Post-Op: Wisdom Teeth Removal

Wisdom teeth removal is very common and safe. With that said, it is also a serious surgery and requires care during the recovery process. Following these aftercare instructions can significantly minimize your risk of ongoing discomfort or infection.

Immediately Following Surgery

• There will be a gauze pad placed over the incision site. Keep this gauze pad in place for half an hour after surgery. After half an hour has passed, remove and discard it. This gauze should be replaced with pressure applied over the surgical site by biting the gauze. This should be repeated until the bleeding is minimal or has stopped.
• Avoid touching the wound area or any kind of vigorous mouth washing, following surgery. Touching or mouth washing may dislodge the blood clot that has formed, which can in turn cause continued bleeding and dry socket.
• As soon as you start feeling pain or discomfort, take the prescription pain medication as instructed. This will usually happen around the time your anesthesia wears off.
• Try to rest on the day of your surgery. Take it easy and restrict physical activities. Get back to your normal physical activities when you feel able.
• Use ice packs on the side of your face where you had wisdom teeth removed. This is an important way to minimize swelling.

Bleeding

Following surgery, a little bit of bleeding is normal and can be anticipated. Some slight bleeding, or red saliva, is nothing to worry about. If you experience excessive bleeding, you may be able to control it by rinsing and wiping away any old blood clots in your mouth. Then, place a gauze pad over the wound area, and bite down on it for at least half an hour. If bleeding continues, repeat this step, or else try biting down on a wet tea bag for half an hour. You can also minimize bleeding by resting, avoiding physical exercise or excitement.

Swelling

Following wisdom teeth removal, you can expect some swelling around the mouth, cheeks, eyes, and side of the face. Swelling reaches its peak 2-3 days after surgery which is because of the body’s normal inflammatory response after trauma. After this initial period, swelling should gradually improve. You can minimize the swelling with the use of ice packs. Place them against the side of the face where surgery was performed and keep them there continuously while you are awake. Note that after 36 hours, ice no longer has any beneficial effect on swelling but can still be used for comfort. After 36 hours, moist heat (e.g., a warm compress) works best.

Also, be aware that your jaw may become a little stiff following your surgery, especially during the second and third days of your recovery. This is a normal response to surgery and is nothing to worry about. You can begin stretching your jaw one week after surgery if you are still having some stiffness or limited opening of your jaw.

Pain

Pain is expected after oral surgery but should be manageable with a multimodal pain medication regimen. Just like swelling, pain reaches its peak 2-3 days after surgery which is because of the body’s normal inflammatory response after trauma. After this initial period, pain should gradually improve.

It is recommended that all patients take over the counter acetaminophen (Tylenol) and ibuprofen (Motrin or Advil) for the first 7 days post-operatively. For older children (>120 lbs) and adults, this can be the maximum recommended dose of both of these medications: 800mg of ibuprofen (4 tablets of 200mg) and 1000mg of acetaminophen (2 tablets of 500mg). This dosage of these medications can be taken together safely every 6 hours or can be alternated so that one of them are being taken every 3 hours. For smaller children, weight-based dosing will be utilized.

For the majority of patients, ibuprofen and acetaminophen are sufficient to control pain. For more severe pain, prescription medications such as oxycodone or hydrocodone may be prescribed to manage acute pain in the first several days post-operatively. When these pain medications are prescribed, they should only be taken as needed and after the maximum dosage of ibuprofen and acetaminophen have been taken. Take any prescription pain medications that are prescribed by your surgeon and use them as directed. Note that prescription pain medications can cause you to feel groggy, and they may also slow your reflexes. When taking prescription pain medicines, avoid driving, operating machinery, and drinking alcohol. 

Following the acute inflammatory phase (3 days post-operatively), pain should become less and less pronounced. If pain persists or intensifies, contact your surgeon.

Diet

After anesthesia or IV sedation, you will want to resume your diet with liquids first. Drink from a glass and avoid using straws. (The sucking motion from the straw may dislodge your blood clot and cause more bleeding or cause dry socket). Once liquids are being tolerated, you can progress to soft foods – this includes soft pasta, mashed potatoes, yogurt, pudding, etc.

With respect to the surgical site, a soft food diet should be implemented for the first 5-7 days post-operatively. Hot (temperature) and spicy foods should be avoided. It is normal for patients to return to a normal diet about a week after their surgery.

Seek nourishment regularly, and drink lots of fluids to ensure that you avoid dehydration. Over the first couple of days, your food intake may be lower, so compensate by drinking more liquids. Aim for a minimum of five to six glasses of liquid daily.

Try to get plenty of calories and protein, and not miss any meals. Getting sound nutrition will help you feel better and regain your strength more quickly.

Exercise

Avoiding strenuous exercise or exertion is important for the first 24-48 hours post-operatively to allow for a healthy blood clot to form and mature. After this point, it is up to the comfort of the patient when these activities can be resumed. For most individuals, 2-3 days of rest suffices. If you exercise regularly or play a sport, be aware that your normal nourishment intake will be temporarily reduced. If you become lightheaded or your surgical site resumes bleeding, stop exercising.

Keep Your Mouth Clean

On the day of your surgery, avoid rinsing or mouth washing of any kind. You may brush your teeth at night, but be very gentle in your rinsing.

On the day after surgery, start by rinsing with a mixture of warm water and salt five to six times daily, especially after eating. Regular gentle rinsing will prevent food from bathing the surgical sites which can cause pain and infection.

Chlorhexidine Gluconate (Peridex) mouth rinse will be prescribed for twice daily rinsing (in addition to the salt water rinsing after meals). This prescription mouth rinse is anti-bacterial and has been shown to reduce the chance of dry-socket.

Discoloration

Some patients may experience some slight discoloration of the skin, in addition to swelling. Any black, blue, green, or yellow discoloration may be caused by blood spreading beneath the tissues. This is very normal. This discoloration can persist and evolve for several weeks after surgery. A warm compress can help with blood flow and mobilize the body’s nature recycling apparatus to manage this discoloration.

Antibiotics

Antibiotics can help prevent infection, so make sure you take them as directed. Do not continue using antibiotics in the event of a rash or other adverse reaction. Contact the office if you have any questions.

Nausea and Vomiting

If you experience nausea or vomiting the day after your surgery, avoid taking anything by mouth for at least an hour, including prescription medications. Then, try sipping on ginger ale, tea, or Coke. Sip slowly for 15 minutes or more. When nausea subsides, you can try eating solid foods and taking your medications again. Anti-nausea medications can be prescribed so it is important to communicate this with your doctor.

Sutures

Sutures (stitches) will be used to approximate gum tissues in an anatomically appropriate position and minimize bleeding. Most often, resorbable (dissolving) sutures will be used. These resorbable sutures will dissolve on average in 1-2 weeks. If the sutures fall out more slowly or more quickly, this is not a reason for concern. It is not uncommon for sutures to come out within just a day or two after surgery.

There will be a cavity or “socket” where the wisdom tooth was removed, and over the course of a month, this cavity will fill with tissue. If the socket is not covered up with your normal gum tissue, it is very important to prevent food from getting lodged within the hole. Use saltwater rinses and tooth brushing to keep this area clean, especially following meals. A “Monojet” plastic syringe may be provided to irrigate these areas beginning on day 5 after surgery to keep the sockets clean.

A dry socket occurs when the blood clot gets dislodged prematurely from the tooth socket, causing pain in the mouth or even in the ear. This is a very uncomfortable occurrence when it happens and sometimes cannot be avoided. Rinsing with chlorhexidine gluconate and avoiding straws and smoking have been shown to reduce the chance of dry socket occurring. Dry socket is a self-limiting problem and will resolve on its own within several days. There are topical medications to alleviate the pain of dry socket but additional healing time is ultimately required for the body to restore the clot.

Other Complications

• Following surgery, you may notice numbness of the lip, tongue, or chin. This is normal and should prove temporary. However, the numbness may cause you to accidentally bite your tongue or your lip, so be extra careful as you eat.
• You may have a slight uptick in temperature after surgery. This is normal and can be managed with Tylenol or Ibuprofen.
• Be careful moving from a lying down position to standing. You will likely feel weak and a bit dizzy. To avoid lightheadedness, you should sit for one minute before you stand up.
• Some patients feel hard projections in the mouth with their tongue. These are the bony walls that support the wisdom tooth. Most of the time, they smooth out on their own. If they cause an ongoing problem, your surgeon can remove them very easily.
• If the corners of your mouth are stretched out, it may result in dry, cracked lips. Use ointments such as Vaseline to keep your lips moist.
• It is also common to experience a sore throat, especially when swallowing. This is simply the result of swelling in the throat muscles, and should subside within a couple of days.
• Stiffness in the jaw muscles may cause difficulty in opening your mouth for a few days after your surgery. This stiffness is normal and will resolve on its own.