Immediately Following Surgery

• A gauze pad will be placed over the surgical area. Firmly bite on the gauze for half an hour. Remove the gauze pad after 30-45 minutes and discard it. 
• Do not rinse your mouth vigorously, touch the wound area, or pull your cheek out to visualize the surgical sites. Doing so may dislodge the clot that is forming and cause bleeding. 
• You will be prescribed pain medication. Take the first dose within one hour of being discharged from the office. This will usually coincide with the effects of the local anesthetic wearing off. Do not take this medication on an empty stomach.
• Rest on the day of surgery and resume normal activity when you feel comfortable.
• To help reduce swelling, place ice packs on the side of your face where the surgery was performed. 

Bleeding

It is normal to experience some bleeding or redness in your saliva 24 hours after the procedure. If you experience this, place a moistened gauze pad directly on the wound and bite down for at least 30-45 minutes. With each exchange of gauze, you will observe a lighter color of redness; some people may require 5-6 gauze exchanges to control the bleeding. If it continues to  persist, bite down on a moistened black tea bag. Black tea contains tannic acid, which constricts blood vessels and helps to form a clot. 

Once the bleeding stops and a clot forms do not:

• Spit
• Use a straw
• Rinse vigorously 
• Smoke for 4 weeks 
• Drink alcohol for 72 hours

Doing any of the above will dislodge the clot and slow the healing process. 

Swelling

Swelling is our body’s natural reaction to surgery and eventual repair. The amount of swelling you experience will depend on the extent of the surgery. It is normal to experience swelling of the cheeks, eyes, sides of the face, and around the mouth. Swelling will not be visible until the day after surgery and will not reach its maximum until the second postoperative day. Swelling can be minimized by applying ice packs immediately following surgery. Apply ice packs during the first 48 hours in a pattern of 20 minutes on and 20 minutes off. After 48 hours, ice is no longer beneficial for reducing swelling.  It may also be beneficial to consider sleeping with your head elevated at 30 degrees during this time. 

If swelling and jaw stiffness persists for several days, do not be alarmed, this is a normal reaction to surgery. Forty-eight hours after surgery, you may begin to apply moist heat to the outside of your face, this will help to further reduce swelling. Moist heat can also be applied in a pattern of 20 minutes on the face and 20 minutes off.

On the day of surgery, begin aggressive oral stretching and manual massage to the sides of the face. This will help with muscle tightness and reestablish a normal oral opening. Following these instructions will ensure a quick recovery with less swelling and post-operative pain.

Pain

As with any surgery, some degree of discomfort is to be expected. You will usually be given a prescription for pain medication. We recommend taking pain medication before the numbing medication has worn off for the best pain management. You will experience the most severe pain within 6 hours of the anesthesia wearing off. After that, your need for pain medication should decrease.

For moderate pain, take a dose (400-600mg) of Ibuprofen (Advil or Motrin) every 4-6 hours as needed for pain. Do not exceed the maximum daily dosage suggested on the bottle.

Do not take Ibuprofen if you:

•  Have an intolerance to it
•  Take blood thinners 
•  Have a history of stomach ulcers 
•  Have a history of kidney disease 

For severe pain, the prescribed medication should be taken as directed. To avoid stomach upset, take the pain medication after a meal or with a small snack. If you have allergies to any medications above, do not take them. If your doctor has advised you not to take any of the medications mentioned above, do not take them.

While taking pain medication, do not:

• Operate a motor vehicle
• Operate machinery (lawn mower, etc.) 
• Drink alcohol 
• Do not drive for the first 24 hours after surgery if you have had oral or I.V. anesthesia

If you still experience significant pain that is not improving 3-5 days after surgery, notify the clinic. Prescription pain medication has the potential to be addictive, so it’s very important that you only take it if you are experiencing significant postoperative pain. If you do not finish all your prescription medication, take the unused medication to an authorized prescription medication collection site (e.g. law enforcement facilities, retail pharmacies, or a hospital) and they will dispose of it responsibly. Never leave unused medication in your medicine cabinet at home. 

We recommend the following protocol for optimum pain management:

Take each medication with a small snack and a full glass of liquid.

Immediately Following Surgery: 1 Prescription pain dosage

3 Hours Later: Ibuprofen dosage

3 Hours Later: 1 Prescription pain dosage

3 Hours Later: Ibuprofen dosage

NOTE: The dosage of the prescription pain medication can be increased to 1 1/2 to 2 times the normal dosage if needed for pain management.

Diet

After general anesthetic or I.V. sedation, take only fluids until the feeling in your mouth has completely returned. Chewing food while your mouth is still numb can result in biting of the cheeks and tongue, which will result in painful ulcers once sensation returns. Do not use a straw for drinking as this can dislodge the clot that forms in the socket. Eat soft foods and chew away from the surgical sites. Until the feeling returns, it’s best to eat soft foods that don’t need to be chewed, such as yogurt, pudding, mashed potatoes. Eating regularly and not missing meals will help you to feel better, have more strength, and heal faster. 

Drink plenty of fluids throughout the day to ensure you remain well-hydrated. Since your food intake will be limited for the first 1-2 days, you should compensate by drinking at least 1-2 liters of fluid per day. 

Caution: You may feel dizzy or faint when standing up from a lying or sitting position. If you are lying down after surgery, sit up slowly and place your feet on the ground.  Stay seated with your head elevated for one minute before standing. On occasion, a patient may feel faint following sedation/anesthesia. If the escort witnesses the patient feeling faint, please elevate the patient’s legs above their head for 30 seconds. This will increase the rate of flow of oxygenated blood to the patient’s head. This will help to decrease the risk of fainting and the risk of feeling nauseous. Staying well hydrated following surgery will also help prevent these symptoms.  

Tooth Sensitivity

It is not uncommon to have some sensitivity in your remaining teeth following wisdom teeth extraction. Some patients even report a sensation that their teeth have shifted position. Your teeth will not change position in the immediate postoperative period. If you have an orthodontic retainer, please resume wearing your retainer within one week of surgery. 

Oral Hygiene

Keeping your mouth clean following surgery is essential to good healing and is one of the best ways to avoid infection. You should brush and floss your teeth the night of surgery, avoiding the surgery site. Be gentle initially when cleaning the surgical areas. You will be prescribed a bottle of Chlorhexidine mouth rinse to be used after brushing and flossing. This mouth rinse should be used twice daily, after breakfast and before bed, for at least one week. Rinse for at least 30 seconds before gently spitting it out. Do not drink or eat food for 15 minutes after using the mouth rinse.

The day after surgery, rinse with warm salt water at least 3 times a day, especially after eating. To make the saltwater rinse, mix one teaspoon of salt with a cup of warm water. In addition to a saltwater rinse, mix 50% hydrogen peroxide/50% water. Dip a Q-tip in the solution and gently wipe over the surgery site. This will ensure plaque doesn’t accumulate on the sutures or teeth surrounding the area. Try to avoid over-the-counter mouthwashes that contain alcohol. 

Beginning day 5, use the plastic irrigation syringe that was given to you on the day of surgery to irrigate out the extraction sites. If you had bone graft placed in any of the wisdom tooth extraction sites, DO NOT irrigate those areas with the syringe. This will flush out the bone graft. 

If bone grafting was not performed, mix up a saltwater solution as mentioned above, pull your cheek aside with a tongue retractor or spoon and gently flush the extraction sites until all food or debris has been removed. If the fluid coming out of the extraction sites is cloudy, continue to irrigate the sites until the fluid is clear or has a very slight pink/blood color. A little bit of bleeding following irrigation is normal. Eventually, the extraction sites will fill with soft tissue/bone and will no longer trap food. However, this can take up to 8 weeks following the extraction. You should continue to irrigate every day during this time period. Failure to flush the food out of the extraction sites will result in a food and bacterial trap that will result in a postoperative infection. 

Discoloration

You may notice that your skin turns blue, green, black, or yellow in the days following surgery. This bruising is a result of blood spreading beneath the tissues. Applying moist heat to the area may help the color fade. 

Nausea and Vomiting

Nausea and vomiting can be side effects of anesthesia and pain medication. To reduce nausea, eat a small snack and drink a large amount of fluids before taking the medication. If you are nauseous and/or vomiting after surgery, avoid eating, drinking, or taking pain medication for at least one hour. After the hour has passed, sip ginger ale, tea, or coke. Sip slowly over a period of fifteen minutes. Do not use a straw. You may begin taking solid foods and the prescribed medication when you no longer feel nauseous. 

Smoking

DO NOT SMOKE for a minimum of 4 weeks following surgery. The toxic chemicals and heat in cigarette or marijuana smoke is harmful to the healing of wounds. Ideally, you should quit smoking as this will give the surgical site the best chance of healing. 

Healing

What to expect following surgery:

• Day 1 & 2: Usually the most uncomfortable. Expect some swelling. Swelling will peak on the second day. 
• Day 3: You should start feeling more comfortable and notice a reduction in your swelling. You will be able to eat a more substantial diet. 
• After day 3, you should start to feel better and see steady and gradual improvement. 
• Day 5: Use the plastic irrigating syringe after every meal until you are sure the tooth socket has completely closed. This will ensure that no food particles get stuck in the tooth socket. Full soft tissue closure can take up to  8 weeks. DO NOT use the irrigating syringe until day five. If your doctor informed you that a bone graft had to be performed in your wisdom tooth extraction site, please do not irrigate this site with the plastic syringe unless instructed otherwise. This will cause the bone graft to be flushed out.

Sinus Precautions

The upper back teeth and the maxillary sinus are located in very close proximity. As a result, a communication (an unnatural space) between the sinus and mouth can occur. If you had a sinus bone graft performed, then a sinus communication was surgically created. If we informed you at the conclusion of your procedure that this occurred, please read the following instructions. Your sinuses may feel stuffy, or you may experience some nasal drainage, but it is important that you do not blow your nose or drink through a straw for at least 14 days after surgery. You may experience slight bleeding from the nose for several days after surgery. To avoid pressure on the sinuses, sneeze with your mouth open for two weeks after surgery. Do not try to hold in the sneeze. 

Take all medications and nasal sprays as prescribed. Do not smoke for four weeks. Only eat soft foods for several days and chew on the opposite side of your mouth. Notify our office if drainage or pain increases or if you experience any changes in your condition. Sinus exposures often heal slowly and with difficulty; therefore, you must keep all of your scheduled appointments until you have fully recovered.

Antibiotics

Antibiotics are not routinely prescribed for wisdom tooth removal. However, if you were prescribed antibiotics, take the antibiotics as directed to help prevent infection. If you experience a rash or an unfavorable reaction to the antibiotic, discontinue use and notify our office immediately. If you experience an upset stomach, we recommend taking acidophilus or a probiotic along with your antibiotic. 

Antibiotics may make oral contraceptives less effective. You should use an alternate form of birth control while on a course of antibiotics.

Other Complications

• You may experience numbness of the lip, chin, or tongue. If this happens, do not be alarmed.  As stated before surgery, this is usually temporary. If your tongue or lip is numb, you could bite it and not realize it, so be careful. If the numbness persists beyond 72 hours, please call Dr. Benjamin Foley and Dr. Thao Le as you may be prescribed an additional medication to help resolve the numbness.
• Immediately after surgery, you may notice a slight elevation of temperature. You may take Tylenol or Ibuprofen to reduce the fever. If a fever above 101.5 degree fahrenheit  develops, notify the office immediately. 
• Because you were not able to eat or drink before surgery, you may feel dizzy. Taking pain medications can also make you feel dizzy. Be careful when going from a lying down to standing position. You could get lightheaded and faint when you stand up suddenly. Before standing, sit for one minute and then stand up.
• Sometimes, patients can feel hard projections in the mouth with their tongue. These are small splinters of the bony walls that supported the tooth. They will usually smooth out on their own. If not, they can be removed by Drs. Benjamin Foley and Thao Le.
• The corners of your mouth may feel stretched and may dry out and crack. Apply ointment such as Vaseline or lip balm to your lips and corners of your mouth.
• It is not uncommon to have a sore throat or pain when swallowing. This will subside in 5-6 days.
• You may feel stiffness (trismus) of the jaw muscles. This may make it difficult to open your mouth for a few days following surgery. This is a normal post-operative event that will resolve in time. Massaging the muscles on the side of the face and performing oral stretching exercises will decrease muscle stiffness and is a very important part of your recovery.

Finally

Your surgeon will place sutures in the area of surgery to minimize postoperative bleeding and to help with healing. The sutures may become dislodged; do not be alarmed if this happens. Remove the suture from your mouth and throw it away. The sutures are dissolvable and do not require removal.  

After the first 48 hours, the pain and swelling associated with your surgery should decrease more and more each day. Call our office for instructions if the pain or swelling worsens or if unusual symptoms occur.

There will be a hole where the tooth was removed, and it will gradually fill in with the new tissue over the subsequent eight weeks. In the meantime, keep the area clean by rinsing with salt water rinses after meals. 

Every surgical case is unique. Although the advice of well-intended friends and family members may alleviate some of your anxiety, please call our office with questions about your individual case.