Perry Silva DDS MD
Oral Maxillofacial Surgery
Dipolmate, American Board of Oral and Maxillofacial Surgery
Fellow, American Association of Oral and Maxillofacial Surgery
After Wisdom Teeth 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 pads placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and replaced every 30 minutes, applying firm pressure to the pads with your jaw. Once bleeding has stopped you may cease using the gauze pads. If bleeding starts repeat the process until it stops.
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.
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.
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 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. A head sling is provided to facilitate this. 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.
For moderate pain over-the -counter pain medications such as Tylenol or Ibuprofen(Motrin/Advil) can be used. In most cases please use the prescribed pain medications as instructed. Avoid sudden movements while on the prescribed medication. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery will peak on day three/four then begin to subside. If pain persists, it may require attention and you should call the office.
After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The use of straws can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form 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 but avoid the extraction site areas. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt. On post-operative day 3 please begin using the curved plastic syringe to irrigate the sites out more thoroughly but also continue with the oral rinsing.
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.
If you have been placed on antibiotics, take them 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, use the anti nausea medicine as prescribed. When the nausea subsides you can begin taking solid foods. If the nausea is persistent please call the office.
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. Please be careful. Call Dr. Silva 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. Before standing up, you should sit for one minute then get up slowly.
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 Silva.
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 lip balm or vaseline.
Sore throats and pain when swallowing are not uncommon. This will subside in 2-3 days.
Stiffness 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.
Sutures are placed in the area of surgery to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures will dissolve approximately one week after surgery.
The pain and swelling usually peaks the third day after surgery. It should subside more and more each day thereafter. If your post-operative pain or swelling worsens or unusual symptoms occur call the office for instructions.
There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses.
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: Our office.
Brushing your teeth is okay – just avoid the surgical sites.
A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. It is normal to have pain at the surgical site. If there is pain radiating to the ear and/or to the anterior teeth this is not normal and may be a dry socket. It usually occurs 3 days following surgery. Please call the office with any questions or concerns.
If you are involved in regular exercise, be aware that exercise may cause the surgical sites to ache for up to two weeks. If you get light headed, stop exercising.