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. Remember to prepare for your surgery; take time off work or study after your surgery to recover fully before returning to your daily occupation.  Let your employer or teacher know that you might be away for about a week.  If you feel that you are making good progress, you might choose to return to light duties.  But, returning to work too soon might delay your recovery.  Do not expect to lead a normal life for the first few days after surgery.  If possible, cancel social engagements, fitness classes, participation in sports, and concentrate on you recovery.

Immediately Following Surgery

  • The gauze pad placed over the surgical area should be kept in place with moderate pressure for a half hour following surgery. 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.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. The extra gauze given to you is to be used if the bleeding is more than a small trickle.  To properly place the gauze, fold it into a small cube and place it directly on the surgical site(s).  Hold it there with firm pressure for 30 minutes.  If bleeding continues around the recently placed gauze this could mean the gauze wasn’t placed properly.  Replacing the gauze too frequently (less than every 30 minutes) will disturb the clot before it has had a chance to get firm, tearing it and causing bleeding to continue.  Repeat if necessary. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside after this, call Brentwood Oral Surgery for further instructions.

Swelling

Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon after wisdom tooth removal. This is the body’s normal reaction to surgery and eventual repair. The swelling will not be noticeable until the day following surgery and will not reach its maximum until two or three days later. The key to preventing swelling is to start icing right after surgery and keep at it all day. Two 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. 36 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain Management

Pain is a potential issue at least for the first twelve hours after the surgery if not the following day as well, and it is impossible to predict the extent of pain experienced by each individual.  A suggested regime to manage pain is below:

The day of surgery

Once you get home from the surgery:

Take pain medication as directed.

If still in pain, call Dr. Matthew or Dr. Korj and a review of the pain management regime will be further discussed. You should have available, the phone number of the pharmacy and your personal health care number if an alternative prescription is advised.

*If ibuprofen is unsuitable, it can be substituted with a different analgesic.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink 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 sites. 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 and a fluid diet of soup, yogurt, smoothies, jello, congee, ice cream, milk shakes are suitable. Drink at least five or six glasses of liquid 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.

Oral Hygiene

No rinsing or brushing of any kind should be performed until the day following surgery.  Brushing, either with a manual or electric toothbrush, should be done very gently.  The day after surgery you should begin gently rinsing at least 5-6 times a day (especially after eating) with a cup of warm water mixed with 1/2 teaspoon of salt.

Skin Bruising

In some cases, bruising of the skin follows swelling. The development of black, blue, green, or yellow bruising is normal and can move from the surgical site to the cheek(s), lower eyelids, chin and to the neck or even chest area.  This is a normal post-operative occurrence, which may appear 2-3 days after surgery and last from 7 to 14 days. Moist heat applied to the area may speed up the removal of the bruising.

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

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 tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.

Other Potential 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 the doctor if you have any questions.
  • If you had anesthesia or other medications administered through an IV during your surgery, note that it is not uncommon for there to be some swelling and redness at the IV site.  Any swelling up to the size of a pinky-width is normal for up to 4 days following surgery.  If you have swelling of a larger area, swelling that persists for more than 4 days, or other concerns please call Burnaby Oral Surgery.
  • A low fever immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
  • After your surgery, please be cautious as you change positions from lying down to standing. You may become light headed unless you slowly change positions.  If you have been lying down, sit up for one minute before you stand up.  Taking pain medications can make you dizzy.
  • Occasionally, patients may feel hard bumps in the mouth with their tongue. They are not roots; they are the bony walls which supported the tooth. These bumps usually smooth out on their own. If not, they can be removed by the doctor.
  • 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 throat and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This should go away in two to three days.
  • Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is normal after surgery and will resolve in time.
  • Sutures (stitches) are placed in the area of surgery to minimize post-operative bleeding and to facilitate healing. We often use re-sorbable sutures which may break into fragments as they begin to dissolve.  Do not be alarmed as this is completely normal. Remove any dislodged suture from your mouth and discard it. If your sutures are not re-sorbable, they will be removed by us at your return visit approximately one to two weeks after surgery. You will find this procedure to be quick and painless.
  • 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 cavity where the tooth was removed. Over the next month the cavity will gradually fill in with the new tissue. In the mean time, 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 professionals best able to effectively help you: your doctor 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. Symptoms of pain at the surgical site and even pain to the ear may occur two to three days following surgery. Call Burnaby Oral Surgery  if this occurs.
  • If you exercise regularly, be aware that your normal food intake is reduced during recovery. Exercise may weaken you. If you get light headed, stop exercising.