After Wisdom Tooth Removal

Home Instructions After Wisdom Teeth Extraction

The removal of impacted wisdom teeth is an invasive surgical procedure. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.

Immediately Following Surgery

  • Keep the gauze pad on the surgical area for 30 minutes, then discard the gauze pad.
  • Avoid vigorously rinsing your mouth and/or touching the wound area following surgery. This can cause bleeding when the blood clot is dislodged. 
  • Take the prescribed pain medications before the numbness wears off.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable – typically 3-10 days.
  • Place ice packs on the sides of your face where surgery was performed. Refer to the section on swelling for a more thorough explanation.

Bleeding

Following surgery, slight bleeding, oozing, or redness in the saliva is expected. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened green or black tea bag for thirty minutes. The tannic acid in the tea helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit with your back propped up, and avoid exercise. If bleeding does not subside, call our office 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. However, the swelling may be minimized by the immediate use of ice packs that we provide. The ice packs should be left in place while you are awake. After 48 hours, ice has minimal effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Three days following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

Unless contraindicated, you will be on a combination of acetaminophen and ibuprofen after surgery. These medications will be prescribed at the maximum safe dosage for you, so do not take more than prescribed. 

  • You will take your first dose of acetaminophen and ibuprofen midday after surgery, preferably with milk or simple foods to avoid an upset stomach.
  • Your next dose will be at bedtime.
  • After this, continue to take a combination of acetaminophen and ibuprofen approximately every 8 hours at the following time points: in the morning, midday and before bed. 

While staggering the medications may provide slightly more pain relief, doses are more frequently missed when the medications are staggered resulting in more pain. So for simplicity and consistent pain control, we recommended taking the medications together. Make sure to take your medications with some food or milk to minimize the possibility of an upset stomach.  Continue to take these medications on a scheduled basis for 4 days (day of surgery and 3 days after), whether or not you have pain.  After this, they can be taken on an as-needed basis.  For more invasive procedures, a stronger pain medication such as oxycodone or tramadol is sometimes prescribed.  This medication acts as a supplement to the acetaminophen and ibuprofen you are already taking.  You will take it in addition to the acetaminophen and ibuprofen, not in place of them.  It can be taken at any point for uncontrolled pain despite taking the acetaminophen and ibuprofen at correct dosage and time intervals. Like all narcotics, these medications may cause nausea, vomiting, constipation, addiction, and decreased breathing. After recovery from surgery, any leftover narcotic medicine should be disposed of at locations such as some pharmacies or police and fire departments. For most patients, pain stays approximately the same for the first 4-5 days and then tapers from there.  You should expect the majority of the discomfort to resolve 7-10 days after surgery.

ANTIBIOTICS

In many cases, a single dose of antibiotics given through the IV during surgery is adequate to reduce the risk of infection.  In some cases, additional post-operative antibiotics will be prescribed.  If antibiotics were prescribed, take them as directed to help prevent or treat an infection. 

ORAL HYGIENE

Good oral hygiene is essential to good healing. No rinsing of any kind should be performed until the day following surgery. An antimicrobial mouthwash (Peridex/Chlorhexidine) may be prescribed. If it was prescribed, begin use the day following surgery after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt water rinses (one teaspoon of salt in a cup of warm water) may be used 4-5 times a day if desired for patient comfort. Gently brush your teeth around the surgical areas.

ACTIVITY

Keep physical activities to a minimum for the first 3-5 days immediately following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking in normal nourishment. This may weaken you and further limit your ability to exercise.

Diet

When you arrive home after surgery, you likely will be hungry and thirsty.  Remove the gauze prior to eating or drinking.  Initially, we recommend you have a drink of water to make sure this settles prior to eating solid foods.  For a few hours after surgery, your lips and tongue will be numb from the local anesthesia so be very careful not to bite them when eating.  For this reason, we recommend starting with something soft that does not require chewing such as pudding, yogurt or soup.

For a few weeks after surgery, there will be small openings that could allow food to get trapped in the surgical site.  For 2 weeks here are the foods to avoid: hot foods, spicy foods as well as foods that could easily get lodged in the surgical site such as chips, nuts and seeds.

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.

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 zofran was prescribed, it may be taken to improve nausea. 

Other Complications

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, 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. Call Drs. Cudney or Ingoldsby 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 could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting 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 Drs. Cudney or Ingoldsby.
  • 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 (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.