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 15–20 minutes. After this time, the gauze pad should be removed and discarded. Refer to section on bleeding for further instructions.
- Place ice packs to the areas of your face where surgery was performed. Refer to the section on swelling for explanation.
- Take the prescribed pain medications within 2–3 hours after surgery, prior to the local anesthetic wearing off.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
For the first 24–48 hours after surgery, do not:
- Disturb the wound(s)
- Use straws
- Drink anything with carbonation
- Vigorously rinse, swish, or spit
Some bleeding is expected after any surgical procedure and is a normal part of healing. You may have bleeding and/or redness in the saliva for 24–48 hours. Gauze will be provided to you to help control bleeding following your procedure. You will need to moisten the gauze with ice cold water, squeeze out the excess water and bite down with firm pressure for 20–30 minutes. If bleeding continues, moisten a tea bag with ice cold water and bite down for 20–30 minutes. The tannic acid in the tea bag helps to form a clot by contracting the blood vessels. A small amount of bleeding can continue intermittently for a few days, especially if the area is stimulated by movement. If stitches were placed inside your mouth, they will dissolve on their own in 7–10 days. Any physical activity will raise your heart rate and increase bleeding, so minimize any exercise for a few days following surgery. After the blood clot forms, it is important not to disturb or dislodge the clot, as it aids healing.
Swelling is also a normal part of post-operative healing and can increase for 2–3 days following any surgery, slowly resolving after this. You may apply an ice pack to the area for 20 minutes at a time for the first 24 hours; this will help minimize pain and swelling during this time. After 24 hours, you may switch to warm, moist heat.
You should begin taking pain medication within 2–3 hours after surgery or as soon as you feel the local anesthetic wearing off. For mild to moderate pain, ibuprofen (Advil® or Motrin®) may be taken. Ibuprofen bought over the counter comes in 200 mg tablets: 3 tablets may be taken every 6 hours as needed for pain. For severe pain, the prescribed pain medication should be taken as directed with food. Do not take any of the above medications if you are allergic or have been instructed by your doctor not to do so.
If you have been sedated for you procedure, you may not drive for 24 hours. You may also have been prescribed a narcotic pain medication. If so, you also cannot drive while taking this. An antibiotic mouth rinse (Peridex™) may be prescribed to help keep the area clean. If so, do not use until the morning after your procedure to avoid stimulating further bleeding. If an antibiotic was prescribed, make sure to take as directed and until completely gone to help prevent infection.
Hydration and nutrition are important for healing following surgery. You may be more comfortable with a soft diet initially, but you can eat what you like. You are only limited by your discomfort. Stick to cold and/or soft foods and liquids while you are numb. Remember to always eat prior to taking any pain medication to avoid nausea. Return to a normal diet as soon as possible unless otherwise directed.
Good oral hygiene is essential to healing. Do not rinse your mouth for the first post-operative day or while there is bleeding. After 24–48 hours, use a warm water rinse or the prescribed antibacterial mouth rinse (Peridex™, as directed) following meals to flush out particles of food and debris that may lodge in the operated area. Continue brushing and flossing your teeth with a soft bristle brush. You may brush and floss your teeth the night of surgery; remember no vigorous swishing or spitting. You may brush and floss around the surgical site, just be gentle initially.
Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing and/or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking in normal nourishment, which may weaken you and further limit your ability to exercise. Limit any vigorous exercise for 24 hours after surgery, as this will increase blood pressure and may cause more bleeding from the extraction site.
- 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 doctors if you have any questions.
- 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 postoperatively. Moist heat applied to the area may speed up the removal of the discoloration.
- Slight elevation of temperature immediately following surgery is not uncommon. Ibuprofen should be taken to reduce the fever; remember to drink plenty of fluids.
- You should be careful going from the lying down position to standing. Standing suddenly may cause you to get light headed. Taking pain medications may cause you to be light headed and dizzy as well.
- Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls that supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by the doctor.
- A sore throat may develop; the muscles of the throat are near the extraction sites. Swelling in the throat muscles can cause pain. This is normal and should subside in 2–3 days.
- Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth following surgery. This is a normal post-operative event which will resolve in time. Warm, moist heat may help.
- Sutures may have been placed; if so, they will dissolve on their own in 7–10 days. Sometimes they become dislodged; this is no cause for alarm. Just remove the loose suture from your mouth and discard it.
- 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 our office for instructions.
- There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean, especially after meals, with warm 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: our doctor or your family dentist.
- Brushing your teeth is okay — just 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.