after wisdom tooth removal

surgical instructions

PLEASE READ THESE INSTRUCTIONS CAREFULLY.  Sometimes the after-effects of oral surgery are quite minimal, so not all of these instructions may apply.  Each person will respond differently from another in similar situations.  The same procedure may also result in varying effects (swelling, bleeding, etc.) from the left side to the right side or from top to bottom. Care of the mouth is very important for proper healing and common sense will often dictate what you should do.  The following instructions will speed the healing process and reduce pain, swelling and bleeding.  However when in doubt, follow these guidelines or call our office any time for clarification.

Day of Surgery

First Hour:

Bite down firmly on the gauze packs that have been placed over the surgical areas, making sure  they remain in place.  Change them every 10 - 15 minutes until the bleeding stops.  Bleeding should never be severe.  If it is, it usually  means that the packs are being clenched between your teeth rather than exerting pressure on the surgical areas.  Try repositioning fresh packs.  If bleeding persists or becomes heavy you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in a moist gauze for 20 - 30 minutes).  If bleeding remains uncontrolled, please call our office.  It is normal to have some bleeding and oozing for up to 24 hours after surgery.    Bleeding will appear worse than it is because it mixes with the saliva.

Diet:

You may drink cool liquids as soon as you get home.  Do not chew or take in hot liquids until your numbness has subsided (this may take up to 14 hours).  It is sometimes advisable, but not required, to confine the first day's intake to bland liquids or pureed foods (puddings, yogurt, applesauce, milkshakes, etc.).  Avoid foods like nuts, sunflower seeds, popcorn, chips, etc., that may get lodged in the socket areas.  Over the next several days you can progress to solid foods at your own pace (pastas, soft vegetables, eggs, fruits, ground meats, etc.).  Liquid intake should consist of juices, milkshakes, water and/or soda pop - anything to reach 8-12 glasses of liquid a day with the exception of alcohol.  Alcohol and drugs do not mix!  Alcohol also increases the possibility of prolonged bleeding.  Increase liquids if solid food intake is less than normal. Using straws is not advisable in the immediate post op period HOWEVER if this is the only way you can comfortably take in fluids – use the straw.  Do not spit.

Exercise Care:

Do not disturb the surgical area today. Do NOT rinse, spit, suck through a straw or probe the area with any objects or your fingers.  You may brush your teeth gently being conservative of the surgical sites.  DO NOT SMOKE for at least 4 days, since it is very detrimental to healing.  SMOKING WILL INCREASE PAIN AND DELAY HEALING.  IT IS DIFFICULT TO CONTROL PAIN CAUSED BY WOUND DAMAGE CAUSED BY TOBACCO PRODUCTS.

Swelling:

Often there is some swelling associated with oral surgery.  You can minimize this by using a cold pack or ice bag wrapped in a towel and applied firmly to the face or cheek adjacent to the surgical area.  This should be applied 15 - 20 minutes on and 15 - 20 minutes off during the first 24 hours after surgery.  If you have been prescribed medicine for the control of swelling, be sure to take it as directed.  After 24 hours, it is usually best to switch from ice to moist heat to the same areas.  Swelling may be greater on the second day than on the first and will be greater in the morning than in the evening.  Bruising may also occur on the face, usually in the chin area by the corners of the mouth.  This bruising is the result of bleeding into the tissue and is of little significance.

Pain:

Unfortunately most oral surgery is also accompanied by some degree of discomfort.  You will usually have a prescription for pain medication, and if you take the first pill before the anesthetic has worn off, you will be able to manage any discomfort better.  Take the pain medication with food - never with alcohol!  DO NOT DRIVE WHILE TAKING THE PAIN MEDICATIONS.   Effects of pain medicines vary widely among individuals.  If you do not achieve adequate relief, you may supplement each pill with an analgesic such as Advil or acetaminophen.  Some people may even require two of the pain pills at one time during early stages (but that may add to the risk of upset stomach).  Remember that the most severe discomfort is usually within the first six hours after the anesthetic wears off; after that your need for medicine should lessen.

Nausea:

Nausea is not an uncommon event after surgery, and it sometimes is caused by stronger pain medicines.  Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with a large volume of water.  Try to keep taking clear fluids and minimize the pain medication, but call us if you do not feel better or if repeated vomiting is a problem.  Cola drinks that have less carbonation may help with nausea.

Instructions for the Second and Third Days

Mouth Rinses:

Do not rinse the mouth for 24 hours following surgery.  Keeping your mouth clean after surgery is essential.  Beginning the next day, rinse the mouth gently with warm salt water.  Use 1 tsp. salt dissolved in an 8 oz glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful.  Repeat as often as you like, but at least three or four times daily, after meals and at bedtime, for the next 5 days.

Brushing:

Begin your normal oral hygiene routine 24 hours after surgery.  Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.

Hot Applications:

Apply warm compresses to the skin overlying areas of swelling (hot water bottle, moist hot towels, heating pad) for 20 minutes on and 20 minutes off to help soothe those tender areas.  This will also decrease swelling and stiffness.

Syringe:

You will be given an irrigating syringe at your check-up visit, use it to keep the sockets clean.  Fill it with warm water and irrigate any open sockets gently, especially after eating.

Bone Fragments:

During the healing process, you may feel sharp edges in the surgical areas with your tongue.  It is probably the bony walls which originally supported the teeth.  Occasionally small slivers of bone may work themselves out during the first week or two after surgery.  They are not pieces of tooth and, if necessary, we will remove them.  Please call the office if you are concerned.

Dry Sockets

Normal healing after a tooth extraction should be as follows:  The first day of surgery is usually the most uncomfortable and there is some degree of swelling and stiffness.  The second day will usually be far more comfortable, and although still swollen, you can usually begin a more substantial diet.  From the third day on GRADUAL, STEADY IMPROVEMENT should mark the remainder of your post-operative course.  If a DRY SOCKET occurs it is usually on the 3rd to 5th day.  The occurrence of a dry socket after a routine (non-impacted tooth) extraction is relatively rare (2% of extractions).  It is however frequent after the removal of impacted lower third molars (20% of extractions).  After an extraction, a blood clot forms in the area where the tooth used to be.  This blood clot acts as a guide for the new bone growth and also serves to protect the exposed area from oral contaminants.  There are different influences that can cause the blood clot to dissolve, but it essentially results in the fact that there is exposed bone.  The exposed bone is sensitive and is the source of pain.

There are various situations that increase the rate at which a dry socket occurs.  These include the use of tobacco post-surgically (up to 300% increase in dry socket).  It is recommend to not smoke for 4 days post-surgery to reduce risk.  This does not mean just cutting back as even one cigarette can cause dry socket.  Other risks include age (greater age = greater risk), infection in the area prior to surgery, difficulty of the surgery, and the use of oral contraceptives. 

The term dry socket describes the appearance of the extraction area when the pain begins.  It is characterized by a deep-seated aching pain.  This pain usually radiates to the ear and to the lower jaw.  It may make the other teeth feel like they are aching.  Pain medication does not usually help the pain.  The pain is persistent and throbs constantly.  Usually the other extraction areas feel quite normal.  If left untreated the dry socket will heal, but its natural course takes 7 to 10 days to resolve. 

The treatment of a dry socket is dictated by a single goal - to stop pain.  A dry socket cannot be prevented or cured.  Treatment is straightforward.  This consists of gently rinsing the affected area followed by insertion of a medicated dressing.  This medicated gauze serves two purposes.  It first will usually give profound pain relief within 5 to 10 minutes.  It will also protect the bone from irritation of oral fluids.  The dressing is changed in our office every other day for 5 to 7 days depending on the severity of the pain.  After the pain subsides healing occurs normally and will be no different than that of an extraction without a dry socket.  If this describes symptoms you are experiencing after third molar (wisdom tooth) surgery, please call our office.

It is our desire that your recovery be as smooth and pleasant as possible.  Following these instructions will assist you, but if you have questions about your progress call the office.  Please try to call during office hours, however Dr. Johnson can be reached after hours as well.  Calling during office hours will afford a faster response. Office Number (425) 277-1844 or (800) 618-1875.

Dr. Carl K. Johnson provides oral and maxillofacial surgery procedures including: dental implants, bone grafting, platelet rich plasma, wisdom teeth, facial trauma, jaw surgery, and oral pathology, at two Washington office locations.

601 S. Carr Road, Suite #300, Renton, WA 98055
Telephone: 425.277.1844
26808 Maple Valley Black Diamond Rd., Maple Valley, WA 98038
Telephone: 425.432.1511

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