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

  • The gauze pad placed over the surgical area should be kept in place for 45 minutes.  After this time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing 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 directed below.  This will usually coincide with the local anesthetic wearing off. 
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable. 
  • Place ice packs to the sides of your face where surgery was performed.  Refer to the section on swelling for explanation. 

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 placing a gauze pad over the area and biting firmly for 60 consecutive minutes. It is important not to remove the gauze to check on the area until the 60 minutes has passed.  Repeat if necessary.  If bleeding continues, bite on a moistened tea bag for 45 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. 

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. The swelling will then gradually decrease over the next 5-7 days. The swelling may be minimized by the immediate use of ice packs.  The ice packs should be left on continuously 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 normal reaction to surgery.

Pain

For pain take prescribed pain medication as soon as it is picked up from the pharmacy.  It is important to be ahead of the pain and to have the medication in your system before the numbness wears off.  The prescribed medication will be taken every 4 hours.  In between that 4-hour period (2 hours after prescribed medication is taken) you can take 2-3 Advil or Motrin.  You may have to follow this regimen for 5-7 days.

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.

Diet

After general anesthetic or I.V sedation, liquids should be initially taken to prevent dehydration. At least 5-6 glasses of liquid should be taken daily. Do not use straws.  The sucking motion can cause more bleeding by dislodging the blood clot. 

You should stay on a soft mushy diet and chew away from the surgical site. Avoid hot, spicy, citrus and/ or hard foods. Your food intake will be limited for the first few days.     

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.

Oral Hygiene

No rinsing of any kind should be performed for the first 24 hours.  You can brush your teeth tomorrow but avoid the surgical site and gently let the toothpaste and saliva out of the mouth.  You may rinse gently after meals. 

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. 

Nausea and Vomiting

If nausea persists contact our office for additional information. 

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.  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. Hershman 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 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 stand up suddenly.  Before standing up, you should sit for one minute 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. Hershman. 
  • If the corners of your mouth are stretched, they may dry out and crack.  Your lips should be kept moist with the Chapstick provided. 
  • Sore throats and pain when swallowing is not uncommon.  The muscles get swollen.  The normal act of swallowing can then become painful.  This will subside in 7-10days.
  • 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 the in surgical area 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 resorb and fall out on their own in a matter of days unless you are told otherwise by Dr. Hershman.

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 my office for instructions.

There will be a cavity where the tooth was removed.  The cavity will gradually fill in with the new tissue over the next 6-8 weeks.  You can begin rinses and cleansing the surgical site 7 days after the surgery.

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. Hershman 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 to 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.

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Oral and MaxilloFacial Surgeon - Brooklyn
2469 65th Street
Brooklyn, NY 11204
718-382-9399