After Wisdom Tooth Removal

Kokomo Oral & Maxillofacial Surgery | Kokomo IN

The removal of impacted teeth is a surgical procedure. Post-operative care is very important. Discomfort and complications can be minimized if these 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. 
• Oozing of blood can be expected for at least the first 24 hours following surgery. Remember that a lot of saliva and a little blood may look like a lot of bleeding.
• Do not spit, gargle, brush your teeth, or rinse your mouth out for at least 24 hours.
• 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 recommended discomfort relieving medications while you are still numb.
• Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
• Place ice packs or frozen peas to the sides of your face where surgery was performed. USE THE ICE! Refer to the section on swelling for a more thorough explanation.
• Avoid smoking for as long as you can because it interferes with healing and may increase post operative pain. It has been our experience that smoking during the first 7 days after surgery increases post operative pain.

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 thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise.

Swelling

USE THE ICE! The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, and sides of the face is not uncommon. This is the body’s normal reaction to surgery. The swelling usually 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 use of ice packs. Two baggies filled with ice, chemical ice packs, or frozen peas should be applied to the sides of the face where surgery was performed. The ice packs should be applied one half hour on and one half hour off while you are awake. After 48 hours, ice has minimal 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.

Discomfort

A very good method to manage post-operative discomfort and inflammation involves alternating doses of ibuprofen (Advil and Motrin) and acetaminophen (Tylenol).  We recommend taking 400 mg of ibuprofen followed two hours later by 650 mg of acetaminophen, then another 400 mg of ibuprofen two hours later, and so  on.  An example of this would be:  400 mg of ibuprofen at 8:00 am, then 650 mg of acetaminophen at 10:00 am, 400 mg of ibuprofen at 12:00 noon, 650 mg of acetaminophen at 2:00, and so on.  If taking prescription medication for discomfort, the prescription pill would take the place of the Tylenol doses in the schedule.  Example: 400 mg ibuprofen at 8:00 am, prescription at 10:00, and so on.  DO NOT take acetaminophen if you are sensitive/allergic or have liver disease.  DO NOT take ibuprofen if you are taking blood thinners or an aspirin on a daily basis. DO NOT take ibuprofen if you are taking other anti-inflammatory drugs daily or are sensitive/allergic .  The maximum dose of ibuprofen is 2400 mg in a 24 hour period.

Diet

Consume ONLY cool liquids and soft foods on the day of surgery. Some good examples would be milkshakes, jello, pudding, yogurt, applesauce, cottage cheese, and ice cream.  For several days following your surgery, soft foods may be desirable, such as soups, mashed potatoes, macaroni and cheese, oatmeal, scrambled eggs, and thoroughly cooked vegetables. Drink from a glass and DO NOT USE A STRAW. 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. Nourishment should be taken regularly. Your food intake might 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.

Keep the Mouth Clean

No rinsing of any kind should be performed until the day following surgery. Beginning the day after surgery  rinse at least 5-6 times a day, especially after eating, with  warm water. 

Other Considerations

• 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. Thompson if you have any questions.
• Slight elevation of temperature immediately following surgery is not uncommon. 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 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 a few 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.

Final Notes

Sutures may be placed in the area of surgery as needed. They will fall out on their own in 3 to 5 days usually. Sometimes they become dislodged sooner than that. This is no cause for alarm. Just remove the suture from your mouth and discard it.

The discomfort and swelling probably will persist for a several days. In some cases this can last up to a week.

There will be a void where the tooth was removed. The void will fill in with new tissue gradually over the next couple months or so.

Brushing your teeth is okay starting the day after surgery- just be gentle at the surgical sites.

Your case is unique.  No two patients are alike.