Surgical Instructions

After Wisdom Tooth Removal

The removal of impacted teeth is a common but significant surgical procedure. Post-operative care is very important. Complications of every kind can be minimized if instructions are followed carefully.

Immediately Following Surgery

The gauze pads placed over the surgical area should be kept in place under pressure for a half-hour. After this time, the gauze pad should be removed and discarded. Additional gauze pressure should only be used for active bleeding (your mouth is filling up). Taking gauze in and out unnecessarily disturbs the wound.
During the first 24 hours, 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 medications as prescribed. Pain medication is best taken after food and before any local anesthetic wears off. Restrict your activities on the day of surgery and resume normal activity when you feel comfortable.
On the first day, place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. DO NOT rinse or spit for 24 hours. Excessive bleeding may be controlled by placing a sufficient number of folded gauze pads over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, repeat the process with 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, do not become excited, sit upright, and avoid exercise. 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, as is some discoloration of the skin. 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 and wrapped in a towel or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be used 20 minutes on and 10 minutes off for the first day only. After that, 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. .

Pain

For moderate pain, over-the-counter medication (like acetaminophen/Tylenol or ibuprofen/ Advil or Motrin) can be tried, if there are no contraindications. For severe pain, take the pain prescription as directed, one-half hour after eating. The prescribed pain medicine may make you groggy and 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 or worsens, it may require attention and you should call the office.

Diet

After your surgery, room temperature liquids and soft foods can be eaten. 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, chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure.

Hygiene

Keep the mouth clean but no rinsing of any kind should be performed until the day following surgery. You can brush your teeth starting the next day, but avoiding the area that was treated. The day after surgery you should begin rinsing at least 4-5 times a day, mealtimes and bedtime, using either mouthwash and water (equal parts) or one-half teaspoon of salt in 10 ounces of warm water. Rinse gently for 30 seconds.

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 post-operative occurrence, which may occur 2-3 days post-operatively and last for a number of days after. This will fade in a short time.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. The prescription should be taken as directed and until all the medication is used up. 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 fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. Often sleep is the best remedy for this problem.

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. Call your doctor 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 over 101 degrees.
You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can also make you dizzy. Before standing up, you should sit for one 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 which supported the tooth. These projections usually smooth out spontaneously. If not, they can usually be easily adjusted by your doctor.
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 or any gentle lip balm.
Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
Stiffness (trimus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time. Self-stretching can be started after swelling goes down.
Discomfort usually lessens after the first 3-5 days. If your pain worsens and a throbbing sensation is interfering with your work or sleep, you may have a delay in healing. This common problem can be quickly relieved by having the doctor place a medicated dressing in the area. This dressing will need to be changed every couple of days for a few times.

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 form your mouth and discard it. The sutures are either self-dissolving or will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure.

There will be a cavity where the tooth was removed. The cavity will gradually fill in over the next month with new tissue. 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: Drs. Schabes, Sacks, and Amrani or your family dentist.

Brushing your teeth is okay - just be gentle at the surgical sites.

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.