. Continue to take this medication as prescribed and complete the entire dosage.

Please be aware that antibiotics may decrease the effectiveness of birth control pills. Please ask your obstetrician if and how long after stopping the antibiotic you should use alternative birth control measures.

OTHER MEDICATIONS

Continue other medications, which you may have been routinely taking before your treatment in our office (unless otherwise directed).

If a steroid (dexamethasone) was given to you, please follow the directions on the package.

Always space different medicines one hour apart from each other and eat before you take them. Use this timing schedule to follow the frequency listed on each prescription:

Date Name of Medicine Frequency Time of Next Dose Time when Medication Taken
         
         
         
         
         
         
         
         

SMOKING

Smokers are not advised to smoke for the first 48 hours, and preferably the first week, after surgery. If you smoke, you will have much more postoperative pain.

SWELLING

Drs. Blecha and Jandali tries to use surgical techniques that prevent swelling. However, the swelling that occurs may be 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 is a part of normal healing. Swelling usually peaks by 72 hours. The swelling that develops by 72 hours then takes 5-6 days to go down.

Your swelling can be reduced with the immediate use of ice packs. Either ice packs or a Ziploc bag filled with ice and placed in a wash cloth should be applied to the sides of the face where surgery was performed. Use the ice in one half hour intervals (one half hour on, on half hour off) on the day of surgery and up to 72 hours. After 72 hours, you can use warm, moist heat applications to the side of the face to help bring swelling down.

DIET

There is real value in re-establishing your diet after wisdom teeth surgery. If your jaw is stiff to open after your surgery, such stiffness may last for 5-6 days and chewing could be difficult.

Once the bleeding is stopped we usually suggest a milk shake. After that we recommend that our patients eat “bulky” food as they are important in preventing nausea and vomiting from out postoperative medications.

Examples of bulky foods include mashed potatoes, oatmeal, and ground-up meats. Be creative. Ask a family member to take bulky foods and chop them up so that you can feed yourself these foods with a spoon and swallow them without chewing. You can eat bulky foods without having to chew them if you cut them up very finely. You should also have 5-6 glasses of liquids per day to supplement the “bulky” foods.

Your jaw may be sore and stiff, but you must eat bulky foods to tolerate your medications and avoid nausea and vomiting.

ORAL HYGIENE

Do not rinse or brush your teeth for 24 hours after surgery. After 24 hours, start to brush the teeth and use salt water rinses as directed below. Please remember that your pain will resolve faster and your mouth will heal faster if you have very good hygiene after surgery. If you are too “shy” to brush and rinse, your pain will often become worse and you are much more likely to develop a postoperative wound infection.

Twenty-four hours after wisdom tooth removal, you need to brush all of your teeth, even those adjacent to the wisdom teeth. Think of it as careful cleaning of all teeth at the gumline. Brushing is not “scrubbing” of the teeth. Rather, it is careful cleaning of the “nooks and crannies” where food gets stuck.

Twenty-four hours after surgery, start to use the salt water rinses. Add one half teaspoon of salt to a glass of warm water and “swish out” the food that gets stuck in the wounds. Remember that salt water rinsing does not replace brushing. You need to both rinse and brush. If your jaw is stiff to open 4-5 days after surgery, you can start to do stretching exercises to try to open your mouth wider. This will improve your opening and will allow you to eat better and to clean your mouth better.

If you were given a syringe to clean out the lower wisdom tooth sockets, you can begin to rinse 4-5 days after surgery. Simply fill up the syringe with warm water and gently feel the gum behind the last lower tooth until the syringe is in the hole (socket) behind the last tooth. Squeeze the syringe plunger with moderate pressure to flush the socket out. Syringing is usually necessary for four weeks after surgery, until no hole (socket) is present. Salt-water rinses of upper wisdom teeth are suggested for three weeks. If you do not clean out the food from the sockets, they can become infected and your pain will last longer.

REMEMBER: A clean wound heals better and faster.

DISCOLORATION

In some cases, discoloration of the skin follows surgery. 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 post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

SORE THROAT / CORNERS OF THE MOUTH

A sore throat may develop from either the extractions or IV anesthesia. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days. Gargling with salt water will help this.

The corners of the mouth can be stretched from doing surgery inside the mouth and they may dry out and crack. Please keep the corners of the mouth moist with a lip balm or an ointment such as Vaseline.

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 or seven-up. You should sip slowly over a period of time until you can finish the entire can. When the nausea subsides you can try to resume eating “bulky” foods. If you can tolerate these “bulky foods,” you can slowly resume taking your medications. It is often the narcotic pain medication that causes nausea. Thus, you should minimize use of narcotic pain medications if you are having nausea. Should they be needed, please be slow to resume taking the narcotic pain medication and you should use a low dose to try to prevent further nausea.

OTHER COMPLICATIONS

  • If numbness of the lip, chin, or tongue is present the day after surgery, 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. Update Drs. Blecha and Jandali on any numbness at your next office visit.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature is greater than 101 degrees develops, notify the office. Your anti-inflammatory medication and your narcotic contain medicines to reduce fever. Low grade fevers often occur if patients do not have enough fluids, so drink lots of fluids.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the adjacent bone that supported the tooth. These projections usually smooth themselves out slowly after surgery. If you do have a prominent area of bone, do not play with it or you may make it worse.
  • 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 after anesthesia. The throat is very sensitive. The normal act of swallowing can then become painful. This will subside in 2-3 days. To relieve this you can use a salt-water gargle once you start the salt-water rinses.
  • Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for 5-6 days following surgery. This is a normal post-operative event that will resolve in time. You can use stretching exercises after meals and at bedtime to relieve this.

FINALLY

Sutures are placed 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 are usually dissolvable and will fall out within 3-7 days after surgery.

There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. During this time, the area should be kept clean especially after meals with salt-water rinses.

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: Drs. Blecha and Jandali or his staff.

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. Your pain should taper over 5-6 days after surgery. If the pain is not tapering 5-6 days after surgery, please call the office. In general, good oral hygiene helps to prevent this problem.

Drs. Blecha and Jandali and his staff are interested in your speedy and comfortable recovery. If any problems should arise during your treatment, please feel free to contact our office.