After Wisdom Tooth Removal

Post Operative Pain

• Pain and stiffness should be expected for 7 to 10 days, especially if the surgery was difficult.
• Take the first dose of pain Medication before the numbness wears off – it is easier to stay ahead of the pain than to catch up with it.
• Take the medications with food to prevent stomach discomfort.
• Take 800mg of Ibuprofen every eight hours, in addition to the pain medicine, unless instructed not to, or you cannot take Ibuprofen.

Bleeding/Bruising

• Apply firm pressure by biting hard on gauze for one hour.
• Bleeding will usually mostly stop in about 1-3 hours.
• Replace gauze after one hour if more than a little bleeding is still present. Slightly dampen the gauze and bite hard on the gauze.
• Oozing of blood for about 24 hours is normal.

Protecting the blood clot to prevent dry socket

• A blood clot must form and remain in the socket for healing to occur.
• Do not rinse vigorously or spit for 72 hours after surgery.
• Avoid carbonated beverages for 7 days.
• Be gentle with tooth brush near surgical site(s), but do not avoid the sites – it is important to keep the area clean.
• Avoid forming suction in your mouth, such as sucking on straws, hard candy, or cigarettes.
• If dry socket has occurred, the pain will seem to increase after the first 72 hours. Pain can seem to radiate upwards near the ear.  Call the office if this occurs.  A dressing can be placed in the socket to help alleviate the pain.

Smoking/Tobacco Use

• Avoid smoking for at least five days. Longer would be better.
• Do not chew tobacco for one week.
• Smoking greatly increases the chances of postoperative problems such as dry socket, pain, and infection.

Eating/Drinking

• Hydration is very important to the healing process. Even if you do not feel like eating, keep drinking plenty of fluids.
• DO NOT DRINK ALCOHOL for five days. Or when taking pain medications.  Alcohol can dissolve the blood clot which may result in a very painful dry socket.
• Taking medications with food will help to avoid nausea or vomiting.
• Bland foods such as Banana, Rice, Applesauce, and Toast are best for nausea.
• Eat soft foods and small bites for a few days. Avoid crunchy foods that break up into small, sharp, hard pieces.

Surgical Sites

• Sockets will remain open for about 3 weeks.
• Avoid inserting anything into sockets, including your tongue or toothbrush.
• Brushing around sites is good. Be gentle if the area is tender, but do not be scared to brush around the area.
• Causing a little bleeding when brushing is okay. Be gentle, but keep the surgical sites clean.

Swelling

• Expect swelling, especially if the surgery was difficult – beginning about 48 hours after surgery. Pain and swelling are usually the worst on the 3^rd day after surgery.
• Apply ice to checks as soon as possible, after Surgery. For the first three days – place ice on cheeks for 20 minutes, then remove for 20 minutes, on each affected side.  Use as often as possible.
• Keep head elevated when resting or sleeping – use extra pillows to elevate your head, or sleep in a recliner the first 72 hours.
• After the first 72 hours, switch to warm, moist heat instead of ice.
• Keep jaw muscles as active as possible to avoid stiffness.

Oral Hygiene

• A clean mouth is a healthy mouth and will improve healing.
• Begin brushing normally, the evening of surgery, while being gentle at the surgical sites.
• Rinse mouth after eating for first two weeks.
• Causing a little bleeding while brushing is often normal.

Stitches

• If stitches were used, they will dissolve in about one week and do not need to be removed unless specified by your surgeon.
• If stitches fall out early after third molar surgery, there is no need to worry.

Report any unusual occurrences

• Large amounts of bleeding. Or bleeding that does not slow with biting hard on gauze for an hour.
• Pain that persists more than 7 – 10 days or increase after 4 days.
• Unusual reaction to medications.

Pain Control

• For moderate pain, alternate Ibuprofen 800mg (four over-the-counter tablets), with 100mg Extra Strength Tylenol (two over-the-counter tablets) every three hours. Take the Ibuprofen, then three hours later, take the Tylenol.  Continue for 5-7 days, or as long as pain control is needed.
• For severe pain, the prescribed medication should be taken as directed.
• 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.
• Avoid alcoholic beverages.
• After the third day, pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

OTHER COMPLICATIONS

• 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. Call Dr. McNaught if you have any questions.
• Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
• You should be careful going from the lying down position to standing. You could get light-headed from low blood sugar or medications. 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.  If not, they can be removed or smoothed by Dr. McNaught.
• If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline or Aquafor.
• Sore throats and pain when swallowing are not uncommon. The muscles get swollen.  The normal act of swallowing can then become painful.  This should subside in 2-3 days.
• Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a common post-operative event which will resolve in time.  This can be caused by the injections (shots) to numb the areas, or from being open for a prolonged period of time.
• Avoid strenuous activities such as heavy lifting or exercise for 5-7 days following surgery.
• Sometimes bruising can occur that can appear over the cheeks, below the eyes, in the chin or neck area. Please contact Dr. McNaught if this seems excessive.

Proper mouth care and following instructions after surgery will speed healing and reduce pain and complications.  Pain for several days after surgery is normal and should be expected.