After Wisdom Tooth Removal

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

Immediately Following Surgery

• A gauze pad will be placed over the incision sites intraorally. Keep it in place for forty-five (45) minutes after surgery or until it becomes saturated, whichever ​​happens first. 12- 24 hours after surgery, bleeding will slow and eventually stop; you may need to replace the gauze and bite with firm pressure for several cycles before this happens. If additional gauze is needed, it is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning. Minor pink oozing is normal and does NOT require gauze. Once bleeding has stopped, you may remove the gauze indefinitely. 
• Avoid trauma to the surgical area or vigorous mouth washing immediately following surgery. Dislodging the blood clot, a condition known as dry socket, may prolong bleeding and impair healing.
• It is recommended that you do not smoke for the rest of your life. However, PLEASE DO NOT SMOKE for at least 7 to 10 days after surgery, since this is very detrimental to healing and may cause dry socket.
• To help keep you comfortable during recovery, we recommend starting any prescribed pain medication before the numbing medicine 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 only when you feel able.
• Use a cold pack, ice bag or a bag of frozen peas wrapped in a towel and applied firmly to the cheek adjacent to the surgical area.  This should be applied twenty minutes on and twenty minutes off during the first 72 hours (3 days) after surgery. When possible, keep your head elevated, which will also help minimize swelling.  After 72 hours, we recommend applying heat therapy on the cheeks with a gentle massage 3-4 times daily to help further reduce swelling and soreness.

Bleeding

Following surgery, some slight bleeding or red saliva is normal and may continue on and off for 12-24 hours. If you experience excessive bleeding, you may be able to control it by placing fresh gauze over the areas and biting on the gauze for 30-45 minutes at a time. It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning. If bleeding continues, repeat this step, or try biting down on a moist tea bag (soaked in water, squeezed damp and wrapped in a moist gauze) for 20 or 30 minutes. Finally, you can minimize bleeding by resting, elevating your head, and avoiding physical exercise or excitement. If bleeding remains uncontrolled, please call our office. 

Do NOT sleep with gauze in your mouth. Old pillowcases and bedding should be used for the first 2 days following the procedure.

Swelling

Following wisdom teeth removal, you can expect swelling around the mouth, cheeks, and even underneath the eyes. This symptom is the body’s normal response to surgery. Usually, the swelling does not become evident until the day after surgery and will reach its peak on day three. You can control the swelling by continuously using ice packs on the outside of your face over the surgical site while you are awake. The ice packs should be applied twenty minutes on and twenty minutes off during the first 72 hours (3 days) after surgery.  After 72 hours (4th day) after surgery, you may apply warm compresses to the skin over the areas of swelling (hot water bottle, hot moist towels, heating pad) for 20 minutes on and 20 minutes off to help soothe tender areas. Massage your cheek 3-4 times per day to help the swelling subside over the next week.

Your jaw may become stiff following surgery, especially during the second and third days of recovery. Stiffness is a normal response to surgery. Once swelling declines, you may begin daily mouth-opening exercises to regain functional functionality. You may require 3-4 weeks of exercising before returning to normal.

Pain

We recommend beginning any prescribed pain medications before your numbing medicine wears off.

If you experience mild to moderate pain, you may take 1-2 tablets of Acetaminophen (Tylenol® or Extra Strength Tylenol®) every 6 hours.  Ibuprofen (Motrin® or Advil®) can also help control pain, swelling, and inflammation. Ibuprofen generally comes in 200mg tablets; your doctor may suggest a 600mg dosage every 6 hours or an 800mg dosage every 8 hours.

Your doctor may prescribe narcotic pain medications for more severe pain. Narcotic pain medications can cause you to feel groggy, and they may also slow your reflexes. We recommend not driving, operating machinery, or drinking alcohol when taking narcotic pain medicines.  

Following 72 hours after surgery, pain should become less and less pronounced each day. If discomfort persists or intensifies, contact the office.

Antibiotics

Antibiotics can help prevent infection, so take them as directed if they are prescribed for you. If you develop a rash or other adverse reactions, contact our office immediately.

Diet

After anesthesia or IV sedation, you will want to resume your diet with liquids first. Avoid extremely hot foods and/or drinks. Drink from a glass and avoid suction using straws for the first week (7 days) after surgery, (the sucking motion from the straw may dislodge your blood clot and cause more bleeding and dry socket). Once tolerating liquids, you can enjoy soft foods that are easy to clean out of your mouth. It is best to avoid foods like nuts, sunflower seeds, popcorn, etc., which may get lodged in the socket areas. Over the next several days you may gradually progress to solid foods.  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 or follow instructions given by your doctor.

We recommend chewing away from the surgical site when possible.

Seek nourishment regularly, and drink lots of fluids to avoid dehydration. Over the first few days, your food intake may be lower, so compensate by drinking more liquids and protein or nutrition shakes for calories and protein. Aim for a minimum of five to six glasses of liquid daily. 

Exercise

If you feel able, you may return to light cardiovascular activities 3-4 days after surgery. If you exercise regularly or play a sport, be aware that you may not be able to intake your regular food and liquid amounts, and you may need to ease back into those activities slowly. If you become lightheaded, avoid exercising for several more days to give your body more time to recover. We recommend avoiding heavy weightlifting and contact sports for 7-10 days.

Keeping Your Mouth Clean

On the day of your surgery, you may gently brush your teeth at night to keep your mouth as clean as possible, but avoid brushing surgery sites for the first 72 hours after surgery. Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth within the bounds of comfort. Begin rinsing with salt water 3-4 times daily, especially after eating. Use ¼ teaspoon of salt dissolved in a ¼ cup of warm water and gently rinse with portions of the solution, taking five minutes to use the entire amount. DO NOT SPIT; let the salt water solution fall out of your mouth into the sink.

Your surgeon may prescribe a prescription-strength mouthwash and/or salt water rinses.

Discoloration

In addition to swelling, you may experience some slight discoloration or bruising of the skin. Any black, blue, green, or yellow discoloration may be caused by blood spreading beneath the tissues. This bruising is normal and may happen within two to three days of your procedure. A warm compress can help manage this discoloration, but it may take 1-2 weeks to resolve fully.

Nausea and Vomiting

Nausea and vomiting can result from medication intake, stress from surgery, or dehydration. If you experience nausea or vomiting the day after your surgery, begin intake of fluid and foods slowly. Try sipping on ginger ale, tea, or Coke. Sip slowly and take any anti-nausea medication prescribed by your surgeon. You can try eating solid foods and continuing your medications once nausea subsides. Prescribed narcotic medication can worsen nausea, and we recommend having some solid food in your stomach before taking any narcotics.

Sutures

Sutures will minimize bleeding and expedite your healing. They will stay in place and self-dissolve in 3-10 days but may dislodge during the first couple of days. Simply remove the dislodged suture from your mouth and discard it.

Over a month, the cavity where your tooth once stood will fill with tissue and close over. Use saltwater rinses and tooth brushing to keep this area clean, especially following meals, and facilitate cleaning. 

A dry socket occurs when the blood clot gets dislodged prematurely from the tooth socket, causing pain in the mouth or the ear. If this happens, reach out to our office for further guidelines.

Other Complications

• Following surgery, you may notice numbness of the lip, tongue, or chin, which is normal and should prove temporary. However, the numbness may cause you to bite your tongue or lip accidentally, so be extra careful as you eat.
• You may have a slight temperature increase after surgery, which is normal, and you can manage it 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.
• You may feel hard projections in the mouth with the tongue. These are bony walls that support the wisdom teeth, and, most of the time, they smooth out on their own. If they cause an ongoing problem, Dr. Fisher can address them to alleviate your symptoms.
• Use ointments such as Vaseline to keep your lips moist. After surgery, the corners of your mouth might stretch, resulting in dry, cracked lips.
• It is also common to experience a sore throat, especially when swallowing. This symptom results from swelling in the throat muscles and should subside within a couple of days.
• Stiffness in the jaw muscles may cause difficulty opening your mouth for a few weeks after surgery. This stiffness is normal and will resolve on its own. Applying a warm washcloth or heating pad to the cheeks and performing mouth-opening exercises can help facilitate your recovery.