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

• The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
• Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
• Take the pain medications as prescribed.
• Restrict your activities the day of surgery and resume normal activity when you feel comfortable. Remember that you cannot drive or use dangerous equipment for 24 hours.
• 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. 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 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.

Swelling:  The swelling that is normally expected is usually proportional to the difficulty of the surgery. 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 may 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 or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain:  For mild to moderate discomfort use Ibuprofen/Motrin/Advil.  If you cannot take these medications you may use Tylenol (Acetaminophen).  Ibuprofen, Motrin or Advil: Take 2 to 4 tablets every 6 hours as needed.  Tylenol:  Take 1 or 2 tablets every 6 hours as needed. 

For severe pain use the prescription pain medication if one was given to you. Add the prescription pain medication to the Ibuprofen, Motrin or Advil.  If you are taking Tylenol, remember that most prescription pain medications contain Tylenol and you should stop taking the Tylenol when you start the prescription pain medications. If the pain does not begin to subside in 2 to 3 days, please call our office. 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. If an antibiotic has been prescribed, finish your antibiotic prescription.  If you are having trouble taking the antibiotics, please call the office for instruction.

Diet:  After surgery drink plenty of liquids.  Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. Diet:  Initially restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you can advance your diet as tolerated.

Keep the mouth clean: Do not rinse your mouth for the first day after your surgery, or while there is bleeding. You can brush your teeth gently as tolerated. After the first day, use a warm salt water rinse several times a day and after meals to keep the extraction sites clean. (1/4 teaspoon of salt in a glass of lukewarm water). If you were given a curved tip syringe, do not start using it before the 7^th day after your surgery.  This syringe is used to gently rinse the lower wisdom tooth sockets after meals and before bedtime.  Rinse gently from ½ inch away from the wound.  Do not jab it directly into the extraction site.

Discoloration:  In some cases, discoloration of the skin follows swelling. This type of bruising may occur 2-3 days post-operatively and is fairly common after surgery.  It will resolve on its own in a few days.

Antibiotics:  If you have been prescribed an antibiotic, please take them as prescribed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and 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.

Activity:  Limit vigorous physical activity for 24 hours.  This may increase blood pressure and cause more bleeding.  After a day or two, you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call our office immediately.

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 the office 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.
• If the corners of your mouth are stretched, they may feel chapped. An ointment such as Vaseline or ChapStick will help.
• 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 a few days.

Finally:  Sutures are often placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, but this is no cause for alarm. Just remove the suture from your mouth and discard it. There will be a cavity where the tooth was removed. The cavity will gradually fill in with the new tissue.

If you have any questions or concerns, please call us at Portland Oral and Maxillofacial Surgery Phone Number (207) 387-2055.  After hours, you will reach our answering service and they will page the doctor and have him call you back.