The removal of impacted teeth is a significant surgical procedure. Post-operative care is very important. Unnecessary pain and the 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 20-30 minutes. After this time, the gauze pad should be removed and discarded.
• 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.
• You may take the pain medication prescribed by the doctor 1-2 hours following your surgery. Begin your pain medication after having a small amount to eat and prior to the “numbness” of the local anesthetic wearing off.
• 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.

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 from your mouth, then placing a gauze pad directly over the area and biting firmly for thirty minutes. Repeat as necessary. If bleeding continues, instead of using gauze pads, try biting 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, remain calm, sit upright, and avoid exercise. 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 and will not reach its maximum until 2-3 days post-operatively. Swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, a bag of frozen corn or peas, or commercially available ice packs should be applied to the sides of the face where surgery was performed. Alternate the ice packs from one side to the other every 15 minutes. After 24-36 hours, ice has no beneficial effect. Thirty-six hours following surgery the application of heat to the sides of the face is beneficial in reducing jaw stiffness and residual swelling. After reaching a peak 2-3 days after surgery, facial swelling should begin to decrease.

Pain

For the first 24 hours following your surgery, take your prescription pain medication as prescribed. You may begin taking your prescription pain medication 1-2 hours following your surgery, after you have had something to eat. Your pain medication will be more effective if it is taken before the local anesthetic “numbness” wears off. If additional pain relief is needed, you may supplement your prescription by taking 400-600mg. of ibuprofen* (Advil, Motrin) every 4 hours. The additive effect will work best if you stagger your prescription medication with the ibuprofen, such that you are taking one or the other (not both) every 2 hours. The prescribed pain medicine will make you groggy 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 each day.
*Do not take ibuprofen or similar compounds if allergic to aspirin.

Diet

Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. Start with liquids, such as, milk shakes, Instant Breakfast, fruit juices, and Ensure. High calorie, high protein intake is very important. Your food intake will be limited for the first few days, however, you may eat whatever you can comfortably tolerate. You should compensate for this and prevent dehydration by increasing your fluid intake. At least 4-5 glasses of liquid should be taken daily. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.

Oral Hygiene

You can brush your teeth and gently rinse the night of surgery. The day after surgery you should begin rinsing at least 4-5 times a day with one half teaspoon of salt in a tall glass of lukewarm water. Thorough cleaning will promote healing and help prevent infection. There will be a “hole” or slight depression at the tooth extraction site. This will slowly fill in with new bone over the next several weeks. Until the socket is completely filled in, keep it free of food debris by brushing and rinsing thoroughly after every meal.

Sutures

Absorbable sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. If non-absorbable sutures were used they will be removed approximately one week after surgery. The removal of sutures takes only a minute or so, and there is no discomfort associated with this procedure.

Activity

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. Keep in mind that you are probably not taking normal nourishment. This may weaken you, cause increased fatigue, and further limit your ability to exercise.

Discoloration/Bruising

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood pigments spreading through the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics take the tablets or liquid as directed. Antibiotics are sometimes given to treat or 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

Although uncommon, nausea is an occassional side effect of prescription medication or intravenous anesthetics. Nausea may also be caused by swallowing a small amount of blood. Although unpleasant, it is usually transient and is not harmful. In the event of nausea and/or vomiting, stop taking all oral medication, lay down, apply a cool compress to your head, and remain inactive. Wait at least one hour before you resume eating. Begin with clear liquids (broth, 7-Up, Sprite, apple juice) and dry carbohydrates (toast, crackers). Avoid caffeine and dairy products until the nausea subsides. If nausea persists, please call for assistance. It may be necessary to change your prescription medication and/or prescribe an anti-nausea medication.

Jaw Stiffness

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 that will resolve in time. Taking 400-600mg. of ibuprofen* every 4 hours and applying heat to the jaw muscles using an electric heating pad on a low setting will help to resolve jaw stiffness.
* Do not take ibuprofen or similar compounds if allergic to aspirin.

Special Concerns & Considerations

• If numbness of the lip, chin, or tongue is still present the morning following your surgery there is no cause for alarm. As stated before surgery, this is due to the close proximity of your tooth roots to the main jaw nerve. Although usually temporary in nature the exact duration of the numbness is unpredictable. You should be aware that if your lip or tongue is numb you could bite it or burn it with hot foods and not feel it, so be careful when eating.
• A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms are pain at the surgical site and referred pain to the ear that typically begins 3-5 days following surgery. This condition can easily be relieved by placement of a medicated packing within the empty socket. Call the office if this occurs.
• Slight elevation of temperature immediately following surgery is not uncommon and is usually due to slight dehydration. Increasing your fluid intake should resolve this problem. If an elevated temperature persists beyond 24-48 hours please notify the office.
• Move slowly when going from a reclining position to standing. Reduced nutritional intake, prescription pain medication, and intravenous anesthetics can cause dizziness, lightheadedness, and loss of balance. After laying down always sit for one minute before standing up. If upon standing you begin to feel lightheaded or dizzy, lay back down, wait 5 minutes, then try again.
• Occasionally, patients may feel hard projections in the mouth with their tongue. These are not roots, they are the bony walls that supported the teeth. These projections usually smooth out within a few weeks. If not, they can be removed by the doctor.
• 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.
• Sore throats and pain when swallowing are not uncommon. This will subside in 2-3 days.
• Your case is individual, no two mouths are alike. Do not take seriously well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Patterson, Dr. Mastin or your family dentist.