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 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 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 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. Two baggies filled with ice, ice packs, or “frozen peas” from the supermarket should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously (30 minutes on, 30 minutes off) 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

Unfortunately, most oral surgery is accompanied by some degree of discomfort. Dr. Vigliante uses long-acting local anesthesia on his patients, allowing them enough time to get comfortable at home, drink some fluids, and begin taking pain medications. Effects of pain medications vary widely among individuals. You will usually have a prescription for pain medication, and if you take the first pill before the anesthetic has worn off, you will be able to manage any discomfort better. It is important not to take the codeine pain medication on an empty stomach as this will cause nausea. Most patients can safely take Ibuprofen (Motrin or Advil) three (3) 200 mg tablets taken every 4-6 hours shortly after surgery. This treatment has many advantages including decreasing postoperative nausea and decreasing swelling after surgery. If you do not achieve adequate relief with ibuprofen alone, we encourage you to supplement the ibuprofen with the stronger codeine pain medication prescribed by Dr. Vigliante. Some people may even require two of the codeine pain pills at one time during early stages (but that may add to the risk of upset stomach). Remember that the most severe discomfort is usually within the first six hours after the anesthetic wears off; after that your need for medicine should lessen.

For severe pain, take the tablets prescribed as directed. The prescribed codeine-type 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

After general anesthetic or I.V. sedation, liquids should be initially taken. This will prevent dehydration. Do not use straws for the first 2 weeks. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. Eat any nourishing food that can be taken with comfort. Temperature of the food doesn’t matter, but avoid extremely hot and spicy foods. It is sometimes advisable, but not required, to confine the first day’s input to bland liquids or pureed foods (creamed soups, puddings, yogurt, milk shakes, etc.). Avoid foods like nuts, sunflower seeds, popcorn, etc., that may get lodged in the socket areas. Over the next several days you can progress to solid foods at your own pace. It is important not to skip meals! If you take nourishment regularly, you will feel better, gain strength, have less discomfort and heal faster. If you are a diabetic, maintain your normal eating habits as much as possible and follow instructions from us, or your physician, regarding your insulin schedule.

Keep the mouth clean

No rinsing of any kind should be performed until 24 hours following surgery. Brushing your teeth the night of surgery is not recommended. You can brush your teeth the day after surgery but rinse gently. 24 hours after surgery, gentle rinsing can begin with a cup of warm water mixed with a teaspoon of salt. 48 hours after surgery you should begin rinsing at least 4 times a day, especially after eating. Dr. Vigliante gives his patients a special syringe to aid them in rinsing hard-to-reach areas of the mouth after surgery.

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. Occasionally, this can happen. 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.

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

The most common cause of nausea and/or vomiting after surgery is taking the stronger pain medicines with an empty stomach. In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed antibiotic and pain medicine. You should then sip on coke, tea or ginger ale. Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with a large volume of water. Try to keep taking clear fluids and minimizing the pain medication, but call the office (703) 723-5366, if you do not feel better or if repeated vomiting is a problem. 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. 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 Vigliante 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.
• 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. Vigliante.
• 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 or triple antibiotic ointment.
• 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.

Finally

• Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. Dr. Vigliante uses absorbable sutures, so this is to be expected. If the sutures persist, they may be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, 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 hollow cavity where the tooth was removed. The hollow cavity will gradually fill in with the new tissue over the next month. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush.
• Your case is individual, since 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. Vigliante or your family dentist.
• BRUSHING your teeth is okay - just be gentle at the surgical sites. You can begin the day after surgery, but remember to rinse gently and avoid the surgical sites with the toothbrush since there will be sutures over the surgical sites most of the time.
• MOUTH RINSES - Keeping your mouth clean after surgery is essential. Starting 24 hours after surgery, use one-quarter teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least three to four times daily for the next five days.
• IRRIGATING SYRINGE - If you were given an irrigating syringe, you can start using this on the 3rd Day after surgery to keep the sockets clean. Fill it with warm, salt water and irrigate any open sockets gently, especially after eating.
• DRY SOCKET is when the blood clot gets dislodged prematurely from the extraction socket of primarily the lower teeth. You may experience a persistent throbbing pain in the jaw unrelieved by any measure. Activities that contribute to dry socket include sucking through a straw, smoking, vomiting, aggressive exercise, aggressive mouth rinsing too early after surgery, spitting, or any activity that may cause the clot to dislodge.
• EXERCISE - 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. Remember, no exercise or contact sports the first week, 75% of your normal routine the second week, and back to 100% the third week. Keep in mind that everyone is different, and some people heal faster than others.
• SMOKING: DO NOT smoke at least 72 hours (3 days) prior to or for 1 week after tooth surgery, since it is very detrimental to the healing process and will greatly increase your risk of DRY socket.
• DO NOT suck through a straw for the first 2 weeks after tooth surgery, as this will increase your risk of DRY socket.