After Wisdom Tooth Removal

The removal of impacted teeth is different from the removal of teeth which are erupted or in full normal position. 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

These instructions outline the first set of things that you should do upon returning home. Further directions are given in separate sections marked by their respective categories.

• The gauze pad placed over the surgical area should be kept in place for one hour. After this time, unless there is active bleeding, the gauze pad should be removed and discarded. If there should be active heavy bleeding after one hour, fold additional gauze pads and replace where needed. Should active heavy bleeding persist after two hours at home, please call our office at 973-376-1144. Refer to the section marked “Bleeding” for further information.
• Use ice packs in the manner directed by our office until bedtime on the day of surgery. Refer to the section on “Swelling” for more information.
• Do not rinse your mouth at all on the day of surgery. You may eat and drink moderately as describe in the
  “Diet” section. Avoid hot liquids.
• Take the prescribed pain medications according to the instructions on the bottle and in the manner explained in our office. This will usually consist of starting an over the counter medication (Advil, Motrin, etc…) as soon as you get home. If there is no pain after two hours at home, you may take one dose of prescription pain reliever at that time. If pain should occur before the two hour period, take one dose at the onset of pain. Don’t wait for pain to increase before taking the first dose of prescription medication.
• Look in the section marked “Pain” for further instructions.
  Be as restful as possible after the surgery. Right after surgery it is best to save your energy for healing, so go home and rest if you can. Surgery and anesthesia may cause lowering of your blood pressure and rapid changes in position may cause dizziness. Be especially careful when getting up from lying down or standing up from sitting down.
• A 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.
• If you should experience any heavy bleeding after 2 hours or an unusual reaction to a medication, please call the office at 973-376-1144.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon in the first day. Active heavy bleeding is characterized by red blood coming from the wound or socket. The best way to control bleeding is by applying pressure with a gauze pad. Extra gauze pads were given to you by our office staff for this purpose if necessary. Moisten a gauze pad with plain water and gently wipe the bleeding point to remove any clots that may have formed. Then fold two gauze pads into a small square and lightly moisten with water. Be sure to place the gauze pads directly over the bleeding point with firm pressure before biting down. Then, bite down on the gauze pad for 30 minutes and replace as necessary until bleeding stops. At this point, if bleeding persists, you may use a teabag (soaked in warm water, squeezed damp dry, and wrapped in moist gauze) for 30 minutes. If you are unable to control heavy bleeding after two hours at home, please call our office at 973-376-1144.

Swelling

Swelling is normally expected after the removal of an impacted wisdom tooth. It is caused by the procedure itself, and is usually proportional to the surgery involved. This swelling does not indicate infection. Swelling from lower wisdom teeth usually affects the angle of the jaw and cheeks and may extend into the upper part of the neck. When swelling is from upper wisdom teeth, it usually involves the cheek bone as well as the region around and under the eye. 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. The proper use of ice packs will aid considerably in minimizing swelling. Remember, ice does not reduce swelling that has already occurred. Therefore, be sure to start applying ice early and throughout the entire first day in which the surgery is performed. You may use plastic bags filled with ice, bags of frozen peas or ice packs, and they should be applied to the face as shown to you in our office. The ice packs should be left on continuously while you are awake. After 24 hours, ice has no beneficial effect.

Associated with the pain and swelling after surgery, there is usually a period of tightness of the jaw muscles for several days. It may only be possible to open the mouth to ¼ of your normal ability. This tightness usually reaches its peak by the 2nd day following surgery and resolves gradually over the remaining week. For this reason, the diet should be limited to soft foods.

Pain

After the initial use of pain medication described in the early section on immediate care, pain control will be at your discretion. There may be times during the first three to four days when pain may be minimal, moderate or at times severe. All of these are considered normal. The first twelve hours are usually the most challenging in controlling pain. For this reason it is best to use medication as directed before the first signs of pain. By alternating the over the counter (OTC) meds with prescription meds every two hours during the first twelve hours, you can insure that some level of pain reliever is in your body at all times and still avoid excessive dosing.

After the first day, if there is no pain at all, then there is no need to use medication. Usually, some level of mild pain will persist and for that you should use the OTC medication which most agrees with you, such as Tylenol, Motrin, or Advil. You may take these medications every four hours as needed.

If OTC medication does not relieve your pain, then use the prescription medication as directed. The prescribed pain medicine may make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery within six hours of using these meds. Avoid alcoholic beverages. Pain or discomfort following surgery should subside somewhat each day. If high level pain persists after three days, it may require attention and you should call the office at 973-376-1144.

Diet

Diet during the early postoperative days should be restricted to soft foods. Examples are apple sauce, mashed potatoes, yogurt, jello, pudding, scrambled eggs, strained baby foods, etc. Hot foods should be allowed to cool prior to eating. With alteration of the diet, concern must be given to the selection of foods to maintain a proper balance of nutritional factors. High calorie, high protein intake is very important A diet should not be restricted, for example, to only apple sauce or yogurt for several days. With the use of a blender, various meats and vegetables can be changed to a more suitable form. The use of Ensure, Sustagen, or Instant Breakfast may be helpful as nutritional aids in the early postoperative period.

Liquid intake is important. In the immediate postoperative period, do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. It is important to prevent dehydration by taking fluids regularly. Because your food intake will be limited for the first few days, you should compensate for this by increasing your fluid intake.

Since you may not be able to eat your normal quantity of food at a sitting, we suggest that you eat smaller amounts more frequently. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.

Rinsing

No rinsing of any kind should be performed on the day of surgery. You can brush your teeth gently the night of surgery. Rinsing of the mouth should begin on the day following surgery. A solution of ½ teaspoon of table salt in an 8oz glass of lukewarm water should be used 4 times a day and whenever food has been eaten. Rinsing facilitates healing by removing debris from the surgical sites. Rinsing will also reduce unpleasant odors that may occur when debris remains adherent to stitches which may be present.

Discoloration

Following surgery, some discoloration may occur. This may be seen under the eye or lower cheek area and may become evident as late as the 2nd to 5th postoperative day. The discoloration can range from a typical black and blue area to a slightly yellowish or brown color of the skin. If discoloration does occur, it usually resolves in a period of approximately 10 days. As it resolves, it may appear to move lower into the skin over the cheek or neck.

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, do not take anything by mouth for at least one hour, including the prescribed medicine. You should then sip on Coke, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.

Pain in other areas

Following the removal of lower wisdom teeth, pain is usually felt radiating from the surgical area to the teeth in front and also to the ear. In the upper area following surgery, pain often radiates to the ear and temple area. It is not uncommon for the teeth immediately in front of the surgical site to ache since they share the same bone area as did the wisdom teeth which were removed. These teeth may also be sensitive to hot and cold due to the inflammation in the region. This is usually a temporary condition unless these teeth were diseased prior to surgery.

Sore throats and pain when swallowing are also not uncommon. The muscles used in chewing and swallowing can become swollen after surgery and the normal act of swallowing can then become painful. This will usually subside in two to three days.

Delayed Healing

It is not uncommon for a delay in healing to occur, especially in the lower surgical sites. If a delay in healing occurs, it becomes evident as an aching or throbbing pain on the 3rd to 6th postoperative day. It may seem to occur after the initial post surgical pain has diminished. This condition (sometimes referred to as a “dry socket”) is seen more commonly with lower wisdom teeth areas since the bone is denser than the bone of the upper jaw and consequently heals more slowly and usually with more discomfort. The problem is caused when the blood clot gets dislodged prematurely from the tooth socket, allowing oral fluids to irritate the exposed bone.

If this condition should occur, it is best to call the office for an earlier appointment so that treatment can be given to relieve pain. This usually consists of washing the area and placing a medicated dressing which usually gives relief within 30 minutes to 1 hour. With the dressing in place, normal healing will occur underneath. It may be necessary to change the dressing several times at 3-5 day intervals.

Delayed Swelling – Bone Spicules

Although, in the majority of the cases healing will progress undetected by the patient after the third postoperative week, occasionally problems such as swelling or drainage may occur several weeks or even months after surgery. The development of bone spicules penetrating through the gum tissue can occur as well. Should such problems become apparent, you should call the office and arrange an appointment for evaluation. In most instances, these conditions may be quickly and simply treated.

Prolonged Numbness or Tingling

Sometimes, following the removal of lower impacted wisdom teeth, a prolonged numbness or tingling of the lower lip, chin, and tongue on the involved side may occur. This may be due to the compression of a sensory nerve in the jaw caused by swelling. This is not unlike the tingling or numbness one may feel after prolonged crossing of the legs which causes one’s foot to “fall asleep”. As in this comparison, return of the normal sensation is gradual through stages such as tingling or “pins and needles.” While this complication is sometimes predictable prior to surgery, studies have shown that reliable predictable patterns cannot be established. We therefore choose to inform all of our patients of this potential complication. The disturbed sensation can last for several weeks or in some cases several months but then will usually return to normal. If this problem occurs, it only affects sensation and produces no change in facial appearance or paralysis of muscles.

As mentioned often, if any problem or question should arise, we encourage you to call our office.

Finally

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. Just remove the suture from your mouth and discard it. The sutures will usually dissolve within the week following surgery.

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 space where the tooth was removed. This space will gradually fill in with new tissue over the next few months. In the meantime, the area should be kept clean, especially after meals with salt-water rinses or a 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. Eidelman, Dr. Freedberg, or your family dentist.

Brushing your teeth is okay – just be gentle at the surgical sites.

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.

Again, please call our office at 973-376-1144 if you have any questions regarding your postoperative healing.