The removal of impacted wisdom 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.
FIVE THINGS NOT TO DO FOR THE FIRST 24 HOURS:
- No smoking
- No use of drinking straws or carbonated beverages
- No hot liquids (lukewarm coffee, tea, or soup is fine)
- No vigorous rinsing with mouthwash or water (mild swishing is fine)
- No spitting – wipe saliva from your lips with a tissue
Any of the above can cause increased bleeding after surgery. Some bleeding following oral surgery is to be expected. You will notice an oozing for 12 to 24 hours following the surgery. Pressure applied over the surgical areas by biting on gauze will decrease the bleeding.
Immediately Following Surgery
The gauze pad placed over the surgical area should be kept in place for 60 minutes. 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 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 explanation.
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 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, sit upright, do not become excited, and avoid exercise. 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 may not reach its maximum until 4-5 days postoperatively. However, the swelling may be minimized by the immediate use of ice packs. Two ice packs or a bag of frozen peas should be applied to the sides of the face where surgery was performed. The ice packs should be used for 20 minutes on and 20 minutes off, without direct contact with the skin. 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.
For mild to moderate pain, we recommend Ibuprofen (Motrin or Advil): 2-4 200mg tablets may be taken every 3-4 hours.
For severe pain, take the tablets prescribed for pain as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Ibuprofen (600mg) can be taken in between the doses of the stronger pain medication. 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 at first. 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 very important. Nourishment should be taken regularly. You should prevent dehydration by taking 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, 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. Therefore, immediately following surgery, if you are laying down, make sure you sit for one minute before standing.
Keep the mouth clean
No rinsing of any kind should be done 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.
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 needed, an anti-nausea medicine may be perscribed.
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 it, so be careful. Call Dr. Falender if you have any questions about this. If the numb feeling extends beyond a few days, please call our office.
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 going from the lying down position to standing, as you were not able to eat or drink prior to surgery, it is difficult to take fluids, and taking pain medications can make you dizzy. You could get light-headed when you stand up suddenly. 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 be removed by Dr. Falender.
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 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.
Sutures are placed at the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, but this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures will dissolve between 5-7 days after surgery.
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, over the next month, fill in with the 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 take seriously well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Falender 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 2-3 days following surgery. Call the office if this occurs.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced, so exercise may weaken you. If you get light-headed, stop exercising.
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