The removal of impacted teeth is an invasive 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.
Immediately Following Surgery:
The gauze pad placed over the surgical area is designed to enable you to keep pressure on the surgical site to prevent bleeding. If you are not actively bleeding the gauze is not necessary. Once you leave the office, if bleeding is still present, the gauze should be kept in place for 20 minutes with biting pressure on the extraction sites. If you are sleeping, while the gauze will still absorb oozing, the lack of pressure will likely not assist much with oozing control. After use, the gauze pad should be removed and discarded. We ask that after the gauze is removed to immediately start cold fluids to stop the bleeding.
No mouth rinsing or touching the wound area following surgery. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
Take the prescribed pain medication before you begin to feel discomfort. This will usually coincide with the return of sensation in your mouth, as the local anesthetic wears off. In the lower jaw, the return of sensation may not occur until that evening.
Restrict your activities the day of surgery regardless of how you feel and resume normal activity when you feel comfortable. You may have been instructed to place ice packs to the sides of your face where surgery was performed. Refer to section on swelling for explanation.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a tea bag over the area and biting for 30 minutes. The tannic acid in the tea bag may help to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. Remember, pushing very cold fluids will also help the clot to seal and the bleeding to subside. If bleeding does not subside, please call to discuss how to proceed.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to inflammation and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days after the surgery. Therefore it is normal and expected to be more swollen the second postoperative day than the first. You may have been instructed to use ice packs following your surgery. The ice packs should be placed 20 – 30 minutes on and 20 minutes off for the first 24 hours following your surgery. After 24 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. 48 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
For severe pain, take the tablets prescribed as directed. If you have been prescribed a narcotic pain medication, it likely also contains Tylenol and thus should not be mixed with additional Tylenol doses. With rare exceptions, Advil may be taken along with your prescribed medication. If you have been prescribed an anti-inflammatory medication along with your narcotic, you should not add further such medication (i.e. Motrin, Ibuprofen, etc.) The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.
After I.V. sedation, cold liquids should be initially taken. Do not use straws. Do drink from a glass. The sucking motion of a straw can cause more bleeding by dislodging the blood clot. You may eat anything soft and cold by chewing away from the surgical sites, but will need to wait 2 hours before doing so to see how you are handling the fluids. High calorie, high protein intake is very important. No carbonated water, i.e. sodas for 24 hours (may resume next day). Nourishment should be taken regularly. You should prevent dehydration by drinking cold fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. A soft and cold diet is required for the first 24 hours; you may eat/drink warm/hot food the next day. 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.
Keep the mouth clean
No rinsing or brushing of any kind should be performed until the day following surgery. You can brush your teeth the morning of surgery prior to coming in. The day after surgery you should begin rinsing at least 3 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt. If Peridex, a prescription mouth rinse, is prescribed, start it the next day for 5 more days.
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissue. 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.
If you have been prescribed antibiotics, take the tablets or liquid as directed. Antibiotics may 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 Sprite, tea, or ginger ale. You should sip slowly over a fifteen-minute period. Stay lying down. Avoid excessive movement and NO MILK PRODUCTS. When the nausea subsides you can begin taking solid foods and the prescribed medicine. If this is not successful please call the office for assistance.
If numbness of the lip, chin, or tongue occurs there is no cause for alarm. 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 your Doctor if you have any questions. Slight elevation of temperature immediately following surgery is not uncommon. If the temperature and numbness persist, notify the office.
Occasionally, patients may feel hard projections in the mouth with their tongue and mistake them as being roots. They are actually the bony walls that supported the tooth. These projections usually smooth out spontaneously, with the help of brushing over the area and doing the salt water rinses. If they do not, they can be smoothed by your 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 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 normal post-operative event that will resolve in time.
Further General Considerations
Sutures are sometimes placed in the area of surgery to minimize post-operative bleeding and to help healing. They are restorable and will become dislodged; this is no cause for alarm. Just remove the sutures from your mouth and discard it.
The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or any unusual symptoms occur call our office for instructions.
There will be a space where the tooth was removed. The space will gradually, over the next few months, fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with saltwater rinses or a toothbrush.
Every case is individual and no two mouths are alike. Therefore, do not accept advice from friends. Discuss your problem with 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 2-3 days following surgery. Call the office if this occurs. We can help.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.