Home Care After Oral Surgery

Postoperative care is very important. Unnecessary pain and and/or swelling can be minimized if the instructions are followed carefully. Printed instructions were given to you (or the person that came with you) at the time of discharge from our office. The material in that printed brochure was reviewed verbally with you and/or the person who came with you. The printed brochure has your postoperative appointment date and time on the back of that brochure. The material in the brochure is listed below.

Immediately Following Oral Surgery

The gauze pad placed over the surgery areas should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded. This procedure can be repeated every half hour until there is no active bleeding-please see section on bleeding below. The patient should NOT sleep with gauze in their mouth.

Vigorous mouth rinsing or touching the surgery 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.

Take any prescribed antibiotic medication as directed and written on the bottle.

Restrict your activities the day of wisdom tooth removal and resume normal activity when you feel comfortable.

Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.

Bleeding

A certain amount of bleeding is to be expected following wisdom tooth removal. 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 gauze pad over the area and biting firmly for 30 minutes. You may have to do this several times. Often times the gauze will act as a wick and be blood tinged or soaked when removed from the mouth. This wicking can last for 24 hrs. or more. This is not unusual and does not constitute active bleeding. If you look at the surgery site(s) and don’t see blood dripping like a slow faucet from the upper sockets or welling up to the naked eye from the lower sockets, there is usually not a problem. If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call our office for further instructions. If after hours or the weekend, please call our office  and listen to the prompts to reach the on call doctor.

Swelling

The swelling that is normally expected is usually proportional to the degree of surgery done. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will be maximum three to four days after surgery. The swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice, ice packs, or bags of frozen vegetables should be applied to the sides of the face where wisdom tooth removal or oral surgery was performed. The ice packs should be left on continuously, as much as possible, while you are awake. After 24 hours, ice has no beneficial effect. The second to third day, the application of warm moist heat (hot water bottle or hot towel) to the sides of the face is beneficial in reducing the size of the swelling. This can be applied 30 minutes on and 30 minutes off while awake.

Pain

For moderate pain following wisdom tooth removal, Ibuprofen, (Motrin or Advil) two to four 200 mg tablets may be taken every six to eight hours as needed. Do not take Ibuprofen, (Motrin or Advil), Naprosyn or Aspirin if you are taking Coumadin, Warfarin, Pradaxa, or any other blood thinner as this could cause increased bleeding. Some patients will only need Tylenol or Extra Strength Tylenol for pain from surgery.

For severe pain, take the pain medication prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery while taking narcotic pain medication. Avoid alcoholic beverages or other sedatives while taking narcotics, as the combination can be dangerous and life threatening. Pain or discomfort following oral surgery should peak on third to fourth day after surgery and then start to subside. Pain is subjective and patients will respond differently to pain from a procedure. Most prescribed narcotic pain medication has Acetaminophen (Tylenol) mixed in with the narcotic. DO NOT take additional Tylenol with the prescribed medication. You can take Ibuprofen (Motrin, Advil) or Naprosyn simultaneously with taking the prescribed narcotic. This will be reviewed with you and the driver or person who brought you to the office at the time of discharge.

Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take them.

Diet

Drink liquids after general anesthesia or IV sedation for wisdom tooth removal/oral surgery. Do not use straws when drinking 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 site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. You should try to prevent dehydration by taking 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 five to six glasses of liquid should be taken 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 quickly from a lying position, you may become dizzy. If you are lying down following wisdom tooth removal/ oral surgery, make sure you sit up for one to two minutes before standing.

Oral Hygiene

Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after wisdom tooth removal. Brush your teeth as best you can. Rinse with warm salt water (one teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete. A clean wound heals better and faster.

Discoloration

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 tissues. This is a normal following wisdom tooth removal and other oral surgery. This may occur two to four days post-operatively. Warm moist heat (hot water bottle or hot towel) applied to the area, the second day after surgery, may speed up the removal of the discoloration. This can be applied 30 minutes on and 30 minutes off while awake and can be continued until all the discoloration is gone.

Antibiotics

If you have been placed on antibiotics after wisdom tooth removal or oral surgery, take the tablets or liquid as directed and printed on the bottle. Antibiotics are 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. If you are taking birth control pills while taking antibiotics, the antibiotics may negate the effects of the birth control pill.

Nausea & Vomiting

Nausea and/or vomiting following wisdom tooth removal or oral surgery can occur. If you experience nausea or vomiting, try to stay on clear liquids, water, 7-Up or ginger ale until the nausea is gone. This could be up until the day after your surgery. Nausea usually passes during the first 24 hours if it occurs. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. If nausea is severe, you may call the office or the on call doctor for further advice.

Other Complications/Problems Postoperatively

If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As discussed at 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. If this is the case, please be careful. Call our office if you have any questions.

You should be careful going from the lying down position to standing up quickly. You were not able to eat or drink prior to oral surgery if you had an IV anesthetic. Taking pain medications (Narcotics) can make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit for one to two minutes and then get up slowly. It is best if someone is with you the first 24 hours after surgery to help you if you feel weak, nauseous, or dizzy.

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 over 6-8 weeks.

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 or Chapstick.

Sore throats and pain when swallowing are not uncommon. The normal act of swallowing can then become painful as this is close to the surgical areas and where injections of local anesthesia may have been given. This usually will subside in three to seven days.

Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following wisdom tooth removal and other oral surgery. This is a normal post-operative event that will resolve in time. You can use warm moist heat (30 minutes on and 30 minutes off- while awake) starting the second day after surgery. This will help relax the muscles of the face and allow active stretching to help increase opening.

Finally

Dissolving sutures are placed in the area of area oral surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. If a suture comes loose, remove the suture from your mouth and discard it. The sutures dissolve themselves in most cases in approximately one week after wisdom tooth removal or other oral surgery. Rarely, non-resorbable sutures are used and these will need to be removed. The removal of sutures requires no anesthesia or needles. It takes only a few minutes and there is no discomfort associated with this procedure.

There will be a cavity where the wisdom tooth was removed. The cavity or bony hole will gradually fill in with new tissue over the next 6-8 weeks. In the meantime, the area should be kept clean especially after meals by using salt-water rinses and a soft toothbrush. Dr. Rotas will show you how to better keep these areas clean at the post surgery visit, usually scheduled for a week after your surgery. At that time you will be given a small irrigating syringe and instructions on how to keep the sockets clean for healing without a problem.

Brushing your teeth is okay- just be gentle at the surgery sites.

A dry socket is when the blood clot gets dislodged prematurely from the wisdom tooth socket. Symptoms of a dry socket are increasing pain at the surgery site (and pain to the ear) a week following wisdom tooth removal when you feel you were getting better. Patients at higher risk for dry socket are females more than males, smokers and patients taking birth control medication. Dry sockets are not that common. Pain from oral surgery peaks 2nd to 4th day after surgery and is normal. This is usually not a dry socket.

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.

Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you, Dr. Rotas and his staff, or your family dentist.