After Wisdom Tooth Removal

The removal of impacted 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. If you have questions, do not hesitate to contact our office.

Immediately Following Surgery

  • Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not controlled. After this time, the gauze pad should be removed and discarded. The gauze may then be changed as necessary.
  • 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. It is recommended usually to start with a half pill when the tingling sensation starts in the lip.
  • If you were sedated, remember to drink water and eat soft food (pudding consistency) within the first 2 hours after surgery to minimize nausea side effects from the pain medications.
  • 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 for the first 24 hours. Bleeding should never be Excessive. Bleeding may be controlled by wiping any old clots from your mouth, then placing a moist gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary.
  • If bleeding continues, bite on a moistened black tea bag wrapped in a moist gauze for thirty minutes. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels.
  • To minimize further bleeding, control your pain, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call our office 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 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 application of ice packs.
  • Start with the ice packs provided, then zip-lock bags filled with ice, or frozen vegetable bags, should be applied to the sides of the face where surgery was performed. The ice packs should be alternating on-off every 20 minutes while you are awake. At night while sleeping for the first 2 nights, we recommend elevating the head with extra 2 pillows or sleep on a recliner.
  • After 48 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. Two days following surgery, the application of a heating pad for 30 minutes to the sides of the face once or twice per day is beneficial in reducing the size of the swelling.

Pain

  • For moderate pain, one tablet of Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil or Motrin) may be taken instead of, or in addition to Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3200 mg daily for an adult. Consult our practice for individuals under 18. 
  • For severe pain, the prescribed medication should be taken as directed. Do not take Tylenol with the prescribed medication. You may however, take Ibuprofen as directed above. Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. 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.
  • If you find that you are taking large amounts of pain medicine at frequent intervals, or if you anticipate needing more prescription medication, please call our office so we can see you. Most pain medications or refills cannot be called-in to the pharmacy. We cannot provide pain medication prescription during the weekends, so if you anticipate needing it, schedule a follow up before the weekend.

Diet

  • After general anesthetic or IV sedation only liquids should initially be consumed. Drink from a glass and do not use 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. Our staff can provide suggested diet instructions.
  • 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 any meals. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
  • It is best to avoid foods like nuts, sunflower seeds, popcorn, etc. which may get lodged in the socket areas.
  • 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.

Keep the mouth clean

  • 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, especially after eating, with a quarter teaspoon of salt mixed into one cup of warm water. 
  • Do not pull the cheek to look into the wound and do not suck into the area trying to clean it from food debris, especially in the first 4 days. On your follow up appointment, we will give you a plastic irrigating syringe and teach you how to use it to clean the extraction sockets..
  • Start brushing your teeth on the following day. Don’t skip any teeth but just be gentle at the surgical sites. it is normal to notice slight oozing of blood after you brush.
  • Don’t rinse your mouth by puffing the cheeks and swishing aggressively. Instead tilt your head sideways and let the water drool out without aggressive spitting.
  • Do not smoke for at least 3 days. smoking will increase the chance of developing a dry socket which is a painful complication.

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 lasts for 7-10 days. Heating pad applied to the area may speed up the removal of the discoloration.

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 soda, 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. Deragopian 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.
  • You should be careful going from the lying down position to standing. You could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting 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. Deragopian.
  • 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 (Trismus) 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.

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 sutures 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 usually no discomfort associated with this procedure.

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. Deragopian or your family dentist.

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 the office if this occurs.

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.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instruction will assist you, but if you have questions about your progress, please call our office. After business hours, you will be directed to an emergency phone number to reach Dr. Deragopian