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
- Continue biting with firm pressure on the guaze for 1 hour. After this time, the gauze pad should be removed and discarded.
- For the first 24 hours following surgery avoid spitting, rinsing, kissing, drinking carbonated beverages or sucking/drinking from a straw.
- Avoid smoking for 72 hours after surgery. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
- After first 24 hours begin rinsing with warm salt water after every meal until soft tissue heals
- After first 24 hours begin brushing with a soft toothbrush gently around and directly on the surgical site and other teeth
- You may eat a soft NONCHEWING diet for 1 week after surgery to avoid food debri in the surgical sites-leading to possible infection and delayed healing (*** examples: applesauce, yogurt, mashed potatoes, icecream, etc/ Avoid foods with particles such as scrambled eggs, oatmeal, nuts,rice ect****)
- Place ice packs to the sides of your face where surgery was performed for 48-72 hours (20 minutes on/20 minutes off while awake). Refer to the section on swelling for explanation. Avoid ice if bonegrafting procedures were performed.
- To minimize swelling sleep with your head slightly elevated (approximately 30 degrees or with 2 pillows) for first 24 hours
- Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
- Restrict your activities the day of and the day after surgery and resume normal activity when you feel comfortable.
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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 1 hour. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty 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.
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 3-4 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, frozen vegetables, or ice packs should be applied to the sides of the face where surgery was performed. Place ice packs to the sides of your face where surgery was performed for 48-72 hours (20 minutes on/20 minutes off while awake). If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery.
For moderate to severe 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 or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.
After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat a soft NONCHEWING diet for 1 week after surgery to avoid food debri in the surgical sites-leading to possible infection and delayed healing (*** examples: applesauce, yogurt, mashed potatoes, icecream, etc/ Avoid foods with particles such as scrambled eggs, oatmeal, nuts,rice ect****). High calorie, high protein intake is very important. Nourishment should be taken regularly. 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 5-6 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.
Keep the mouth clean
No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery . The day after surgery (24 hours later) you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt and brushing directly on and around the surgical site to stimulate healing and reduce infection.
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.
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 and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.
- 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 The Maryland Oral Surgery Group 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.
- 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 2-3 days.
- Stiffness (Trimus) 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.
- 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.
Sutures are placed 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 form your mouth and discard it. The sutures are resorbeable and will be dissolved approximately one week after surgery. If nonresorbeable sutures are used, they will be removed at the postop appointment. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure.
The pain and swelling peaks about day 3-4, and will gradually decrease. If your post-operative pain or swelling worsens or unusual symptoms occur call my office for instructions.
There will be an empty cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue and bone. In the mean time, 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. Sharon S. Russell, DDS and The Maryland Oral Surgery Team Upper Marlboro Office Phone Number The Maryland Oral Surgery Group Phone Number 301-967-0183. 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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