After Removal of Impacted Teeth
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.
Essentials of Care
- The gauze pad placed over the surgical area should be kept in place for at least half hour. After this time, the gauze pad should be removed and discarded. Replace gauze if bleeding persists.
- Vigorous mouth rinsing, sucking 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.
- Begin a diet of liquids to soft foods as soon as you can.
- Take the prescribed pain medications with food 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.
- 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.
- Do not smoke following surgery of any kind.
- Do not wait for your follow-up appointment to ask questions or tell us that you are having a difficult time. Call our office for assistance.
A certain amount of bleeding is to be expected following surgery. 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 thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty 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, sit upright, and avoid unnecessary movement. If bleeding does not subside, call 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 bodys normal reaction to surgery and eventual repair. The swelling will not become apparent until 1-2 days 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 ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 48 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. Thirty-six hours following surgery, the application of gentle moist heat to the sides of the face is beneficial in reducing the swelling and stiffness. Sleep with your head elevated on two pillows for 2-3 nights following the procedure.
Adult patients with moderate pain may take one or two tablets of Tylenol or Extra Strength Tylenol every three to four hours. Alternatively Ibuprofen, (Motrin or Advil) 400-800 mg (2-4 200mg tablets) may be taken every 3-6 hours respectively. Please contact our office for instructions or if you have any questions prior to taking any medications.
For severe pain, take the medication prescribed as directed. The prescribed pain medicine will make you sleepy 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, or at any time you feel the level of pain is not managed with the above medications you should call the office.
Do not wait for severe pain to take medication. As soon as you feel any beginning of discomfort start with the above regimen. Severe breakthrough pain is very difficult to overcome.
After general anesthetic or sedation, liquids should be initially taken. Advance your diet as you feel more comfortable. Try to avoid straws if possible. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. Very hot or cold foods should be avoided. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by drinking plenty of your favorite juice or Gatorade type drinks regularly. Your solid food intake may be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 6-8 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 and drink.
Keep your 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 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.
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. This may also occur at the injection sites on your arm or hands. If there is pain, redness, or hardness please contact our office. Application of moist heat to the discolored areas will speed up resolution.
If you have been placed on antibiotics, take the tablets or liquid as directed. It is important to take your antibiotic on a regular schedule. It is not effective to take a catch up dose if one is missed. Antibiotics will be given to help prevent or treat active infections. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.
Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything (not even plain water) by mouth until nausea has resolved. Do not take the prescribed medicine while nauseated. After resolution of acute nausea clear liquids such as Apple Juice, Jell-O, water, tea or ginger ale can be tried. You should sip slowly over a fifteen-minute period. If nausea has not recurred then bland solid foods such as cottage cheese is recommended for the next 6-8 hours. Pain medication may be taken after bland food diet has been resumed. When the nausea subsides you can begin taking solid foods. If you have nausea and vomiting that persists for more than 12 hours please call the office.
- 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 very normal and not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
- 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.
- The corners of your mouth may dry out and crack. Your lips should be kept moist with an ointment such as vaseline.
- Sore throats and pain when swallowing are not uncommon. This will subside in 2-3 days.
- Stiffness (Trimus) 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. Application of gentle moist heat to the facial muscles after the prescribed icing period will soothe the muscles and release the stiffness.
Sutures may be placed at the area of surgery to minimize post-operative bleeding and to help with tissue healing in the early post-operative period. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. If non-resorbable sutures are used they will be removed approximately one week after surgery. The removal of sutures has no discomfort associated with this procedure. So its really nothing to worry about.
There will be a cavity where the tooth was removed. The cavity will gradually heal over the next month and 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, either one of our doctors or staff.
Brushing your teeth is okay – just avoid toothpaste for the first few days and be gentle at the 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 to the ear may occur 2-3 days following surgery. Call the office if this occurs.
Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.