After Wisdom Tooth Removal

The removal of impacted 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.

Immediately Following Surgery

Oral Surgery Post Operative Instructions

• Keep gauze pads in place and bite down with medium pressure until arriving at home.
• Remove gauze and have your caretaker look in your mouth with a light. If the surgical sites are lightly covered with blood, this is normal. Remove gauze pads and leave them out of your mouth. If perhaps there is welling up of blood from a lower extraction or dripping from an upper extraction, place in new moistened (with warm water) gauze pads for 20-30 minutes.
• Do not spit out, swallow your saliva or you will disturb the clot and you will bleed. Don’t rinse out, or you will bleed. When you swallow you are swallowing 99% saliva and 1% blood. Swallow as you normally do on a daily basis.
• Once the gauze pads are removed, eat and drink. Foods that are conducive are light and soft (i.e. pasta, eggs, soups, milk shakes, mashed potatoes, boiled chicken, turkey, flakey fish etc.) If you don’t feel like eating much, drink a lot of fluids, and stay well hydrated. When drinking fluids, don’t use a straw, drink from the side of the glass or cup. Straws disturb the clot and you will bleed.
• Take pain medications right after eating, before the numbing medication wears off.
• Take other medications given as prescribed on their containers.
• Keep teeth and gums extremely clean and spotless. Don’t be afraid to brush teeth after every time you eat. After brushing teeth with a toothbrush and toothpaste, place water in your mouth, tilt your head side to side and let the water fall out of your mouth. No vigorous rinsing for the first 24 hours.
• After the first 24 hours gently brush (massage) the gum tissue over the surgical sites with a soft toothbrush. The cleaner you keep the surgical site the faster it will heal and the more comfortable you will feel. Keeping the gums clean at the surgical site can’t be stressed enough.
• Mild oozing of blood is not uncommon for the first 24-48 hours. 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 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, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.
• A normal diet may be returned to 24 hours after surgery and is more dependent upon your level of comfort when eating. A good rule of thumb is, if it feels comfortable to eat then you may eat it, if it feels sore then return to food items that are softer.
• Avoid heavy lifting or vigorous exercise for 4-5 days, but don’t avoid walking, deep breathing. Light to normal activity encourages healing and will make you feel better.
• Avoid smoking during the healing phase (approximately 7-10 days) or you run the risk of dry socket (painful) and/or prolonged healing.
• Avoid driving 24 hours after a general anesthetic was administered or during the administration of narcotic pain medications.
• Don’t hesitate to contact my office if you have any questions or concerns. I can be reached 24/7 via the office phone number through a live answering service.

Dr. Thomas E. Helfst 400 Stroud Bldg. Stroudsburg, P.A. 570 420-8180

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 two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Our office provides a customized wrap to accommodate custom ice packs. The packs should be applied to the sides of the face where surgery was performed. The ice packs should be applied in an on and off fashion, 20 minutes on the face and 20 minutes off the face for the first 24 hours. The ice only needs to be applied while you are awake. After 24 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 moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

To avoid pain, take the tablets prescribed 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. Avoid alcoholic beverages. Pain medication is usually only necessary for the first 1-2 days following surgery. If pain persists, it may require attention and you should call the office.

Diet

Drink liquids after general anesthesia or IV sedation. Do not use straws when drinking 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 site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. 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 five to six 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. If you are lying down following surgery, make sure you sit for one minute before standing.

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 postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area will speed up the removal of the discoloration.

Antibiotics

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 & Vomiting

In the event of nausea and/or vomiting following surgery don’t be alarmed, this is possibly a reaction to anesthesia, motion, or not eating for a period of time. The key is to stay well hydrated. Start with something bland for the stomach (i.e. yogurt, chamomile tea, toasted bread). Drink plenty of fluids, to remain well hydrated. Vomiting causes dehydration. Of utmost importance, eat prior to taking any medications. Medications on an empty stomach will encourage nausea.

Other Complications

• 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 and most likely caused by swelling. 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 Dr. Helfst if you have any questions.
• A slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol should be taken to reduce the fever.
• You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and 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. Helfst if required.
• 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 two to three 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 that 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 are designed to dissolve in approximately 5-7 days and there will be no need to remove them at your post-operative visit in 7 days.

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 fill in with new tissue over the next month. In the meantime, the area should be kept clean especially after meals with salt-water rinses an a soft toothbrush.

Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Helfst or your family dentist.

Brushing your teeth, and the surgical sites 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 two to three days following surgery. Call the office if this occurs.

If you are involved in regular exercise, try to delay it for 4-5 days. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.