Surgical Instructions

After Wisdom Tooth Removal

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

  • Place ice packs to the sides of your face where surgery was performed for the first 24 hours. Refer to the section on swelling for an explanation.
  • 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 soon as you begin to feel discomfort. This will usually coincide with the local anesthetic wearing off.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable or as directed by Dr. Fox.

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 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened black tea bag for 30 minutes. The tannic acid in the tea bag will help to form a stable blood clot. If the bleeding does not subside, call Dr. Fox 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 will reach its maximum two to three days post-operatively. Swelling may be minimized by the immediate use of ice packs and medications, if prescribed. Two plastic bags 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 24 hours, ice has minimal beneficial effect. Forty-eight hours following surgery, the application of moist heat to the sides of the face can beneficial in reducing the size of the swelling.

Pain

For mild to moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours. Alternatively, ibuprofen (Motrin or Advil) may be taken, two to four 200 mg tablets every three to four hours as needed for pain.

For severe pain, take the prescribed medications as directed. The narcotic pain medicine can make you drowsy and will slow down your reflexes. Therefore, do not drive an automobile or work around machinery while taking these medications. Alcoholic beverages should be avoided. Pain or discomfort following surgery should subside more and more each day. If poorly controlled pain persists, it may require additional attention and you should contact the office.

Diet

Begin with liquids after general anesthesia or IV sedation. Do not use straws, this could lead to a dry socket. You may advance your diet as tolerated. You can prevent dehydration by taking fluids regularly. Your solid/firm food intake is expected to be limited for the first few days. You can compensate for this by maintaining a liquid/non-chew diet. You will feel better, 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. When you are lying down following surgery, make sure you sit for one minute before standing.

Keeping 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 salt water rinsing at least five to six times a day. Salt water is simply a cup of warm water mixed with a teaspoon of salt.

Discoloration

In some cases, bruising of the skin follows swelling. The development of bruised blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This can be a normal postoperative occurrence, which may occur two to three days after surgery. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been prescribed antibiotics, take the tablets or liquid as directed. Antibiotics may be given to help treat an infection. Discontinue antibiotic use and contact the office in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

Nausea & 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 can then sip on Coke, tea, or ginger ale as well as an over-the-counter remedy. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. If the nausea persists please contact the office for further direction.

Other Complications

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this can follow surgery and is usually temporary in nature. Call Dr. Fox if you have any questions.
  • A slight elevation of temperature immediately following surgery is common. If the temperature persists, notify the office. Ibuprofen should be taken to reduce the fever if needed.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are likely the bony walls which supported the tooth or possibly a suture. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Fox.
  • 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 can be common. The nearby throat muscles get swollen. The normal act of swallowing can then become painful. This will subside in two to three days.
  • Stiffness of the jaw muscles (trismus) may cause difficulty in opening your mouth for a number of days following surgery. This is a normal post-operative event that will resolve in time.
  • Dry socket is an uncommon healing complication that can require in-office treatment to resolve. If complaints persist after local measures, please contact the office for an appointment.

Finally

Sutures are sometimes placed in the area of surgery to minimize post-operative bleeding and to help with healing. They will usually ‘dissolve’ with time. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures, if present, will be removed approximately one week after surgery.