After Wisdom Tooth Removal

Oral Surgery Instructions

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully.

If you have any questions please feel free to call us at Hartman Oral and Maxillofacial Surgery Phone Number 717-766-7697.

Immediately Following Surgery

  • The gauze pad placed over the surgical area should be kept in place for a thirty minutes. After this time, the gauze pad should be removed and discarded. If there is more than oozing from the surgical sites, new gauze pads can be placed for an additional thirty minutes.
  • Vigorous mouth rinsing and/or touching the wound area following surgery should be avoided. This may prolong bleeding by causing the blood clot that has formed to become dislodged.
  • Take the prescribed pain medication once you have had a chance to drink some clear liquids. It is important to start the pain medication before you start to feel discomfort.  The numbness associated with the local anesthetic typically wears off about eight hours after the procedure.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs on the sides of your face where surgery was performed. Refer to the section on swelling for a more thorough 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 black tea bag for thirty minutes. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels. To further minimize bleeding, do not become excited, sit upright, try to remain relaxed, and avoid exercise. If bleeding does not subside, call our office for further instructions.

Swelling

The swelling that is normally expected is 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. The swelling may be minimized by the immediate use of ice packs. 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 amount of swelling.

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3200mg daily for an adult. Consult our practice for individuals under 18. Do not take the two medications at the same time.

For severe pain, over the counter medications such as Tylenol (acetaminophen) or Motrin (ibuprofen) can be taken. As strengths vary, please consult the medication bottle for amounts and timing. Please note some stronger pain medications prescribed by Dr. Hartman will have acetaminophen or ibuprofen as a co-ingredient. Be careful not to take this over the counter medicine if it is already in the prescribed medication.

Diet

After general anesthetia only liquids should initially be consumed. Drink from a glass and do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. A high calorie, high protein intake is very important. 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 any meals. Recommended first meals after surgery include soft, clear, foods such as Jell-O or soup broth (warm, not hot.) Gradually progress to other soft foods such as scrambled eggs, mashed potatoes, and macaroni and cheese. Dairy products may be started the day after surgery. You will feel better, have more strength, 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 up for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. The day after surgery you should begin rinsing with the prescribed mouth rinse (Chlorhexidine). Additional gentle rinsing may be performed after meals with a teaspoon of salt mixed into one cup of warm water. Resume brushing your teeth the day after surgery. It is ok to gently brush over the surgical sites to help keep them clean.

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 tissue. This is a normal post-operative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may decrease the duration of the discoloration.

Antibiotics

Antibiotics may be given to help prevent infection. If you have been placed on antibiotics, take the tablets or liquid as directed. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. 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 clear liquids (sports drinks, tea, or ginger ale.) You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking soft 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. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. Call Dr. Hartman if the numbness persists the day after surgery.
  • 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 could get light headed from dehydration, low blood sugar, or medications. You should remain seated for one minute before getting up.
  • Occasionally, patients may feel hard projections in the surgical site 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. Hartman.
  • 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.
  • Sore throat 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 which will resolve in time.

Finally

Sutures are often 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. The sutures will dissolve approximately one week after surgery.

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 our office for instructions.

There will be a void where the tooth was removed. The void will fill in with new tissue gradually over the next month. In the meantime, the area should be kept clean, especially after meals, with salt water rinses or a toothbrush.

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

A dry socket can occur when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain near the ear may occur 2-3 days following surgery. Call the office if this occurs.

Since no two mouths are alike, your case is unique. Do not hesitate to call the office at Hartman Oral and Maxillofacial Surgery Phone Number 717-766-7697 if you have any questions or concerns.