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 1 hour. After this time, the gauze pad should be removed and discarded. Additional gauze packs may be placed as necessary.
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 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 surgery and resume normal activity when you feel comfortable.
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 1 hour. Repeat if necessary. If bleeding continues, wrap a gauze around a moistened tea bag and place it over the bleeding site. Bite down with firm pressure for thirty minutes. The tannic acid in the tea bag helps to form a clot. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling

Postoperative swelling is a normal occurence and expected. This is the body’s normal reaction to surgery and eventual repair. To minimize the swelling, it is best to place cold over the side of the face where surgery was performed. The swelling may not become apparent until the day following surgery and reach its maximum at 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 applied for 20 minutes at a time while you are awake. Do not place cold continuously directly on the skin as burning may result. After 24 hours, ice has minimal beneficial effect. Once swelling occurs, it is best to place moist heat to the side of the face. At this time, it is best to exercise your jaw. This will help allevaite the swelling and relieve any jaw stiffness.

Pain

Dr. Yanagihara will prescribe you a narcotic analgesics for postoperative discomfort. You may receive a prescription for Tylenol with codeine, Vicodin, or Percocet. It is best to take this before the local anesthesia wears off, usually and hour and a half after administered. If pain persist after taking your medication, supplementing with an over the counter pain medication may help. Motrin or Ibuprofen two 200mg tablets every 4 hours is often helpful. Do not take any medication if you are allergic to them or if they will interact with you regular medication(s). It is best to consult with the doctor before taking additional medications. Moderate pain is often controlled with over the counter pain medications.

The prescribed pain medicine will make you sleepy and will slow down your reflexes. Do not drive an automobile, work around machinery, perform duties which could hurt yourself, or make legal decisions. Do not mix alcoholic beverages with pain medications. 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

After I.V. anesthesia, 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 anything that is comfortable by chewing away from the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. 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 but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of hot water mixed with a teaspoon of salt.

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 resolution 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 decarbonated regular 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. The syrup in fruitcocktail may also decrease your nausea.

Other Complications

If numbness of the lip, gums, teeth, 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. Yanagihara if you have any questions.
Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office.
You should be careful going from the lying down position to standing. You may be a little dehydrated due to not eating or drinking prior to surgery along with difficulty taking fluids postoperatively. 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. Yanagihara.
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.
Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a couple days following surgery. Exercising the jaws will keep trismus to a minimum. If trismus persist, please call the office immediately as it may be a sign of serious infection.

Finally

Sutures may be utilized to aid in healing and minimize bleeding. These sutures will dissolve over a week and need not be removed. Sometimes they become dislodged, this is no cause for alarm. Just cut or remove the suture from your mouth and discard it. So it’s really nothing to worry about.

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 my office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually fill in with the new tissue over the next several weeks. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush. Upon your return for postoperative evaluation, a syringe will be given to you to irrigate any debris caught in the socket. Rinsing out the socket too early may lead to a dry 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. Yanagihara or your family dentist.

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

A dry socket occurs when the blood clot disintegrates possibly due to low grade infection and gets dislodged from the socket. No further bleeding occurs, hence “dry socket.” Symptoms of severe pain at the surgical site and even pain to the ear and anterior jaw may occur 4-7 days following surgery. The intense pain is not relieved with narcotic analgesics. Call the office if this occurs.

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.