Wisdom Teeth Removal

Wisdom teeth removal is very common and safe. With that said, it is a surgery and requires care during the recovery process. Following these aftercare instructions can significantly minimize your risk of ongoing discomfort or infection.

Immediately Following Surgery

• There will be a gauze pad placed over the incision sites intraorally. Keep this gauze pad in place for half an hour after surgery, or until it becomes fully saturated, whichever happens first. It is very common to experience a small amount of blood oozing from the surgical sites for the first 12-24 hours after surgery. While this oozing will slow and eventually stop, most patients will need to replace the gauze and bite with firm pressure for several cycles before this happens. Once oozing has stopped, you may remove the gauze indefinitely.
• Avoid trauma to the wound area or any kind of vigorous mouth washing immediately following surgery. Dislodging the blood clot may prolong bleeding and impair healing.
• To help keep you comfortable during recovery, it is recommended that you start any prescribed pain medication before the numbing medicine wears off.
• Try to rest on the day of your surgery. Take it easy and restrict physical activities. Get back to your normal physical activities only when you feel able.
• Use ice packs on the side of your cheeks for 48 hours post-surgery. When possible, it is also beneficial to keep your head elevated during this time. These are important ways to minimize swelling. After 48-72 hours, it is recommended to switch to heat therapy on the cheeks with a gentle massage 3-4 times per day to facilitate the reduction of any swelling and soreness that you experienced.

Bleeding

Following surgery, a little bit of bleeding is normal and can be anticipated. Some slight bleeding, or red saliva, is nothing to worry about and may continue off and on for 12-24 hours. If you experience excessive bleeding, you may be able to control it by first rinsing away any old blood clots in your mouth. Next, place a folded gauze pad over the wound area, and bite down on it with firm pressure for at least half an hour, or until the gauze becomes fully saturated. These steps may need to be repeated multiple times. Additionally, you may try biting down on a moist tea bag for half an hour. Finally, you can minimize bleeding by resting, head elevation, and avoiding physical exercise or excitement.

Swelling

Following wisdom teeth removal, you can expect some swelling around the mouth, cheeks, and even underneath the eyes. This is the body’s normal response to surgery. Usually, swelling does not become evident until the day after surgery and will reach its peak on day two or three. You can control swelling with the use of ice packs. Place them against the outside of the face where surgery was performed, and keep them there continuously while you are awake. Note that, after 36-48 hours, ice will no longer provide as much benefit. At this point, moist heat (e.g., a warm compress) with gentle cheek massage 3-4 times per day will help the swelling to subside over the next week.

Also, be aware that your jaw may become stiff following surgery, especially during the second and third days of your recovery. This is a normal response to surgery and is nothing to worry about. Once the swelling begins to decline, you may begin daily mouth opening exercises to regain full mouth opening. It is not uncommon to require 3-4 weeks of exercising before you begin to feel back to normal.

Pain

It is recommended to begin any prescribed pain medications prior to your numbing medicine wearing off.

If you experience mild to moderate pain, you may take 1-2 tablets of Tylenol or Extra Strength Tylenol every 6 hours. Ibuprofen (Motrin or Advil) may also be taken to help control not only pain, but also swelling and inflammation. Ibuprofen generally comes in 200mg tablets and may be taken in a 600mg dosage every 6 hours, or an 800mg dosage every 8 hours.

For more severe pain, take narcotic pain medications if prescribed by your surgeon and use them as directed. Note that narcotic pain medications can cause you to feel groggy, and they may also slow your reflexes. When taking narcotic pain medicines, avoid driving, operating machinery, and drinking alcohol. Narcotics prescribed by your doctor may also contain Tylenol, and it is important to not take any additional Tylenol if you are regularly taking this medication. In contrast, Ibuprofen (Motrin or Advil) does not contain any Tylenol and is safe to take alongside any narcotic.

Following 72 hours after surgery, pain should become less and less pronounced each day. If pain persists or intensifies, contact your surgeon.

Diet

After anesthesia or IV sedation, you will want to resume your diet with liquids first. Drink from a glass and avoid any vigorous suctioning with straws (the sucking motion from the straw may dislodge your blood clot and cause more bleeding). Once tolerating liquids, you can enjoy any soft foods that are easy to clean out of the mouth. We recommend chewing away from the surgical site when possible. 

Seek nourishment regularly, and drink lots of fluids to ensure that you avoid dehydration. Over the first couple of days, your food intake may be lower, so compensate by drinking more liquids, and protein/nutrition shakes to obtain plenty of calories and protein. Aim for a minimum of five to six glasses of liquid daily.

Exercise

It is okay to begin light cardiovascular activities 3-4 days after surgery, if you feel able. If you exercise regularly or play a sport, be aware that your normal nourishment intake will be temporarily reduced, and you may need to ease back into activities. If you become lightheaded, avoid exercising for several more days to allow additional recovery. It is beneficial to avoid heavy weightlifting and contact sports like football, basketball, wrestling, hockey, etc., for up to 7-10 days. 

Keep Your Mouth Clean

The cleaner you keep your mouth and surgical sites, the better and faster they will heal.

On the day of your surgery, you may gently brush your teeth at night and keep your entire mouth as clean as possible. Begin rinsing with saltwater 3-4 times daily, especially after eating. Your surgeon may also prescribe a prescription-strength mouthwash that can be used in place of or in addition to saltwater rinses.

Discoloration

In addition to swelling, some patients may experience some slight discoloration or bruising of the skin. Any black, blue, green, or yellow discoloration may be caused by blood spreading beneath the tissues (bruising). This is very normal and may happen within two to three days of your procedure. A warm compress can help manage this discoloration, but it may require 1-2 weeks to fully resolve.

Antibiotics

Antibiotics can help prevent infection, so make sure you take them as directed if your surgeon prescribes them. Do not continue using antibiotics in the event of a rash or other adverse reaction. Contact the office if you have any questions.

Nausea and Vomiting

Nausea and vomiting can be caused by the medications and stress of your recent surgery. Dehydration from not drinking prior to the surgery can further worsen these symptoms. If you experience nausea or vomiting after surgery, begin fluid and food intake slowly and progress as tolerated. Try sipping on ginger ale, tea, or Coke. Sip slowly and take any anti-nausea medications prescribed by your surgeon. When nausea subsides, you can try eating solid foods and taking your medications again. Remember that any prescribed narcotic medication can worsen nausea. It may help to have some solid food in your stomach prior to taking any narcotics.

Sutures

Sutures will be used to minimize bleeding and expedite your healing. In most instances, the sutures are self-dissolving and will remain in place for 3-10 days. While they may become dislodged after surgery (even after a day or two), this is nothing to worry about. Simply remove the dislodged suture from your mouth, as necessary, and discard it.

There will be a cavity where the wisdom tooth was removed, and over the course of about a month, this cavity will fill with tissue and ultimately close over. Using salt water rinses and tooth brushing to keep this area very clean, especially following meals, is vital to facilitate healing. Additionally, you will be provided with an irrigating syringe to use daily. Allowing food to become trapped, particularly in the lower extraction sites, can lead to prolonged pain and infection during recovery.

A dry socket occurs when the blood clot gets dislodged prematurely from the tooth socket, causing pain in the mouth or even in the ear. The severe pain associated with this condition will typically not occur until 3-5 days following surgery. If this happens, reach out to our office for further guidelines.

Other Complications

• Following surgery, you may notice numbness of the lip, tongue, or chin. This is normal and should prove temporary. However, the numbness may cause you to accidentally bite your tongue or your lip, so be extra careful as you eat.
• You may have a slight uptick in temperature after surgery. This is normal and can be managed with Tylenol or Ibuprofen.
• Be careful moving from a lying down position to standing. You will likely feel weak and a bit dizzy. To avoid lightheadedness, you should sit for one minute before you stand up.
• Some patients feel hard projections in the mouth with their tongue. These are the bony walls that support the wisdom tooth. Most of the time, they smooth out on their own. If they cause an ongoing problem, our surgeons can address them to alleviate your symptoms.
• If the corners of your mouth are stretched out, it may result in dry, cracked lips. Use ointments such as Vaseline to keep your lips moist.
• It is also common to experience a sore throat, especially when swallowing. This is simply the result of swelling in the throat muscles, and should subside within a couple of days.
• Stiffness in the jaw muscles may cause difficulty in opening your mouth for a few weeks after your surgery. This stiffness is normal and will resolve on its own. You can facilitate recovery by applying a warm washcloth or heating pad to the cheeks and performing mouth opening exercises daily.