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.  Sometimes the after-effects of oral surgery are quite minimal, so not all of the instructions may apply.  Common sense will often dictate what you should do.  However, when in doubt, follow these guidelines or call our office for clarification.  Our number is 716-632-5557.

Immediately Following Surgery

  • Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place.  Do not change them for the first hour unless the bleeding is not controlled.  The packs may be gently removed after one hour.  If active bleeding persists, place enough new gauze to obtain pressure over the surgical site for another 30 minutes.  The gauze may then be changed as necessary (typically every 30-45 minutes).  It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning. 
  • Do not disturb the surgical area today.  Do NOT rinse vigorously or probe the area with any objects.  You may brush your teeth gently.  PLEASE DO NOT SMOKE for at least 48 hours, since this is very detrimental to healing and may cause a dry socket. 
  • Take the prescribed pain medications before the anesthetic wears off so you will be able to manage any discomfort better.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable, usually within 3-5 days.
  • 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. Bleeding should never be severe.  If so, it usually means that the packs are being clenched between teeth only and are not exerting pressure on the surgical areas.  Try repositioning the packs and then holding pressure for 30 minutes.  If bleeding persists or becomes heavy you should try the gauze one more time and then try a moistened tea bag wrapped in moist gauze for 20-30 minutes.  If bleeding remains uncontrolled, please call our office. 

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. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, frozen peas or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be applied for 20 minutes on and 20 minutes off during the first 24 hours after surgery.  It is not necessary to use ice while you are sleeping.   After 36 hours, ice has no beneficial effect. If you have been prescribed medicine for the control of swelling, be sure to take it as directed. 

Pain

Unfortunately, most oral surgery is accompanied by some degree of discomfort.  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.  you must allow time for your medicine to work.  You must also take the medication on a regular schedule.  Remember that the most severe pain is usually within six hours after the local anesthetic wears off; after that your need for medicine should lesson.  If you have been given a prescription for Motrin(Ibuprofen) you may take it with Tylenol(Acetaminophen).  Both drugs are taken every 6 hours and can be taken as follows:  if you take Motrin at 12 PM, you can take Tylenol at 3 PM, Motrin at 6 PM, and Tylenol at 9 .  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 call for a refill during weekday business hours.    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.

Diet

Eat any nourishing food that can be taken with comfort.  Avoid extremely hot foods.  Do not use a straw for the first few days after surgery.  It is sometimes advisable, but not absolutely required, to confine the first day’s intake to liquids or soft foods (soups, puddings, yogurt, milkshakes, scrambled eggs, fish, etc.)  It is best to avoid foods like nuts, sunflower seeds, popcorn, etc., which may get lodged in the socket areas.  Over the next several days you may gradually progress to solid foods.  It is important not to skip meals!  If you take nourishment regularly you will feel better, gain strength, have less discomfort, and heal faster,.  If you are a diabetic, maintain your normal eating habits or follow instructions given by your doctor. 

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 but rinse gently. Keeping your mouth clean after surgery is essential.  Please use warm salt water three times per day, rinsing for 30 seconds each time.  You may also use an over the counter mouthwash, such as Listerine, as soon as it is comfortable to do so.  By the third post operative day dip a cotton swab into the solution before rinsing and gently dab the surgical area.  Begin your normal oral hygiene routine as soon as possible after surgery.  Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth within the bounds of comfort. 

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. Moist heat applied to the area may 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 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.

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. Sindoni 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. Sindoni.
  • 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.

Finally

Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing.  Sutures placed during surgery will resorb and drop out on their own after approximately 5 -14 days.  If they become bothersome, call and schedule a visit to have them removed. 

Normal healing after tooth extraction should be as follows:  The first two days after surgery are generally the most uncomfortable and there is usually some swelling.  On the third day you should be more comfortable and although still swollen, can usually begin a more substantial diet.  The remainder of the post-operative course should be gradual, steady improvement.  If you don’t see continued improvement, please call our office.  If you are given a plastic irrigating syringe, DO NOT use it for the first five days.  Then use it daily according to the instructions until you are certain that the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket.

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. Sindoni or your family dentist.

Brushing your teeth 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 2-3 days following surgery. Call the office if this occurs.

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 during normal office hours, please call our office.  Outside of business hours, follow the prompts for an emergency.  Calling during office hours will afford a faster response to your question or concern.  PLEASE NOTE:  Telephone calls for (pain medicine) prescription renewals are ONLY accepted during office hours.