After Wisdom Tooth Removal
Advice From Thomas Peltzer, DMD
The removal of impacted teeth is a significant and very common surgical procedure performed by Dr. Thomas Peltzer in CT. My oral surgery training and 30 years of experience in removing impacted wisdom teeth has taught me a few things. 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 should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded. Repeat application of gauze packs as necessary until bleeding subsides.
- Vigorous mouth rinsing 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.
- Take the prescribed pain medications before you begin to feel discomfort. This will start working before you become uncomfortable due to the local anesthetic becoming diminished. It’s far easier to prevent surgical discomfort before it begins than to try and play “catch up” by taking your pain medication after the local anesthetic (novocaine) has worn off.
- Dr. Peltzer frequently also prescribes a prednisone regimen known as Medrol dose pack for several days following removal of impacted wisdom teeth to minimize swelling and inflammation. These are two of the most common causes of pain following wisdom teeth surgery.
- They can be minimized with a gradually tapering dose of prednisone Dr. Peltzer will prescribe for you via the Medrol dose pack.
- Restrict your activities the day of surgery 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.
A certain amount of bleeding is to be expected following surgery. Some bleeding is not uncommon and occurs in the first 12-24 hours, often related to the extent of surgery and your medical history. 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. Repeat if necessary. 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, do sit upright, and avoid exercise. If bleeding does not subside, call Gentle Dental Care for further instructions.
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 not become apparent until the day following surgery and will not reach its maximum until two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously at twenty minute intervals 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. Forty-eight hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
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) two to four 200 mg tablets may be taken every three to four hours. Again, be sure to take your pain medicine before the local anesthetic has worn off. Recent information presented at the American Dental Society of Anesthesiology Session in Chicago in December 2011 revealed the importance of taking your pain medicine immediately following surgery while you are still numb for maximum effectiveness.
For severe pain, take the prescribed pain medication as directed. Narcotic pain medicine may 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.
Drink liquids after surgery with IV sedation dentistry. 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 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.
Words to the Wise: If you suddenly sit up or stand from a lying position, you may become dizzy. This is a normal response to the medications administered to you during dental sedation and no cause for alarm. If you are lying down following surgery, make sure you sit for one minute before standing.
Keep The Mouth Clean
Only very gentle rinsing should be performed until the day following surgery. You can brush your teeth gently the night of surgery but rinse very gently. You will notice some bleeding. Do not worry as your sutures will prevent you from causing any problems. The day after surgery you should begin rinsing at least five to six times a day with a cup of warm water mixed with a teaspoon of salt, especially after eating.
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 postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration. Don’t worry, this is normal and the slight discoloration will clear up before you know it.
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent or to treat infection. Dr. Peltzer will decide if antibiotics are beneficial for your particular case. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and immediately notify the office. Call the office if you have any questions.
Nausea & 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 Coke, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. Notify the office if vomiting does not resolve.
Dr. Peltzer may decide to prescribe oral tablets known as Zofran, that have anti nausea effects which will allow you to more comfortably take your pain medication or antibiotic. Try not to take these medications on an empty stomach.
- If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, 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 Dr. Peltzer if you have any questions.
- A 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 if you were instructed not able to eat or drink prior to surgery in preparation for dental anesthesia. It may have been difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and then get 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. Trust your body. It knows how to heal correctly. Patience is important. If the hard projections persist, Dr. Peltzer can easily remove them later.
- 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 very common. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in two to three 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 that will resolve. Your body simply requires time to heal.
Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth gently and discard it. The sutures will be removed approximately one week after surgery. Usually Dr. Peltzer uses self absorbing sutures designed to dissolve on their own.
The removal of sutures, if needed, requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about. The nature of your particular surgery will allow Dr. Peltzer to decide which type of sutures to use, if any, and how long they will require to dissolve.
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 the office for instructions.
There will be an opening where the tooth was removed. The space will gradually fill in with new tissue over the subsequent months. In the meantime, the area should be kept clean especially after meals with salt-water rinses or a toothbrush.
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. Peltzer is most familiar with your specific circumstances.
Brushing your teeth is okay – just be gentle and avoid the direct 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 radiating to the ear may occur two to seven days following surgery. Call the office if this occurs. Medication can easily be placed into the tooth socket to relieve the discomfort.
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.
You have just experienced surgery, it’s over and you have healed beautifully. Now you never need worry about problems that retained wisdom teeth frequently cause those who delay surgery until they are older and then they are more prone to post surgical difficulties.
Visit us at www.ConnecticutSedation Dentist.com or call 860-747-5711 in CT. Dr Peltzer is a member of the prestigious American Society of Dentist Anesthesiologists (ASDA) and the American Dental Society of Anesthesiology.