After Wisdom Tooth Removal

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and complications such as infection and dry socket can be minimized if these instructions are followed carefully.

The goal is to keep the blood clot in the empty bony sockets, as this blood clot has everything you need to heal. Before you leave our office, we will inspect your surgical sites together with a mirror and you will receive a demonstration on how to change your gauze.

Consider the blood clot your best friend and do not spit your best friend out.

Day of Surgery: Blood clot forms on this day

How to protect your blood clot

  • NO SPITTING, no spitting, no spitting.
  • Bite on the gauze for 30 minutes straight. Change gauze every 30 minutes at total of 2 hours maximum.
  • Do not eat, drink or sleep with gauze in your mouth.
  • Do not touch the wound socket with your tongue or finger.
  • Do not play with the stitches.
  • Do not suck on the wound socket.
  • Place ice packs to cheek to help minimize swelling. 
  • On this first day of surgery, there is no hygiene: no rinsing, spitting, or brushing.
  • Do not pick at the surgical sites. Picking at the sites will disrupt the blood clot.
  • Eat soft, mushy, non-chew foods

Day after the surgery and onwards

Hygiene starts on this day. A clean environment will help heal the surgical sites.

  • Use a soft tooth brush to brush teeth at least 2 times a day.
  • Do not allow tooth brush to touch the surgical site which has your stable blood clot.
  • To clean the surgical sites, use a gentle warm salt water swish and spit 5 – 6 times a day.
  • For adults, use Perioguard as a rinse, swish for 30 seconds and gentle spit, at least 2 times a day.
  • A soft, mushy type diet will not stick between teeth, so no need for aggressive brushing. (Please see list of Food Suggestions).
  • You may advance to your regular diet once you have seen us for post-operative visit

Sinus Precautions

It is very likely your upper wisdom teeth roots were in or close to your sinuses (highly impacted). We ask you to take simple sinus precautions in order to prevent a hole forming between the mouth and sinus.

  • Do not blow the nose hard for up to four weeks. Wipe away any secretions from your nose with a soft tissue.
  • Do not use a straw
  • Do not suck on the site
  • Do not smoke

Bleeding

Slight bleeding, oozing, or redness in the saliva is normal. 

Bite on gauze for 30 minutes straight. Replace gauze every half hour for a total of two hours. If you use gauze more than two hours, overuse of gauze may cause the sticky blood clot to attach itself to the cotton gauze and be accidentally pulled out, causing re-bleed. If bleeding continues, bite on a moistened black tea bag for thirty minutes. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise.

If bleeding does not subside, call our office at 713-439-7575 for further instruction.

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 an average 3 days  post – operatively. However, the swelling may be minimized by the immediate use of ice packs in the first 24 hours. Sleep with your head elevated on a few pillows.

Pain

Note: Pain medication is recommended in accordance with your health history.

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every 3-4 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken four times daily, not to exceed 3200mg daily for a healthy adult. Consult our practice for individuals under 18. Do not take the two medications at the same time. Check with your treating surgeon to ensure these OTC medications are appropriate for you.

For severe pain, the prescribed medication should be taken as directed. DO NOT combine prescription medication with other Tylenol products, alcohol or recreational drugs. 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. 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. Prescribed pain medication is meant to be used responsibly.

Diet

Drink from a glass/cup and do not use straws. The straw sucking motion can cause more bleeding by dislodging the blood clot.

You may eat anything soft by chewing away from the surgical sites. A high calorie, high protein intake is very important. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake with  5-6 glasses of liquid such as Ensure, Gatorade, water, milk, etc. Try not to miss any meals. 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 up for one minute before standing.

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. 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 will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. Call the office if you have any questions.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take the prescribed medicine. Sip on warm tea, chicken soup broth or ginger ale without a straw. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. 

Smoking/Tobacco Products

Refrain from smoking for 7 days after surgery, in order to prevent dry-socket, infection and osteomyelitis.

Other Complications

  • Numbness: 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. You should alert the office for follow up.
  • Fever: 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.
  • Dizziness: 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.
  • Bone Spicules: 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 or fall out while brushing. If not, they can be removed by Drs. Jason Hullett or Anu Hullett.
  • Cracked Lips: 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.
  • Soreness Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will 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 normal post-operative event which will resolve in time.

Sutures

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. They are meant to unravel and melt. This is no cause for alarm if you feel a loose end. Just remove the suture from your mouth and discard it.

If they are present at your one week post-op inspection, Dr. Hullett can easily remove them without anesthesia or needles.

Finally

Treat yourself well in this week of healing, watch a funny movie, treat yourself to a comfort food, give yourself permission to relax. Take a light walk in the sunlight. It is recommended to take 20 minutes out of your day to focus on a calming thought.

A positive attitude leads to positive outcomes.