The removal of impacted teeth is a serious 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. After surgery, you will be given home care instructions (written), as well as a prescription, and a packet of gauze
Immediately Following Surgery:
The gauze pad placed over the surgical area should be kept in place for an hour or two. After this time, the gauze pad should be removed and discarded. Replace the gauze pads as required. Try not to chew on the gauze. Steady pressure gives the best results.
Vigorous mouth rinsing, using straws, or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged. You may begin gentle rinsing with water or mouthwashes after 24 hours.
Unless you have received different instructions from the doctor, take 2-3 tablets of ibuprofen 200mg (Advil, Motrin IB) every 4-6 hours.
Restrict your activities the day of surgery (rest and keep your head up) 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 explanation.
Do not drive the day of surgery if you had an IV anesthetic.
Do not smoke for at least 5 days following surgery. See your doctor about a nicotine patch if needed. Smoking is a primary cause of dry sockets and post-operative healing complications.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon for the first 24-36 hours. Excessive bleeding may be controlled by wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for 1 hour. Repeat if necessary. If bleeding continues, bite on a moistened tea bag wrapped in a piece of gauze for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, try not to become agitated, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions. It is normal to have blood tinged (red) saliva (spit) for a few days after your extractions.
Swelling is the first stage of healing.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 surgery and eventual repair. The swelling will sometimes not become apparent until the morning following surgery and will not reach its maximum until about 2 days post-operatively. Expect swelling to last anywhere from 3 to 6 days. Swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be applied 20 minutes on and 20 minutes off while you are awake. After 36 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. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. Swelling that reoccurs several days after the initial swelling goes down could be a sign of an infection. If this occurs, call our office.
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or
Ibuprofen, (Motrin or Advil) 2 or 3 200 mg tablets may be taken every 3-4 hours.
If you find that Tylenol or ibuprofen is not controlling your pain well enough, you should take the prescription pain medication. Think of the narcotic prescription medication as an ‘as needed’ medication. The prescribed pain medicine could make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery while taking the prescription narcotics. Additionally, narcotic medications can cause nausea or vomiting. Avoid alcoholic beverages.
Make sure that you take your Tylenol or ibuprofen medication regularly for the first few days to stay ahead of the pain. If your pain increases after the first 4 or 5 days, then please contact our office.
After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot leading to what is known at the ‘dry socket’. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should 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 5-6 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 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 of any kind should be performed until 24 hours following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt. Your doctor may have prescribed a mouthwash for you (Peridex). If so, rinse with the prescription mouthwash twice per day in addition.
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 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 needed antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Unless you have any reactions or are directed to stop by a doctor, antibiotics should be taken as directed until they are gone. 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 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. Nausea is often the result of low blood pressure, low blood sugar, narcotic use, and sometimes swallowing some blood from the surgery. Nausea that persists longer than 24 hour usually requires treatment, and you should contact our office should this occur.
The Dry Socket
And finally, a dry socket is when the blood clot gets dislodged prematurely or dissolves from the tooth socket. Food and debris could then get into the socket. Symptoms of pain at the surgical site and even pain to the ear may occur in the next 2 or 3 day. It is also not unusual for there to be a foul odor, or bad taste associated the pain. A dry socket is not an infection, but will require treatment. Dry sockets occur most often in the lower jaw and are usually associated with removal of the molar teeth. Stitches, which are usually placed after the removal of an impacted tooth, do not prevent dry sockets. Women taking birth control pills and smokers are more prone to dry sockets. Call the office if you believe you are developing a dry socket.
Common sense is probably the single most important element in successful healing. Don’t be afraid to call our office and speak to our triage coordinator for post-operative care. You aren’t expected to know everything about having teeth removed and we are happy to help you