Bay Area Oral & Facial Surgery
Oral & Facial Surgery
San Francisco CA
415-392-3122

After Wisdom Tooth Removal

Patient Information

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The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important and you will receive oral and written instructions at our office. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.

Immediately Following Surgery

  • The gauze pads placed over the surgical area should be kept in place for one to two hours. After this time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing or touching the wound area following surgery should be avoided for the rest of the day. 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 an explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Typically, after discarding the first gauze pads, fresh gauze pads should be placed and changed every hour or so until bleeding has diminished. You will be provided with gauze to take home after your surgery.

Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing two folded gauze pads over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in black tea 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 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 often not become apparent until the day following surgery and will not reach its maximum until two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Plastic bags filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. Use a towel between your skin and the ice pack. Use the ice packs 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 moderate pain, one or two tablets of Tylenol or an Extra Strength Tylenol tablet may be taken every four hours or ibuprofen (Motrin or Advil) two to three 200 mg tablets may be taken every four to six hours.

For 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.

Diet

Drink liquids after general anesthesia or IV sedation. Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical site(s). High calorie, high protein intake is very important. You should prevent dehydration by taking fluids regularly. Avoid hot liquids or foods the first day. Your food intake will be limited in the beginning. You should compensate for this by increasing your fluid intake. Drink plenty of liquid daily and try not to miss meals. You will feel better, have more strength, less discomfort, and heal faster if you eat. Suggested foods after oral surgery include soup, Jell-O, mashed potatoes, porridge, pudding, and soft noodles.

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 very gently. Alternatively, do not brush your teeth until the next morning. The day after surgery you my begin your usual brushing and flossing, but be gentle at the extraction sites. Also, you should begin rinsing at least five to six times a day with a cup of warm water mixed with a half teaspoon of salt especially after eating.

A plastic syringe with a cured tip will be provided to you to assist you in flushing food out of the socket. You may start to use the syringe within 2-3 days of your extraction. Fill the syringe with warm water or warm salty water and gently direct the water stream towards the socket. Doing this at least once a day until the socket heals is helpful in preventing food particles from packing down into socket, especially following removal of lower wisdom teeth.

Discoloration

In some cases, bruising of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues during or after surgery. This is a normal postoperative occurrence, which may occur two to three 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 & 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. Sip slowly over a 15-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. 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. Be careful. Call Dr. Tom or Dr. Silva if you have any questions.
  • A 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. It may be difficult to take enough fluids to maintain hydration. Taking pain medications can make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and 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. Tom, Dr. Silva or Dr. Connelly.
  • 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 two to three 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 that will resolve in time.

Finally

Sutures (stitches) are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged early. This is no cause for alarm. Just remove the loose suture from your mouth and discard it. Most sutures will soften and fall out on their own within one week after surgery. If not, the removal of sutures requires no anesthesia or needles. It takes only a few seconds, and there is no discomfort associated with this procedure. 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 the office for instructions.

There will be a socket (hole) where the tooth was removed. The socket will gradually fill in with new tissue over the next month. In the meantime, 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. Tom, Dr. Silva, Dr. Conelly, 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. It may also occur if the socket does not fill in with new gum tissue as quickly as anticipated. Symptoms of pain at the surgical site and even pain to the ear may occur two to three days following surgery. Most patients do not get a dry socket. However, most dry sockets occur following extraction of lower molars, including wisdom teeth. Dry sockets are also more common if you smoke after surgery. Call the office if you have symptoms. Dr. Tom, Dr. Silva or Dr. Connelly may be able to treat the area to make you more comfortable. In time, all dry sockets heal.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. If you feel weak or get light-headed, stop exercising.