Oral Surgery Procedures Introduction

After Wisdom Tooth Removal

The removal of impacted teeth is a surgical procedure. Post-operative care is very important. Unnecessary pain and complications 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 at least a half hour. After this time, the gauze pad may be removed and discarded, or changed as needed for the bleeding. This may in some cases be 2 to 3 hours.
  • Vigorous mouth rinsing 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.
  • Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished and the I.V. medications wearing off.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Use ice packs, if given, as directed (see post operative swelling instructions).

Bleeding

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 of blood from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes and place ice on the face in this area. Repeat if necessary. If bleeding continues, you may 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 exercise. Remember that pressure and cold stop oozing. You may need to take pain medication to enable you to bite firmly on the surgery site. If bleeding does not subside, call for further instructions.

Swelling

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 body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery (24 hours) and will often not reach its maximum until 48 to 72 hours after surgery. However, the swelling may be decreased by the immediate use of ice packs. Ice should be applied to the sides of the face where surgery was performed with the face wrap or hand held. The ice packs should be left on continuously. After 36 to 48 hours, use of ice should be discontinued. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Forty-eight hours following surgery, the application of moist heat may be beneficial in reducing the size of the swelling and soreness.

Pain

For mild pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours.

For moderate pain, take prescriptions as directed. The prescribed pain medicine may make you sleepy or groggy and can 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, it may require attention and you should call the office.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Use straws sparingly. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake may be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 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. Caution: 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.

Keep the mouth clean

You may brush your teeth several times the night of surgery but rinse very gently. Twenty-four hours after surgery you may begin gentle rinsing, especially after eating, with a glass of warm water mixed with a very small amount of salt (very mild and easy).

Discoloration

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 (bruising). This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area (after 48 hours) may speed up the removal of the discoloration after day three (remember to discontinue use of ice after 48 hours).

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics may be given to help prevent infection. 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 by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking soft foods and the prescribed medicine. Please call if vomiting continues for more than 4 hours.

Possible Complications/Side Effects

  • 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 if the oral temperature is greater than 102°.
  • If numbness of the lip, chin, or tongue occurs there is usually 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 (501) 771-7600 for the North Little Rock office or (501) 327-5255 for the Conway office if you have any questions.
  • You should be careful going from the lying down position to standing, if you were not able to eat or drink prior to surgery and it was also difficult to take fluids. Taking pain medications may make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then stand.
  • Occasionally, patients after surgery may feel hard projections in the tooth socket area with their tongue. They are not roots; they are the bony walls which supported the tooth. These projections usually smooth out naturally with time. If not, they may be removed by at the office.
  • If the corners of your mouth were stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline or Chapstick.
  • Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing may then become painful. This will subside in 1 to 2 days.
  • Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth wide for a few days following surgery. This is a normal post-operative event which will resolve in time.

Additionally

  • Sutures may be placed in the area of surgery to minimize bleeding and to help healing. Sometimes they become dislodged; this is no cause for alarm. Gently remove the suture form your mouth and discard it. (Most of the sutures used will dissolve in 3 to 5 days. If any are bothersome place call for an appointment for removal).
  • The pain and swelling should subside more and more each day following surgery. Maximum swelling usually occurs at 48 to 60 hours after surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call my office for instructions.
  • There may be a hole (socket) where the tooth was removed. This hole over the next month will gradually fill in with the new tissue. In the mean time, the area (the socket) should be kept clean especially after meals with mild, warm water rinses and 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: Drs. Elimon and Johnson or your family dentist.
  • Brushing your teeth is okay - just be gentle at the surgical sites, for 1 to 3 days.
  • A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms are pain at the surgical site and even pain to the ear often occuring 2-4 days following surgery. It is not an infection and you may take additional pain medication or call the office a post operative check.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.