Post-Operative Instructions: Wisdom Teeth Removal

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After Your Surgery

Post-Operative Instructions

Wisdom Tooth Removal Home Care

The removal of impacted teeth is a surgical procedure. Post-operative care is very important. Unnecessary discomfort and complications, such as infection and swelling, can be minimized if these instructions are followed carefully.

NOTE: NO PRESCRIPTIONS WILL BE GIVEN AFTER HOURS OR ON WEEKENDS.

Immediately Following Surgery
  • The gauze pad placed over the surgical area should be kept in place for about 30 minutes post surgery. After this time, the gauze pad should be removed and discarded. Gauze is usually required on and off for about 24 hours post-operatively should bleeding occur. It is completely normal to have some oozing for the first 24 hours.
  • Pressure is usually all that is necessary to stop intraoral bleeding. The RN will describe proper placement of gauze to you, but remember the wounds are behind the back teeth.
  • Vigorous mouth rinsing and/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.
  • Please avoid pulling on your cheek to "look at the holes." It doesn't benefit you and can only lead to problems.
  • Take the prescribed pain medications prior to the local anaesthetic wearing out and beginning to feel discomfort. The pain medication is to be taken as prescribed to ensure a smooth post-operative course.
  • 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.
  • No smoking (tobacco or other products) or vaping for 2 weeks post-operatively.
Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon for 24-48 hours after surgery. Very rarely is there significant bleeding with wisdom tooth surgery. Should you have some bleeding, the first step is to try and relax. Most bleeding may be controlled by rinsing gently to remove old clots from your mouth, then placing a gauze pad over the area and biting firmly for 30 minutes (watch the clock!). Repeat if necessary. If bleeding continues, bite on a slightly moistened black tea bag for 30 minutes. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels. To minimize further bleeding, sit upright, do not become excited, and avoid agitation, as this increases your blood pressure and subsequently increases bleeding. If bleeding does not subside, call our office for further instructions.

Sutures

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged (sometimes as quickly as 24 hours post-operatively). This is no cause for alarm. Just remove the suture from your mouth and discard. The sutures DO NOT need to be removed after surgery. They are self dissolving, unless you are told otherwise.

Swelling

The swelling that is normally expected may or may not be 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. Two baggies filled with ice, or frozen peas, should be applied to the sides of the face where surgery was performed. The ice packs should be left on at 20 minutes on/off 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. 36 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the stiffness associated with surgery.

Pain

Specific medication instructions will be provided during discharge teaching. Prescribed pain medications should be alternated in specified intervals for best results.

NOTE: The third post-operative day is often the worst for swelling and discomfort- don't be alarmed.

Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it. Do NOT drive an automobile or work around machinery while taking narcotic pain medication. Avoid alcoholic beverages. Pain or discomfort following surgery should subside continuously each day, after the third post-operative day. If pain persists or worsens later on in the course, it may require attention and you should call APEX Surgical. Tylenol #2's contain codeine which can cause nausea, dizziness and constipation. Drink plenty of water and eat foods high in fibre (e.g., bran muffin).

For breastfeeding patients: you have been given sedating medication during your procedure. If you are planning to continue breastfeeding post-surgery, you MUST pump and discard your first expression post-surgery. If you have been prescribed narcotics such as codeine or tramadol you MUST NOT breastfeed while taking them and should substitute with either formula or previously frozen breastmilk. Please alert your pharmacist that you are currently breastfeeding.

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 up for 1 minute before standing.

Dry socket

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket and one's body reacts unfavourably. Symptoms of increasing pain at the surgical site and even pain radiating to the ear may occur 4-5 days following surgery. If the pain is new and intolerable call APEX Surgical for instruction.

EATING

First 24 Hours
Adequate nutrition is essential for normal healing. Following surgery, your diet should be restricted to cold liquids. Yogurt, smoothies, milkshakes and dietary supplements such as Instant Breakfast® or Ensure® are good choices. AVOID PEROXIDE, ALCOHOL, CARBONATED BEVERAGES, AND DRINKING THROUGH A STRAW.

After 24 Hours
You may have soft foods such as cooked vegetables, fish, pasta, and meatloaf, which are easily chewed. You should use utensils and avoid chewing at the surgical site for 2 weeks. DO NOT SKIP MEALS. If you take nourishment regularly, you will feel better, gain strength, have less discomfort, and heal faster. Please make sure to avoid seeds or anything small that could get stuck in the extraction site.

Hygiene

No rinsing of any kind should be performed until 24 hours after surgery. 48 hours after surgery, you should begin irrigating the sockets with the syringe provided at least 5-6 times a day, especially after eating, with a ½ teaspoon of salt mixed into one cup of warm water. There will be a prescription mouth rinse given to you after surgery—take it as prescribed. Brush your teeth gently starting the day after surgery, taking care to avoid the surgical sites. Note: a bad smell can be normal after tooth extraction if not associated with other symptoms.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow bruising 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

It is rare that antibiotics are prescribed after routine wisdom tooth surgery and show NO benefit according to the most recent literature. They are not given in the majority of cases. However, if you have been placed on antibiotics, take the tablets or liquid as directed until completion. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour. You should slowly sip on water over a 15-minute period. Alternatively, if you are having no relief, you may go to your local pharmacy and ask the pharmacist for Gravol suppositories. When the nausea subsides you can begin taking solid foods.

Other Sequelae
  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As reviewed in 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.
  • Slight elevation of temperature immediately following surgery is not uncommon. It normally doesn't represent an infection or fever and should decrease with Tylenol®.You should be careful going from the lying down position to standing. You could get light headed. Before standing up, you should sit for one minute before getting 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 and nature runs its course. If not, and they are painful they can be removed at APEX Surgical.
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment.
  • 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 of the jaw muscles/joints 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.
Normal Healing

There is always a void where the tooth was removed. The void will fill in with new tissue/bone gradually over the next few months (dependent on your age). In the meantime, the area should be kept clean, especially after meals, with gentle salt water rinses or a toothbrush.

The pain and swelling should subside more and more each day following surgery, with the third day post-surgery typically being the worst symptomatically. If your post-operative pain or swelling worsens after day 3 or unusual symptoms occur, call APEX Surgical for instructions: (250) 371-7076.

Your case is unique, no two mouths are alike. Remember, we are here for you should you require our help. We wish you a speedy recovery and quick healing.

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