After Wisdom Tooth Removal


The removal of impacted wisdom 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.

Instructions for the First Day of Surgery

Bleeding – In the first hour, bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not controlled. The packs may be gently removed after one hour. If active bleeding persists, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 30 to 45 minutes). It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning. Before getting concerned, remember that the mouth and its wounds are constantly washed by saliva. What may appear to be excessive blood loss is more likely to be a lot of saliva tinged with a small amount of blood. Bleeding is minimized by not spitting, talking or rinsing. Place a bath towel or plastic bag over the pillow, as drooling is likely while sleeping.

**Remember it is normal to have mild oozing for the first 24 hours**

Avoid – To prevent loss of the clot, you should exercise extreme caution and observe the following. Do Not Disturb the surgical area today. Do Not Rinse vigorously or probe the area with any objects or your fingers. Do Not Smoke for at least 48 hours, since it is very detrimental to healing. Do Not Drink through a straw or spit after surgery for 2 weeks. These actions can pull the blood clot out of the hole where the tooth was, that can lead to a dry socket. It is most common when lower back teeth are removed and happens more often in smokers and women who take birth control pills. A sure sign of a dry socket is persistent, acute pain in the jaw.

Oozing – Intermittent bleeding or oozing is normal for as long as 2 weeks following surgery. It may be controlled by placing fresh gauze over the surgical area and biting down firmly for 30-60 minutes. Make sure the gauze is pressing on the surgical site not just between the teeth.

Steady Bleeding – Bleeding should never be severe. If it is, it usually means that the packs are being clenched between your teeth rather than exerting pressure on the surgical areas. Try replacing fresh packs. If bleeding persists or becomes heavy, you may substitute a tea bag (soaked in cold water, squeezed damp-dry and wrapped in moist gauze) for 60 minutes. If bleeding remains uncontrolled, please call our office.

Swelling – Often there is some swelling associated with oral surgery. Severe cheek swelling is also normal following this procedure. You can minimize swelling by using a cold pack or ice bag wrapped in a towel, and apply firmly to face or cheeks adjacent to the surgical area. This should be applied 20 minutes on and 20 minutes off during the first 72 hours after surgery. After 72 hours, if the swelling is decreasing, it is best to switch from ice to moist heat, otherwise continue ice. Remember most swelling occurs on the second and third days after surgery.

Pain – Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first pill before the anesthetic has worn off, you should be able to better manage post-operative pain. If you do not achieve adequate relief at first with the non-narcotic pain medications, you may supplement with the narcotic medication. Some patients find that narcotic pain medicine causes nausea, but if you precede each pain pill with a small amount of food, chances for nausea will be reduced. The effects of pain medications vary widely among individuals. Alternating medications is typically more effective than taking both at the same time. Make sure to take prescribed pain medication as directed. Do not drive an automobile or operate heavy machinery while taking narcotic medications. No alcoholic beverages should be consumed while taking these medications.

Nausea and Vomiting – Nausea is not an uncommon event after surgery. 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 coke, 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. Call us if you do not feel better or if repeated vomiting is a problem.

Diet – Please avoid hot liquids or foods during the first 2 days. A light soft diet with plenty of liquids is recommended. Examples include apple sauce, yogurt, cereals, milk shakes, ice cream, mashed potatoes, pasta and fish. Chew food on the opposite side of the surgical area if possible. Be sure to drink plenty of water (8 glasses/day). Avoid foods like nuts, sunflower seeds, popcorn, etc. that may get lodged in the socket areas. Over the next several days, you can progress to solid foods at your own pace. 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 diabetic, maintain your normal eating habits as much as possible and follow instructions from your doctor regarding your insulin schedule.

Instructions for the Second and Third Days

Oral Hygiene – Keeping your teeth clean after surgery is essential. Do not brush the teeth in the extraction area for 1 week, but do start to gently rinse as directed after 24 hours. Continue to brush and floss as usual outside the surgical area. A glass of warm water mixed with 1 teaspoon of salt is a good rinse for healing. You can do this every 3-4 hours, especially after meals. The cleaner you keep the surgical area, the faster it will heal. Do not use mouthwash for 2 weeks.

Warm Applications – If swelling is decreasing after 72 hours, you may apply warm compresses. Apply compresses to the skin overlying areas of swelling (hot water bottle, moist hot towels, heating pad) for 20 minutes on and 20 minutes off to help soothe those tender areas.

Dry Socket – Occasionally this occurs after a tooth extraction, and results from the blood clot not forming properly during the healing time, leaving the tooth socket exposed. A Dry Socket can be painful and typically develops 4-5 days after tooth extraction. Dry socket can be treated by Dr. Farren. This can be done by cleaning the tooth socket, removing any debris from the hole, and filling the socket with a medicated dressing or special paste to relieve discomfort. You may have to come back to the office every 1-2 days for a dressing change until the socket starts to heal and your pain lessens.

Rest – Sleep works wonders for the body, so take it easy for the rest of the day. Go to bed earlier than usual with your head slightly elevated.

Exercise – Limited activity for the first 3-4 days is recommended. Normal activity can be resumed after the first 3-4 days, avoiding any strenuous physical activity for the rest of the first week (exercise, sports, heavy lifting, etc.).

Healing – 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. Follow oral the hygiene instructions detailed above.

Other Complications
• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in your consultation, 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. Call Dr. Farren if you have any questions.
• 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 low blood sugar or medications. Before standing up, you should sit for one minute before getting up.
• Occasionally, patients may feel hard projections in the mouth 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. Farren.
• 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 throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 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.
• Bruising may develop. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Finally – 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, (518) 682-6400.