Post-Operative Instructions:
Wisdom Teeth Removal

Post-op wisdom teeth removal

The removal of 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 following instructions are followed carefully.

Essentials of Care

• The gauze pad placed over the surgical area should be kept in place for at least a half-hour. After this time, the gauze pad should be removed and discarded. Replace the gauze if bleeding persists.
• Vigorous mouth rinsing, sucking, 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.
• Begin a diet of liquids and soft foods as soon as you can.
• Take the prescribed pain medications with food 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.
• Press ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for more explanation.
• If you suddenly sit up or stand up from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.
• Do not smoke following surgery of any kind.
• Do not wait for your follow-up appointment to ask questions or tell us that you are having a difficult time. Call our office for assistance.

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 away any old clots from your mouth, then placing a gauze pad over the area and biting down firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on 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 unnecessary movement. If bleeding does not subside, call for further instructions.

Swelling

The swelling to be 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 healing. The swelling will not become apparent until 1-2 days 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 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 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. Thirty-six hours following surgery, the application of gentle moist heat to the sides of the face is beneficial in reducing the swelling and stiffness. Sleep with your head elevated on two pillows for 2-3 nights following the procedure.

Pain

Unfortunately, most oral surgery is accompanied by some degree of discomfort. Acute pain management should always start with over-the-counter pain medications, such as acetaminophen (Tylenol^®) or ibuprofen (Motrin^®, Advil^®). If your surgeon approves these medications for you, you should take them as directed on the pill bottles, or by your surgeon. If you take the first pill before the anesthetic has worn off, you will be able to manage any discomfort better. Precede each pain pill with a small amount of food, and chances for nausea will be reduced.

The effects of pain medications vary widely among individuals. For severe pain, you may take your prescription opioid (narcotic). Do not take more opioid pills, or more often, than prescribed by your surgeon. If prescribed, Vicodin^® / Norco^® may be taken every 4-6 hours for pain. DO NOT USE TYLENOL. If you notice that the pain medication is not providing comfort for long enough, alternate the Vicodin / Norco and Ibuprofen throughout the day (ex: take 1 Vicodin, then 2 hours later, take ibuprofen…2 hours later another Vicodin / Norco). If you are unable to achieve a comfortable state, please call us for further advice. Do not drive or drink alcohol while you are taking opioids. Do not use opioids with benzodiazepines, sleeping medications, or other depressants. If you have any questions, ask your surgeon or any pharmacist before using these medications together as they can increase your risk of an accidental overdose.

Diet

After general anesthetic or sedation, liquids should initially be taken. Advance your diet as you feel more comfortable. Try to avoid straws if possible. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. Very hot or cold foods should be avoided. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by drinking plenty of your favorite juice or Gatorade-type drinks regularly. Your solid food intake may be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 6-8 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 and drink.

Keep your 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 rinsing at least 5-6 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt.

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 tissue. This is a normal occurrence, which may occur 2-3 days post-operatively. This may also occur at the injection sites on your arm or hands. If there is pain, redness, or hardness please contact our office. Application of moist heat to the discolored areas will speed up resolution.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. It is important to take your antibiotic on a regular schedule. It is not effective to take a catch-up dose if one is missed. Antibiotics will be given to help prevent or treat active infections. 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 (not even plain water) until nausea has resolved. Do not take the prescribed medicine while nauseated. After resolution of acute nausea clear liquids such as apple juice, Jell-O^®, water, tea or ginger ale can be tried. You should sip slowly over a fifteen-minute period. If nausea has not recurred, then bland solid foods such as cottage cheese is recommended for the next 6-8 hours. Pain medication may be taken after a bland food diet has been resumed. When the nausea subsides, you can begin eating solid foods. If you have nausea and vomiting that persists for more than 12 hours, please call the office.

Other Comments:

• 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 our office if you have any questions.
• Slight elevation of temperature immediately following surgery is very normal and not uncommon. If the elevated temperature persists, notify the office. Tylenol^® or ibuprofen should be taken to reduce the fever.
• 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.
• The corners of your mouth 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. 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 over time. The application of gentle moist heat to the facial muscles after the prescribed icing period will soothe the muscles and release the stiffness.