After Wisdom Tooth Removal

Post-Operative Instructions (wisdom teeth & multiple extractions)

 Your post surgical care has an important effect on your healing.  While a certain amount of discomfort, swelling and restricted jaw function is normal and expected, following these instructions can help minimize these occurrences.


DAY ONE:  THE DAY OF SURGERY

Hemorrhage Control: It is normal to have some post operative bleeding for about twenty four hours after surgery.  However, after the first two to three hours, this bleeding should be mainly light “oozing”.  IT IS NOT NORMAL TO HAVE TWENTY FOUR HOURS OF BLEEDING AS IF YOU HAVE BEEN CUT.  If your bleeding continues at the same rate as it was directly after surgery and you have followed the instructions below YOU SHOULD CONTACT DR. CLINE AT 430-9910.

1.)    Place the gauze directly over the surgical sites as demonstrated in the office and gently close your teeth together maintaining light, but continuous pressure on the gauze.  It is suggested you do this using a mirror or with the help of someone while numb to ensure the gauze is in the correct position AND that you do not bite yourself.

               

2.)    When the gauze over your surgical site becomes saturated (soggy) it is time to change it.  This may take only 10-15 minutes with the first piece of gauze you use.  As the bleeding slows, you will notice that it will take longer periods of time for the gauze to become saturated with blood.  After about two hours, you will find that the gauze will be saturated mainly by saliva with an area or “spot” more lightly saturated by blood.

 

3.)    The gauze may be lightly moistened with water in the area that contacts just over the extraction site.  This prevents the developing blood clot from sticking to the gauze and becoming displaced when you remove the gauze to change it.  Displacement of the clot while changing the gauze can result in prolonged bleeding.  This is why we recommend you only change the gauze when it is fully saturated.  If it is rather dry and you need to remove it, you can take a small sip of water to moisten it before removal.

 

4.)    Keep your head elevated above your heart with pillows while in bed, or use a reclining chair the first twenty four hours after surgery.

 

5.)    Remove the gauze to eat.

 

6.)   REMOVE THE GAUZE WHILE SLEEPING TO PREVENT ACCIDENTAL AIRWAY OBSTRUCTION!

 

7.)    Do not rinse your mouth or spit the first twenty-four hours after your surgery.  The forming blood clot is somewhat fragile during this time and these activities can dislodge the clot, resulting in prolonged or break-through bleeding. You should also refrain from using a straw for the first 3 days to help protect the blood clot from being dislodged and developing a “dry socket”.

 

8.)    Do not smoke ANYTHING (except salmon…just checking to see if you are reading carefully) the first three days after surgery.  This can prolong your bleeding and interfere with healing.

Oral Hygiene:

1.)    Please do not rinse, spit or use any devises to clean the surgical sites the day of surgery.  You will be a bit of a “yuck-mouth” the first twenty-four hours after your surgery while you are concentrating your efforts on developing a healthy post-operative blood clot in the surgical sites.  Don’t worry (be happy), you will get further oral hygiene instructions to begin the day after surgery later in this information.

 

2.)    If you were prescribed antibiotic medication please take it as directed.  If you develop itching, hives, a rash, nausea or vomiting discontinue all medications and contact the office immediately.



Pain Control:

 

1.)    Dr. Cline highly recommends Ibuprofen (generic Advil) in doses of 600 mg every four hours (three “over the counter” tablets) the first three days after surgery regardless if there is pain or not.  Ibuprofen suppresses the production of prostaglandins (a natural substance your body releases after tissue injury that increases swelling and painful nerve transmission).  

 

THOSE ALLERGIC TO IBUPROFEN SHOULD NOT FOLLOW THIS PROTOCOL!

 

2.)    You may have been provided with a prescription strength pain reliever in the event you need more relief than the Ibuprofen provides.  Take it as directed.  Ideally, you should pick up this medication before the day of your surgery so it is available for you to take as soon as you return home after surgery while your mouth is still numb.  As soon as you get home you should:

a.       Remove your gauze and eat something soft and cold (see dietary instructions) and then….
b.       Wait about fifteen minutes after eating and then take the first dose of your pain reliever while your mouth is still numb so it will be working in your system by the time the numbness wears off.

This assists you in “staying ahead” of the pain cycle and results in the use of less post operative medication to remain comfortable.  If you wait until you feel discomfort before taking your first dose of your pain reliever, you may have to wait 30 to 45 minutes before you start to get relief.

3.)    If you develop a rash, hives, itching, nausea or vomiting discontinue all medication and contact the office immediately.  Most patients experience the most intense discomfort the third to fourth day after surgery.  This is mainly the result of two simultaneously occurring events.
a.       Peak prostaglandin production (which can be reduced by the use of Ibuprofen as previously described)
b.       Peak post operative swelling (which can be reduced by the use of cold/ice packs the first twenty four hours after surgery as described in the next section of these instructions)

The more you exert yourself the first two days after surgery, the more discomfort you will experience the third and fourth days after surgery…

            So Take It Easy!

 

DO NOT DRIVE A MOTOR VEHICLE OR OPERATE MECHANICAL EQUIPMENT AFTER TAKING PAIN MEDICATION CONTAINING CODEINE OR OTHER RELATED NARCOTIC PRODUCTS.  MANY PRESCRIPTION STRENGTH MEDICATIONS CAN RESULT IN RESPIRATORY DEPRESSION.  TAKE ALL MEDICATIONS ONLY AS DIRECTED.  IMMEDIATELY DISCONTINUE ALL MEDICATIONS AND CONTACT THE OFFICE IF YOU EXPERIENCE ANY BREATHING DIFFICULTY!


Swelling Control:
 

1.)    The application of cold/ice packs to the outside of your face to the area corresponding to the surgical site the first twenty four hours after surgery is the best way to reduce post operative swelling and the resulting discomfort.  Most swelling peaks about the third/fourth day after surgery.  The more cold you apply directly after surgery (the first twenty four hours) the smaller the peak of swelling will be on the third/ fourth post-operative days AS WELL AS the more reduced the resultant peak discomfort. 

·         If you fail to use cold/ice packs during the first twenty four hours after surgery you lose your window of opportunity for this therapy to reduce the swelling and discomfort that can peak around day 3 or 4.

 

2.)    Cold/ice packs should be applied in cycles of 20 minutes on the face/20 minutes off the face for the first twenty four hours after surgery.

 

3.)    Dr. Cline recommends cutting a leg off a pair of nylons or tights and placing your cold packs inside the leg of this stretchy material.  You can then place the cold packs directly over the requited area of the face and tie the legging on top of your head to secure the packs in this position freeing your hands (visualize those old fashioned cartoon characters with a head wrap after a tooth ache).

 

4.)    We will provide cold packs for you to use immediately after surgery while you are in our recovery suite.  These are disposable cold packs that do not re-freeze well, so you will want to have additional cold packs ready for use at home as the ones from our office will likely be warm by the time you arrive home.

 

5.)    There are a large number of cold packs available from local pharmacies and retail stores.  We have found that small bags of frozen peas or corn work just as effectively and are more cost effective and less damaging to the environment.


Diet:
   A soft, cold diet is recommended the day of surgery.  Keep your diet room temperature or colder the first twenty four hours after surgery, as warmer foods can increase your bleeding.  Good post- operative foods to consider during this time include apple sauce, yogurt, pudding, ice cream and smoothies.  Be sure to get adequate hydration as this helps decrease the incidence of post operative nausea and weakness.

1.)    DO NOT USE A STRAW for a couple of days ( at least 3 days is best) after surgery as this can contribute to blood clot displacement and prolong your bleeding or develop a “dry socket”.

2.)    ABSOLUTELY NO nuts, seeds, chips or popcorn until after your post operative evaluation (in about seven days). If these happen to be some of your favorite foods, have a “crunchy dinner party” the night before your surgery to get your fill, as these food items are strictly “off-limits” until your post operative evaluation.


Nausea:
  A small amount of carbonated beverage every 5 to 6 hours can reduce the occurrence of post operative nausea.  Some patients just have very sensitive systems and experience nausea or vomiting with almost any kind of pain reliever.  Please inform us in advance if you know this to be your case.  There are medications that are very effective at preventing nausea and terminating vomiting.  Dr. Cline would be happy to provide you with a post operative prescription.

1.)    Please avoid foods high in acid (i.e. orange juice, grapefruit juice, cranberry juice, lemon juice, etc.) as they contribute to nausea (apple and white grape are good examples of fruit juices with lower citric acid content).


2.)   
Dehydration is another source of post operative nausea.  Even if you don’t feel hungry or thirsty, please be sure to drink the equivalent of half a cup (4 oz.) of fluid an hour.  The pre-operative fasting state of many patients, in combination with reduced post-operative oral intake can increase the risk of dehydration, especially for small children, petite patients and the elderly.


DAY TWO:   THE DAYS AFTER SURGERY

Oral Hygiene:

·         The morning after surgery you may resume brushing your teeth.  The soft-headed Nimbus toothbrush in your take-home bag is designed to be used directly after surgery.

o   Brush all of your teeth, but carefully avoid the surgical sites.


·        
Beginning the day after surgery, you should begin rinsing your mouth with warm salt water (8 oz warm water + 1 tsp salt) after all oral intake.  You should continue rinsing in this fashion until your post operative evaluation.

Discoloration:

·         In some cases, discoloration of the skin follows swelling.  The development of blue, purple, green or yellow discoloration is due to bruising (blood cells in the tissues).  This is a normal post operative occurrence and usually occurs two to three days after surgery.  Warm moist heat applied to the area assists in the resolution of discoloration, as well as relieving muscle stiffness.

 

Muscle Stiffness:

·         Muscle stiffness is a common post-operative experience.  Most patients experience limited mouth opening for about 10-14 days. 

o   Heat applied to the jaw muscles (temple, angle of the lower jaw, cheek area) helps soothe stiff, sore muscles.

§  Place a moist face cloth in the microwave for 10-15 seconds. Once it is cool enough to handle place it in a zip-lock bag and you have a very affordable heat pack.

§  Hand or foot warmers like those utilized by skiers/snow-boarders work well also.


·   
We discourage stretching your jaw muscles until after your post-operative evaluation, as it is very uncomfortable, and doesn’t result in much increase in the amount you can open your mouth until the pot-operative inflammatory response has resolved (7-10 days).

o   If needed, Dr. Cline will prescribe the appropriate post-operative stretch and exercise routine at your post operative evaluation.


Nausea & Vomiting:
  The tendency for nausea or vomiting after surgery is variable for everyone.  If  you experience nausea 36 hours or later after your surgery, the most common cause is the post- operative medication (pain relievers are the number one cause, followed by antibiotics).  If you have late onset post-operative nausea and/or vomiting:

·         Rinse your mouth and use gauze to stop any residual bleeding you may experience

·         Sip a small amount of  soda (non-diet) very slowly over a 15 minute period

o   When nausea subsides you may resume eating solid foods

·         If your nausea and/or vomiting is persistent please call the office for instructions

Sutures:  Sutures may have been placed in the area of surgery to minimize post-operative bleeding and to help healing. 

                      
·    Due to the dissolving nature of these sutures, they may become dislodged while changing your guaze or eating. This is no cause for alarm.                      

                        
·      If a suture comes untied and is “dangling” in your mouth you may remove it with gentle finger pressure (clean hands, please).

I
n General: 

       ·         Swelling and tenderness usually peak on the evening of the third – the morning of the fourth post operative day.  After this, they both should resolve more and more each day. 

       ·         There will be a cavity (opening) where the tooth/teeth were removed.  This will gradually fill in with soft tissue (from the bottom to the top) over the next 3-4 weeks.  In the mean time, the area should be kept clean with tooth brushing, rinsing and irrigation (as instructed at your post operative evaluation).

       ·         If you are involved with regular exercise, be aware that your normal nourishment intake may be reduced.  In addition, healing requires energy.  Your regular exercise routine may weaken you, resulting in light headedness or overly fatigue you.  If you experience these conditions, stop exercising.  Consider gradually easing into your regular routine.

       ·         “Dry Socket” occurs when the blood clot has been prematurely dislodged from the socket before the soft tissue has fully lined the internal bony architecture.  Signs and symptoms include:

                   o Intense pain from the surgical site that radiates to the ear and along the entire jaw               
                  
                   
§  This pain is intense enough to wake you up at night out of a sound sleep

                   
§  This pain is not relieved by pain relievers (either prescribed or over the counter

                  
o   If you think you may be experiencing dry socket please call the office.  There is topical  socket medication that can be placed to treat this condition (there is no reason to suffer).

 
Your case is individual. No two mouths are exactly alike.  Please do not follow well intended advice from friends if it contradicts the instructions you have received from our office.  If you have a question, please discuss your concern with those most familiar with your particular case and best able to effectively help you:  Dr. Cline and her clinical team.

Other Conditions:

·         If numbness of the lip, chin, teeth, gums or tongue occurs, there is no cause for alarm.  As mentioned at your consultation visit, this is usually temporary in nature.  Please be sure to report this condition to Dr. Cline at your post operative evaluation.

·         A slight elevation in temperature the first three days following surgery is not uncommon.  If the increase persists or reaches higher than 101ºF, please notify the office.  350 mg of Tylenol taken every 6 hours can be used to “break” the fever.

·         You should avoid rapidly moving from lying down to a sitting or standing position.  You may be slightly dehydrated after surgery (especially if you have had limited fluid intake or experienced vomiting).  In addition, some pain relievers can make you feel dizzy or “light headed”.  Sudden changes from flat to upright position can result in fainting, falling or “head rush”.  Before rising, you should slowly sit up and remain sitting 20-30 seconds before standing.

·         Occasionally, patients may feel hard projections in their mouth near or at the surgical site with their tongue.  These are not “left over roots”, but the bony walls of the socket and/or supporting alveolar bone.  These projections usually smooth over spontaneously.  If this does not seem to be the case, please mention them at your post operative evaluation.

·         The corners of your mouth may be stretched during surgery resulting in a chapping or cracking.  Keep your lips moist with a non-petroleum lip moisturizer (there is a small one in your take home bag for just this purpose).

·         Sore throat or pain on swallowing the first few days after surgery is not uncommon.  A sore throat is usually due to the dryness of your throat during surgery.  Muscle soreness experienced during swallowing is usually due to the protective retraction of the tongue away from the surgical sites during your procedure.  As tongue size and strength (it’s a strong muscle) varies from individual to individual, the occurrence of post-operative tenderness during swallowing is highly variable.  The good news is that is usually resolves spontaneously within three to four days.

 

 

 

* Call our office if you have any questions or concerns at 831-430-9910