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.
Immediately Following Surgery
- Patients receiving an IV anesthetic should return home from our office immediately and lie down with your head elevated until the effects of the medications have dissappeared. You may feel drowsy for a short period of time or for several hours. Do not drive an automobile or operate machinery for at least 12 hours, or longer if you feel any residual effects from the anesthetic.
- The gauze pad placed over the surgical area should be kept in place for 30-45 minutes. After this time, the gauze pad should be removed and discarded.
- 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.
- Place ice packs to the sides of your face where the surgery was performed. Refer to the section on swelling for a more thorough explanation.
- Restrict your activities the first few days. After a few days, you should feel fine and can resume your normal activities. If you have heavy bleeding, new or increasing swelling after3 days, or a reaction to the medication, call our office at River Valley Oral and Maxillofacial Surgery Phone Number 309-797-1770.
- 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.
*If you have had surgery at our office and are having a postoperative problem, call our office for advise or an appointment. You may also simply come to our office at 7:30am Monday-Friday for an evaluation.
A certain amount of bleeding is to be expected following surgery. Bite on a gauze pad for 30-45 minutes immediately after the appointment. Visually make sure the pack is directly over the surgical area as numbness can make this hard to feel. Slight bleeding, oozing, or redness in the saliva is not uncommon for 48 hours following surgery. 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 30-45 minutes. Repeat if necessary. If bleeding continues, bite on an ice water moistened black tea bag for 30-45 minutes. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels. It is also helpful to remain calm, sitting upright with your head above your heart to avoid any increase in heart rate. If bleeding does not subside, call our office for further instructions.
After the blood clot forms, it is important to not disturb or dislodge the clot. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 24 hours. These activities may dislodge or dissolve the clot and hinder the healing process. Normal oral hygiene/brushing should be done with care away from the surgical areas starting the day after surgery. Limit vigorous exercise for the next 48 hours, as this increases blood pressure and may cause more bleeding from the extraction site.
You will experience some discomfort following any surgery. Extractions are no exception. During your surgery, you received a local anesthetic injection, which will keep the area numb from 1-6 hours. After your surgery, you should eat something soft so that you can take your pain medication with food in your stomach. Taking pain medication on an empty stomach can cause nausea and vomiting. The medication should be started as soon as possible after surgery to stay ahead of the pain and inflammation.
For children, take over the counter pain medication as directed.
For Adults with moderate pain, take over the counter pain medication. We recommend taking two or three 200mg ibuprofen *Advil, Motrin) every 6 hours (maximum=3200mg/24hrs). Do not take ibuprofen if you are pregnant or have kidney disease. Short term use of ibuprofen can cause gastrointestinal upset, ulcers and bleeding. High dose use can damage your kidneys, especially in the elderly and dehydrated. Ibuprofen and acetaminophen (Tylenol) taken in combination may improve pain relief. We recommend taking 200-400mg of ibuprofen together with 500-1000mg acetaminophen every 6 hours. Do not exceed the adult daily maximum of acetaminophen (4000mg) or use alcohol as this may harm your liver. Consult with your physician as to whether you can take these medications with your unique health history.
For Adults with severe pain not controlled by over-the-counter (OTC) medications, take the medication prescribed by your doctor as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. No alcoholic beverages. This type of pain medication usually contains an opiod and acetaminophen or Ibuprofen. Opiods are habit forming and should be used with caution. Do not take additional Tylenol along with the prescribed medication. Too much Tylenol can harm your liver. Please dispose of unused prescribed medications, especially opiods, at a take back center. If you are unsure, call the office for clarification.
Swelling, Bruising and Jaw Stiffness
After a tooth or teeth are extracted, you may experience some swelling, bruising and a jaw stiffness. 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 start to become apparent on the day of surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by immediately applying an ice pack or an unopened bag of frozen peas or corn to the area post surgery. Every 30 minutes remove the ice packs for 5 minutes. The ice packs should be applied continuously while you are awake. Continue the use of the ice for 48 hours. After 48 hours, ice has no beneficial effect on swelling. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Take pain medications as prescribed. The swelling usually occurs over the first two days and slowly subsides after about a week. If new swelling occurs after the initial swelling subsides, advise your doctor.
After General Anesthetic or IV sedation, only liquids should initially be consumed. Drink from a glass and do not use a straw. The sucking motion can cause more bleeding by dislodging the blood clot. Do not rinse for the first 24 hours following tooth extraction. 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. As long as you are not nauseated, a milkshake is easy to eat while numb and packs a lot of calories. 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. You can advance your diet as soon as you are comfortable.
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 water. If the water is tolerated, follow it with broth, tea, or ginger ale. You should sip slowly over a fifteen-minute period. We do not recommend eating dairy products such as yogurt, ice cream or milkshakes until the nausea subsides. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.
Keep Mouth Clean
It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day avoiding the surgical area. This will speed healing and help keep your mouth fresh and clean. Do not rinse for the first 24 hours following tooth extraction. After 24 hours warm salt water rinses should be used to keep the surgical area clean until enough healing has taken place to allow brushing. If you were prescribed a rinse use this in place of salt water. Do not rinse with peroxide.
We discourage smoking for 5 days following tooth extraction. Smoking delays healing and puts you at much greater risk of developing a dry socket.
A dry socket is caused by having the blood clot within the extraction site liquefy and dissolve out of the area. This results in pain as the bone becomes inflamed. This occurs in a small number of patients, usually on the third day following extraction. If the pain is increasing after the third day (the area hurts more on the third day than it did on the first day), let your doctor know. This is usually treated with a medicated dressing, placed in the extraction site, which will alleviate the pain. Anti-inflammatories, such as ibuprofen, are often very effective in helping with the pain until you can be evaluated. The medicated dressing must be removed within 5-7 days to prevent infection.
Orthodontic appliances can be worn immediately following surgery unless advised otherwise by your doctor.
Disability from Work
We assume you will be able to resume your work duties within 24 hours after your extraction, unless otherwise advised. Anyone taking off work without a prior written excuse from our office will be doing so at their own discretion, and will be responsible to their employer for the consequences. You will be provided a work excuse if deemed necessary. Discuss this with your doctor prior to surgery.
Numbness of the lip and chin rarely occur. This may occur following the removal of a lower wisdom tooth. Most often this is temporary and will resolve within a few days to weeks. Occasionally, some numbness may persist for months, and in rare cases can be permanent.
Infection after an extraction is rare, but does occasionally occur. Signs of infection would be new swelling, pain, and redness to the area. If antibiotics are prescribed, continue to take them for the indicated length of time even if signs and symptoms of infection are gone. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact 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. You could get light headed from low blood sugar, dehydration 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 adjacent to the extraction site. They are not roots; they are the bony walls which supported the tooth. These projections usually smooth out spontaneously over time. If not, they can be removed.
- 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 postoperative event which will resolve in time.
Sutures may be placed in the area of surgery to approximate tissues 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 pain and swelling should subside more and more each day following surgery. If your postoperative 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: Drs. Lutchka or Thatcher or your family dentist.
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.