Wisdom Tooth Surgery

Wisdom teeth removal is a surgical procedure that requires careful postoperative care. Following these instructions will help you avoid unnecessary pain and swelling and also minimize the risk of infection and complications.

Please read these instructions carefully. This information will help you understand normal reactions after surgery, as well as care that can be taken to ensure your comfort during the healing time.

Early Care After Surgery

On the day of the surgery, patients have optimal results when following this sequence:

• Control Bleeding First: The patient should stay in a sitting position and bite on gauze until the bleeding stops. Do not spit. Apply ice packs to the affected areas immediately.
• Eat Something: Getting something in the stomach is important. A milkshake is suggested.
• Start Medications: If the patient is experiencing pain, then the pain medication should be taken first, followed by the antibiotic an hour later. If the patient is not experiencing pain, then the antibiotic should be taken first, with the use of pain medication when the pain is starting to occur.

Bleeding

Apply moistened sterile gauze (a thumb-size roll) or a teabag over the wound. Bite hard with constant pressure for an hour, using 80% of your maximum bite force. The bulk of the gauze should be placed over the socket directly, so it acts as a barrier to minimize the amount of blood that is exiting the socket.

If the mouth is filling up with blood, then it means that the gauze is not sealing off the area. The gauze should be adjusted to achieve a better seal. Another cause for blood filling the mouth is if intermittent pressure is applied on the gauze or the patient starts talking, causing the gauze to move out of position.

Even when the above techniques are used properly, it may take as long as 3 to 4 hours for the bleeding to stop.

When the lower wisdom teeth are removed, Drs. Blecha and Jandali usually suture the wound open, which means you can see a hole in the gum at the back of your mouth. You will likely see blood in the hole and on the adjacent area.

If you see “jelly clots” (blood clots) on adjacent teeth, then they should be wiped off. This might stimulate some bleeding but is the correct care for the wound. These clots form when the gauze does not seal off the gum opening. Blood seeps outside of the socket and clots on nearby teeth and tissues.

Determine if the wound is still bleeding by looking at the socket directly for 20 to 30 seconds. If you see that blood “pools up” in the socket, then a new pressure gauze should be placed, and the patient should bite down for another hour.

When upper wisdom teeth are removed, it might be difficult to see the upper socket. If the wound is still bleeding, then you might see an occasional dripping of blood from the back molar teeth or running down the cheek next to the area.

Look for signs of blood “dripping” or “pooling” to determine if another gauze pad needs to be placed over the socket. During the hour of gauze placement, the patient should not talk or open the mouth since these activities can cause the gauze to move out of position.

Ignore bloodstain on the gauze as a sign of bleeding. Ideally, someone other than the patient should check for bleeding and help with the gauze application. At the end of each hour, the gauze should be removed and the wound needs to be checked for further bleeding. Look at the wound directly for 20–30 seconds, using a flashlight and spoon handle (as a retractor) if needed. Don’t be surprised if the patient can’t open wide. A partial opening should be sufficient for you to see if it is bleeding.

Variable bleeding is expected after oral surgery. It is not uncommon to experience oozing, slight bleeding, or redness in the saliva. Wiping or rinsing any old clots from the mouth can help with the control of excessive bleeding. If the wiping creates more bleeding, then the mouth can be rinsed one time using a mixture of 50% hydrogen peroxide and 50% water. The mouth will foam, then it can be rinsed one time using cool water. No further rinsing is suggested. Next, place a new gauze pad over the area for one hour, then check the socket for bleeding again.

If the bleeding continues after following these instructions, then bite on a moistened tea bag for 30 minutes. Tea bags contain tannic acid that helps with clot formation by contracting bleeding vessels. Further bleeding can be minimized by sleeping with the head elevated and avoiding exercise or strenuous activity.

If the bleeding does not stop, then call our office for further instructions. In the first 24 hours, it is normal to have minimal bleeding and red or pink saliva. Also, bleeding can occasionally recur through the week after surgery. Usually, the bleeding will stop by itself, but pressure gauze can be applied if the bleeding is persistent.

Consider placing a towel to cover your pillow the night of the surgery. Minor oozing and drooling might occur while sleeping.

If your oral surgery was not an extraction of a tooth, then you should follow the bleeding control instructions provided by our staff. We always provide detailed information specific to the procedure that was performed.

Pain

The first 12–24 hours are usually when the most discomfort is experienced. Severe pain can be treated using the prescribed medications, taken as directed. When impacted teeth are removed, Drs. Blecha and Jandali typically prescribe an anti-inflammatory medication to help with recovery, such as Diflunisal or Celebrex. As you notice the development of pain because the local anesthesia is wearing off, then this medication should be taken first for pain relief. When you begin taking this anti-inflammatory medication, it is recommended to continue taking it as prescribed until the pain is gone or you finish the prescription. Advil and Aleve are in the same family of drugs, so these over-the-counter medications should not be taken when you are using the prescription.

If you can’t achieve reasonable pain relief with the anti-inflammatory medication, continue using the pills as prescribed. Occasional doses of narcotic pain reliever can be added, such as Norco or Tylenol with Codeine #3. Talk to the doctor about prescription options for supplemental pain relief.

Keep in mind that most pain medications can cause an upset stomach. The risk of stomach discomfort is highest when medication is taken on an empty stomach and prescription pain medication is used. If general anesthesia was used and the stomach is empty, then it is recommended to drink a milkshake followed by the first dose of medication 30 minutes later. A more effective option is to eat something soft and bulky (mashed potatoes, oatmeal, ground meat, etc.) 30 minutes before the medication.

Important Medication Reminders

CAUTION: Patients should not drive or operate mechanical equipment when using prescription pain medication. Also, alcohol should not be mixed with any type of pain medication (over-the-counter or prescription). Do not mix alcohol with antibiotics.

• Different medications should be spaced at least an hour apart from each other
• Eat food with some thickness 30 minutes before taking medication
• Always follow the dosage and frequency prescribed on each bottle
• Pain medications are beneficial to take the edge off of strong pain, but they do not eliminate all pain
• Avoid alcohol when using pain medication and/or antibiotics
• If taking narcotic medications, you should not work or drive a vehicle. This doesn’t apply to the use of anti-inflammatory pills.

Postoperative pain varies between patients. The worst pain is usually experienced in the first 72 hours, but some people experience a worsening of pain after the first few days. The overall trend is that pain should taper off within 5–6 days, although it is common to experience pain variations from one day to the next.

Exercise, strenuous activities, or following a “busy” lifestyle tends to cause a throbbing sensation in the wound. Use common sense and minimize activities if you find the pain or discomfort intensifies.

Antibiotics

If you have been prescribed antibiotics, then the first dosage should be taken 1 hour after taking pain medication. Continue using this medication as prescribed until the entire prescription has been finished.

Be aware that antibiotics might decrease the effectiveness of other medications, such as birth control pills. Talk to your obstetrician to know how long alternative birth control methods should be used after stopping the antibiotic.

Other Medications

You should continue taking other medications that were routinely used before your surgery (unless otherwise directed). Talk to the doctor to avoid complications when using other medications.

If a steroid (dexamethasone) was prescribed, please follow the directions on the package.

Medications should always be spaced one hour apart, and it is important to eat before each dosage. Also, track the timing to follow the correct frequency. Here is a recommended tracker to use:

Swelling

Drs. Blecha and Jandali use precise surgical techniques to minimize and prevent swelling whenever possible. But the swelling that occurs will be proportional to the procedure. It is common for patients to experience swelling around the cheeks, mouth, eyes, and sides of the face. This reaction is expected and a normal part of the healing process. Usually, the swelling peaks within 72 hours, then will take 5–6 days to subside.

Ice packs can be used for swelling reduction. If you don’t have ice packs, homemade packs can be created using a Ziploc bag filled with ice. All ice packs should be wrapped in a dry washcloth or hand towel before applying the pack on the sides of the face.

Ice can be used in 30-minute intervals: 30 minutes on, 30 minutes off. Start the ice pack treatment on the day of the surgery and continue as needed – up to 72 hours after the surgery. After 72 hours, you can bring the swelling down by placing moist, warm, heat applications on the sides of the face.

Smoking

It is recommended that patients shouldn’t smoke for the first 48 hours after surgery. Preferably, patients should wait for a week after surgery before smoking again.

Diet

Reestablishing your diet after oral surgery is beneficial to promote healing. Chewing might be difficult in the first 5–6 days if your jaw is stiff and difficult to open.

When the bleeding stops, we recommend a milkshake. Next, patients can move on to soft, bulky foods, such as oatmeal, mashed potatoes, and ground meat. These ingredients are important in preventing vomiting and nausea from the use of medications.

Ask a family member to chop up the foods into small enough pieces so you can eat them with a spoon and swallow without chewing. Drink 5–6 glasses of liquid per day to supplement the bulky foods.

Even if your jaw is stiff and sore, you must be consistent with eating bulky foods so your stomach can tolerate your medications.

Nausea and Vomiting

The risk of postoperative nausea and vomiting is highest when the patient isn’t eating well and is taking postoperative medications. Pain medications are commonly the cause of stomach upset.

If nausea and/or vomiting is experienced after the surgery, then don’t eat or take anything by mouth for an hour (including prescribed medications). Slowly sip on a Sprite or Coke for 15 minutes.

When the nausea subsides, try to eat bulky foods (as listed above). If these foods are tolerated, then you can try to resume the use of medications once again. Usually, the narcotic pain medication is the cause of nausea. If these prescriptions are needed for pain management, be slow in resuming the use of the prescription and try taking a lower dose to minimize nausea.

Oral Hygiene

Do not rinse or brush your teeth for 24 hours after surgery. After 24 hours, clean the mouth by brushing and following the salt-water rinses as directed below. Keep in mind that good hygiene after surgery is essential to help your mouth heal faster and to reduce the pain as quickly as possible. If you are too “shy” to brush and rinse, then it increases the likelihood of the development of a postoperative wound infection and pain that worsens.

Twenty-four hours after tooth extraction, all of the teeth should be brushed (including the teeth adjacent to the surgical site). Don’t scrub too hard. Instead, carefully clean the surface of all teeth, including “nooks and crannies” where food can get stuck.

At this time, you should also start using salt-water rinses. Mix 1/2 teaspoon salt in a glass of warm water, then gently “swish” to remove food that gets stuck in the surgical wounds. You should brush and rinse – saltwater swishing does not replace brushing.

If you were given a syringe to use for cleaning the lower wisdom teeth sockets, then this rinsing can begin 4 to 5 days after surgery. Fill the syringe with warm water, then gently feel the gum to find the socket in the back of the mouth. The syringe should be placed into the socket, then use moderate pressure to squeeze the syringe plunger so the socket is flushed. Syringing is recommended for about four weeks, or until the socket has filled in and no hole is present.

For upper wisdom teeth, saltwater rinses are suggested for three weeks.

These rinsing techniques are important for removing food that might become trapped in the sockets. Food particles can cause an infection to develop, which could extend your pain and recovery time.

If you find it difficult to open your stiff jaw 4–5 days after surgery, then stretching exercises can be used so you can open your mouth wider. Not only will opening your mouth wider make it easier to clean your teeth, but it also improves your ability to eat.

REMEMBER: A clean wound heals better and faster.

Activity

Immediately following surgery, physical activities should be kept to a minimum. Avoid exercise for 5–6 days. Strenuous activities can result in throbbing or bleeding. If these problems occur, then you should discontinue the activity.

During this recovery time, your normal caloric intake may be reduced because it is difficult to eat. As a result, exercise may weaken you. If you are feeling light-headed, then stop exercising. Be careful to ease your way back into an exercise routine to avoid complications for your recovery.

Discoloration

Some patients experience skin discoloration after surgery. When the blood spreads beneath the tissues, it can cause the development of green, blue, black, or yellow discoloration. This postoperative discoloration is normal, and usually shows up 2 or 3 days after surgery. Moist heat can be applied to the area to speed up the healing and fade the discoloration.

Sore Throat & Corners of the Mouth

The IV anesthesia or extractions can cause the development of a sore throat. The throat muscles are near the surgical site, and it can cause pain when these muscles swell. This pain is normal and should subside in 2–3 days. Saltwater gargling can help to reduce the pain.

During the surgery, the corners of the mouth can be stretched – causing them to crack and dry out. This discomfort can be managed by applying lip balm or an ointment (such as Vaseline) to keep the corners of the mouth moist.

Other Complications

• Don’t be alarmed if you notice numbness of the chin, lip, or tongue on the day after the surgery. This was discussed before the surgery, and the numbness is usually temporary. Be careful to avoid biting your lip or tongue when they are numb. When visiting the office for a follow-up appointment, update the doctor about any numbness you are still feeling.
• It is common to experience a slight increase in body temperature following surgery. Our office should be notified if the temperature is higher than 101 degrees Fahrenheit. Anti-inflammatory and narcotic medications help to reduce fever. Low-grade fever could indicate dehydration, so increase the consumption of water and other fluids.
• Some patients feel hard projections in the mouth. These bumps are not roots; they are the adjacent bone that supported the tooth. With time, the projections usually smooth out naturally. When there is a prominent area of bone, avoid touching or playing with it with your tongue (which can make it worse).
• Stiffness in the jaw is common for 5–6 days after surgery. These stiff jaw muscles are normal, and they will relax with time. You can stretch during mealtimes or at bedtime to relieve the stiffness.

Final Notes

Sutures are placed in the tooth sockets to help with healing and minimize postoperative bleeding. Sometimes these sutures become dislodged, which is no cause for alarm. Simply remove the suture from the mouth and discard it. Usually, these sutures are dissolvable and will fall out within 3–7 days after the surgery.

You will notice a cavity where the tooth was removed. The hole will slowly fill in over the next month. It is important to keep the socket clean during this time, especially after eating.

When the blood clot is dislodged from the socket prematurely, a dry socket can occur. This can cause an increase in pain at the surgical site, and patients sometimes experience radiating pain into the ear. Contact the office if the pain doesn’t taper off within 5–6 days after surgery.

Every patient is unique… no two mouths are alike! Your friends might offer well-intended advice, but you should always listen to the recommendations of the doctor.

Drs. Blecha and Jandali and our staff are here to support you in a comfortable, speedy recovery. If any questions or problems arise after surgery, please contact our office for assistance.