Robert Bryan Roach, J.R. D.D.S.
Diplomate of the American Board of Oral and Maxillofacial Surgery

1202 E. Sonterra Blvd. Suite 801 San Antonio, TX 78258
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Surgical Instructions

After Wisdom Tooth Removal

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.

Immediately Following Surgery

  • The gauze pad placed over the surgical area should be kept in place for one hour. After this time, the gauze pad should be removed and discarded.
  • 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 as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
  • 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 explanation.

Bleeding

Bleeding is to be expected in variable amounts for several hours and oozing may continue throughout the night. This is normal and should not be cause for alarm. Saliva may be pink for 2-3 days. Control of this normal process is best affected by keeping the gauze sponges where they have been placed. If the bleeding seems to be excessive, there are several things to do. First, remove any superficial blood by thoroughly rinsing the mouth one time with cold water. Then, place a tightly folded piece of clean moist gauze over the bleeding area, using enough gauze to apply firm pressure to the tissues when jaws are closed. Maintain pressure with the gauze pack for a full 30 minutes. Remain quiet and keep the head elevated. If this does not control the bleeding, wrap a moist tea bag in gauze, place this over the socket and bite firmly. There will also be an increase in the amount of saliva as the anesthetic agents wear off one to three hours after surgery. This is also normal and should not be cause for alarm. Bleeding plus saliva therefore does cause a noticeable increase in the total volume of secretions. Hemorrhage (bright red bleeding that wells up rapidly from the socket) rarely occurs, but should this be a problem, please call our office for further instructions.

Swelling

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 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs to the sides of the face where surgery was performed. Use the ice packs intermittently (10 minutes on / 10 minutes off) for the first 24 hours after surgery. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm as 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. If difficulty of swallowing or breathing occurs, you must contact our office for further instructions.

Pain

Pain may be expected soon after the surgery and reaches its maximum during the first few hours. It is recommended that one of your prescription tablets be taken approximately within TWO HOURS after surgery, with a drink of water. Thereafter, take it for the first night regularly. Starting on the day after surgery, take one your narcotic medication as needed (at 4 hour intervals, or according to your individual instructions). Although the medications are desirable to control pain, excess may result in nausea. To increase tolerance for drugs, it is helpful if the patient remains inactive or, better still, go to bed during the period of discomfort. One should not drive while taking medication for pain. In most cases, prescription medication is only necessary for the 48-72 hours. Beyond that, over the counter pain pills such as Ibuprofen (Advil) or Tylenol may be used to relieve any discomfort. The sooner you begin non-prescription medication, the sooner you will recover.

If severe pain persists after the 4th day, it may require attention and you should call our office at 210-494-2005.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Drink from a glass, do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. 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 the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 3-4 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt.

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 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.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. If you take birth control pills, you should be aware that birth control pills may become ineffective while on antibiotics and you should use alternative means of birth control. Call our office if you have any questions.

Nausea and Vomiting

If nausea is a problem, drink using small sips of clear liquids or carbonated beverages. Sipping frequently is better than taking large, single gulps. Also, sometimes the prescription pain medication can cause nausea or vomiting so try changing to an over-the-counter pill such as Advil or Tylenol. Dairy products can sometimes cause nausea, so stay with clear liquids. Dehydration is often a main cause for nausea, so be sure you are well hydrated.

When the nausea subsides you can begin taking solid foods and the prescribed medicine.

Other Complications

  • 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 our office if you have any questions.
  • Slight elevation of temperature immediately following surgery is common. If the temperature persists, notify the office. Tylenol or ibuprofen (Advil) should be taken to reduce the fever.
  • You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute 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. If not, they can be removed by one of our doctors.
  • 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 any lip balm.
  • 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 a normal post-operative event which will resolve in time.

Finally

  • Sutures are placed 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 form your mouth and discard it. The sutures will dissolve on their own around one week after surgery.
  • 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 my office for instructions.
  • There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, 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: one of our surgeons or your family dentist.
  • 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 3-4 days following surgery. Call our office if this occurs.
  • 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.

Sinus Precautions

If you were informed that a sinus communication occurred during your surgery as a result of the close relationship between the roots of an upper tooth and your sinus, or if you have had some surgery that involved work near or in your sinus, please follow these additional instructions:

  • Do not blow your nose.
  • Do not sneeze through your nose. If a sneeze happens, sneeze with your mouth open.
  • Do not smoke.
  • Do not use a straw.
  • Avoid swimming and strenuous exercise for at least one week.
  • A decongestant may be prescribed if sinus congestion occurs.
  • Afrin Nasal Spray may also be prescribed to help prevent nasal congestion and keep your sinuses clear while healing.

It is not uncommon to have a slight amount of bleeding from your nostril on the affected side for several days. Please remember that occasionally a second procedure may be required if there is a persistent sinus communication.