After Wisdom Tooth Removal
Immediate Post-Surgical Instructions for Wisdom Teeth extractions:
- Go straight home. Do not stop along the way for any errands, unless it is necessary to pick up prescriptions
- Eat something as soon as possible and take the pain medications after that.
- Keep head elevated for first 2 days while resting
- Ice packs on the outside of the face immediately after returning home
ROUTINE POST-SURGICAL INSTRUCTIONS
PRESCRIPTION MEDICATIONS: It is essential that you get something soft and cold to eat or drink immediately after the surgery. Start the pain medication AFTER you get something to eat or drink but BEFORE the pain sets in. Start your next dose of antibiotics a couple hours after you start taking the pain medication. If you have been given a prescription Vistaril 50mg, this medication has 3 functions: taken with your Percocet or Vicodin, it acts as a booster to help with the pain, helps to prevent any nausea, and also works as a sedative to help you sleep. Take the antibiotics as instructed until they are finished.
For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed.
EATING: Make sure to take the gauze out while eating. For the first 24 hours after surgery soft COLD foods are best, eat/drink. After the first day, soft warm things are fine. Examples of soft foods to eat: ice cream, milkshakes, pudding, Jello, yogurt, smoothies, applesauce, soups, mashed potatoes, scrambled eggs, soft cooked cereals, pasta. Make sure to drink plenty of fluids. Continue to stay on a soft diet for the 1st week after which you can usually slowly advance your diet as it pertains to your situation. Nothing hard like (chips or nuts) for 3 weeks.
- Using straws for 3-4 weeks following surgeries
- Foods with small seeds, berries, popcorn, nuts, chips, or grained bread that may get lodged in the socket areas.
- Alcohol or carbonated drinks for 4 days following surgery- can increase the possibility of prolonged bleeding
GAUZE PACKS: You will have gauze tucked in at the extraction sites. The gauze will help control the bleeding after surgery. Take the gauze out when you eat and replace with new gauze after eating. You should have received a packet that contains individual pieces of gauze. When changing the gauze, take one individual piece of gauze, fold it in half, then fold that in half again and then place them over the surgical areas. Instruct the patient to bite down on the gauze and maintain good, firm pressure. Remind the patient every 5-10 minutes to keep biting firmly on the gauze because they will tend to relax and not bite down. If the gauze is light red, it generally implies that the majority is saliva mixed with a little bit of blood and is not a problem, therefore it may not require changing yet. Keep an eye on the gauze and replace when it becomes dark, red and heavily saturated. It is normal to experience some bleeding following surgery throughout the first 24 hours after surgery, however there should be a trend that it will taper down. In general the gauze should be removed before the patient goes to bed for the night, however sometimes the gauze can be removed earlier in the day and remain out, if the bleeding has stopped. If bleeding continues after that, you may have the patient bite down on a dry Lipton tea bag over the surgical site for 1 hour while applying pressure. Contact our office if bleeding persists.
ICE PACKS: Ice packs should be applied on the outside of the face immediately after surgery, on each side where there were extractions for 3 days following surgery. Have the patient ice as much as they can tolerate for the first 3 days, which will help to minimize the swelling, (crushed ice, frozen peas or corn) wrapped in a damp towel. Have the patient wear a hooded sweatshirt and tuck the ice packs on each side so they can stay in place while the patient is resting.
MOIST HEAT: On the 4th day, apply warm moist heat to the surgical areas on the OUTSIDE cheek area of the face (moist hot towels, hot water bottle, heating pad). This will help to soothe those tender areas. This will help to decrease swelling and stiffness.
SWELLING: It is normal following surgery for swelling to occur. The peak swelling day is on the 3rd day. After 3 days the swelling should slowly decrease. Swelling that increases after the fourth day of surgery should immediately be brought to the attention of our office. You may swell More or Less than average during this period but you will swell and don’t be alarmed.
RINSING: Do Not do any rinsing, spitting or sucking for 24 hours following surgery since this could prematurely dissolve the blood clot. Keeping your mouth clean after surgery is essential.
Warm Salt Water: Warm salt water GENTLE rinsing is important to start 2nd day after surgery. After the 48 hour period, more vigorous rinsing is advised. Mix a small amount of warm water and some table salt to rinse around in your mouth for 30 seconds to 1 minute and then gently spit out. Do this as frequently as you can throughout the day (10-15 times a day if you can). Make sure to rinse after any meals or snacks throughout the day. The more rinsing you do, the cleaner the areas will be and help with the healing. Avoid doing this within 1 hour of rinsing with the Peridex rinse. *Continue doing salt water rinsing for 4 weeks
Peridex Rinse: We have prescribed you an antibiotic rinse to start using the following day after surgery. This is to be used twice a day (once during the day and once right before bed). Try to use this rinse right before bed to ensure it stays on the tissue. Do not eat or drink anything 1-2 hours after you use the rinse.
*After you return for your post-op appointment and are given further instructions, you still need to continue using the Peridex rinse however, rather than rinsing your entire mouth, apply a small amount of the Peridex using a (q-tip, toothbrush, or syringe) to the surgical areas only. Peridex can leave a residual stain on your teeth if you use it for any prolonged period of time- longer than 1 ½ – 2 weeks.
TOOTH BRUSHING: You may brush your teeth starting the day after surgery, but avoid the surgical areas to prevent disruption of the blood clot. Once you return to our office 7-10 days later, it is necessary that you brush on the surgical areas to help with the healing and keeping the areas clean.
SMOKING: DO NOT SMOKE or use other tobacco products for at least 24-48 hours and ideally to go as long thereafter without smoking, since it is very detrimental to healing. SMOKING WILL INCREASE PAIN AND DELAY HEALING. IT IS DIFFICULT TO CONTROL PAIN CAUSED BY WOUND DAMAGE CAUSED BY TOBACCO PRODUCTS.
SUTURES: A variety of sutures may have been used as a part of your treatment. The sutures will either dissolve on their own or come out on their own (usually within 7-10 days) or be removed at the appropriate postoperative appointment. Do not try to remove or pull on the sutures. Sometimes these will come out at different times but that is normal.
ACTIVITY: Avoid excessive physical activity during the immediate post-operative period (1 week). Use caution in your activities during the time you are under the influence of pain medication. Obtain adequate sleep.
Musical Instruments: If you play any musical wind instruments, the general guideline is to avoid playing them for 1 week after surgery.
Contact Sports: Ease into physical activity and don’t do anything that would risk the face being bumped or hit (basketball, football, wrestling or other contact sports) for at least 1 week.
Retainers:If you normally wear a removable orthodontic retainer, typically you can resume wearing it as soon as it is comfortable for you. Usually keep out 1-2 days then resume wearing.
- Do eat prior to taking any pain medication. This will help avoid nausea
- Do have an adult with you for the first 24 hours after IV anesthesia
- Do drink plenty of fluids after surgery
- Do restrict your diet to soft foods
- Do plan on resting 1-2 days after wisdom teeth extractions
- Don’t drive or operate any equipment for 24 hours after IV anesthesia
- Don’t drink alcoholic beverages while taking pain medication
- Don’t stand up quickly from a couch or bed after surgery, you could become lightheaded, dizzy, or faint
- Avoid vigorous rinsing and swishing the day of surgery as it may lead to a dry socket
- Avoid excessive exercise and heavy lifting as these can cause increased pain and bleeding
- Avoid direct sun and tanning if you are on an antibiotic. Certain antibiotics can make you sensitive to the sun and cause a severe burn.
POSSIBLE CONDITIONS AFTER SURGERY
One or more of the following conditions may develop after surgery. If so, please refer to this sheet and call our office if you have additional questions.
ALLERGIC REACTIONS: (rash, itching, difficulty breathing, wheezing, nasal congestion, swelling about the eyes and face not associated with surgery.) If you develop any of the above symptoms during your post-operative course, you are advised to notify our office IMMEDIATELY and STOP TAKING ALL MEDICATION.
PAIN: Most oral surgery is accompanied by some degree of discomfort after the surgery. You will usually have a prescription for pain medication. If you take the first pill before the anesthetic has worn off, you should be able to manage any discomfort better. Some patients find that stronger pain medicine causes nausea, but if you precede each pain pill with a small amount of food, chances for nausea will be reduced. The effects of pain medications vary widely among individuals. Remember that the most severe pain is usually within six hours after surgery; after that your need for medicine should lessen. If you find you are taking large amounts of pain medicine at frequent intervals, please call our office. If you anticipate needing more prescription medication for the weekend, you must plan ahead to call for a refill during weekday business hours.
NAUSEA: Nausea following surgery is usually due to taking medication on an empty stomach. Keep eating and take as few pain pills as possible. Nausea can be reduced by preceding each pain pill with a small amount of soft food, and taking the pill with a large volume of water.
BLEEDING: Slight oozing from the surgical area(s) is normal. Most bleeding will be experienced during the first 24 hours after surgery. Don’t be alarmed, a drop of blood in a mouthful of saliva makes the whole mouthful look red or pink. Yawning, chewing hard foods or spitting excessively could restart minor bleeding. You can easily control this by placing gauze or moistened tea bags directly over the bleeding site and firmly closing the jaws. Bleeding should never be severe. If so, it usually means that the gauze packs may not be applying pressure directly to the surgical site and may require re-positioning and assuring that pressure is applied on the surgical area(s). If bleeding continues or becomes heavy, take the gauze out and place a new (dry) Lipton tea bag on the surgical site and apply firm pressure for at least 1 hour. If bleeding remains uncontrolled, please call our office.
BRUISING: Bruising may be present to varying degrees. It can change from a purplish blue to yellow to normal over a period of 5-7 days.
FEVER: (increased body temperature) The normal, avg oral temperature is 98.6 degrees F. Your temperature may rise slightly for 1-2 days after surgery. A constant raised temperature should be reported to our office. Remember to drink plenty of fluids during this period to prevent dehydration and fever, but not within 15 mins of taking your temperature.
SORE LIPS/CHEEKS: The corners of your mouth or other areas of your lips or mouth may become dry and cracked after surgery. This is best treated by applying Vaseline.
MUSCLE STIFFNESS: Tenderness and stiffness within the chewing muscles may develop during the post-operative period and is normal. It is usually due to swelling in the area of the muscles and is best treated with moist heat. It will slowly resolve over 5-10 days. Do exercises opening and shutting your mouth to stretch and help loosen the muscles.
SHARP EDGES: If you feel something hard or sharp edges in the surgical areas, it is likely you are feeling the bony walls which once supported the extracted teeth. Occasionally small slivers of bone may work themselves out during the following week or so. If they cause concern or discomfort, please call the office.
I.V. INJECTION SITE: The point where the needle entered the vein may develop a bluish color which will change to yellow and then to normal in a matter of days. There may be a slight tenderness to the area and perhaps a small lump. These signs and symptoms are usually of no concern and are best treated with hot moist towel.
Should the arm begin to swell, become discolored or tenderness progress up toward the shoulder, we advise you to call our office immediately for additional instructions.
INFECTION: Occasionally a surgical site can become infected post-operatively. This is usually associated with redness, soft or hard swelling and warm sensation in the area, and sometimes a foul taste or odor in your mouth. If any of these symptoms occur after surgery, you must contact us immediately. If you are out of the area you must seek the services of another oral surgeon. If you presented to our office with established infection, our treatment is designed to remove the cause and establish drainage. If the swelling continues to increase and you have a persistent fever, please notify our office as soon as possible.
NUMBNESS: As was explained prior to surgery, a partial numbness of your lips, chin, teeth or tongue may be apparent when the local anesthesia wears off. Time will usually resolve this condition. It could be as short as a few weeks or as long as 9-12 months before feeling returns. It returns slowly and it is hard for you to perceive the change. Any altered sensations should be reported to us at your post-operative appointment or sooner.
WEAKENED JAW: Removal of teeth deep in the jaw can leave it temporarily weakened. It is about 3 months before new bone forms and full strength is reached. During this period, avoid situations that might result in forceful blows to your jaw (contact sports).
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office. Please try to call during office hours; however a 24-hour answering service is available for after hours contact with a doctor. The after hours telephone number is (253) 770-1000.