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Surgical
Instructions

After Wisdom Tooth Removal

The removal of impacted teeth is a surgical procedure, and, just as with any other type of surgery, following instructions and providing good post-operative care is very important. Unnecessary pain and complications, including infection and swelling, 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 a half hour. After this time, if there is no bleeding 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.

Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the effect of the local anesthetic becoming diminished.

Restrict your activities the day of surgery and resume normal activity no sooner than when you feel comfortable. Generally speaking, most patients require two full days of rest after surgery; some require more. Heavy physical exertion should be avoided in most cases for 5-6 days. If a throbbing sensation occurs in the surgical area, this is a sign that the exertion is too strenuous.

Place ice packs on the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon, even for a few days after surgery. Excessive bleeding may be controlled by first gently rinsing or wiping any old clots from your mouth, then placing a gauze pad directly over the site of surgery and biting firmly with constant pressure for thirty minutes. The gauze can be folded or two can be combined if needed. Repeat this if it doesn’t work the first thirty minutes. If bleeding continues, bite on a moistened tea bag for thirty minutes, again, being sure to place it directly over the surgery site (typically, the tooth socket) with firm, constant pressure. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. Avoid hot liquids and foods. It is also important to sit upright, remain calm and limit your physical activity. If bleeding does not subside, call us (510-797-9100) for further instructions.

Swelling

The normal swelling that is expected is usually proportional to the surgery involved. A certain amount is almost always to be expected. 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 may not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs, before it occurs. Two small, plastic bags filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be used on a schedule of 20 minutes on and 5 minutes off, continuously, as long as the patient is not sleeping or eating. After 24 hours, ice generally has no beneficial effect on the swelling, but many patients find it to be a helpful adjunct in reducing pain. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face can be beneficial in reducing the size of the swelling. Once the normal post-operative swelling has resolved, it should not re-occur; if swelling does return, or, is progressively worsening, please contact the office (510-797-9100 or 408-916-9100).

Pain

For moderate 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 three to four hours, not to exceed the manufacturer’s recommended daily dose. Do not take any medications if you’ve had prior allergic reactions to them.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile, do not work around machinery, and do not consume alcoholic beverages while under the influence of these or any other medications which make you feel tired, sleepy or dizzy. Pain or discomfort following surgery should decrease gradually each day. If pain persists or worsens, it may require attention and you should call the office (510-797-9100).

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be a challenge 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; fluid replacement and maintenance is very important and should not be ignored. Try not to miss a single meal; commonly available nutritional supplement drinks can be very helpful. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Avoid any fluids or foods that are hot; your lips and mouth will be numb so test with your hand. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. This is often a sign of poor fluid/food intake. If you have been lying down following surgery, make sure you sit upright for a few minutes before standing.

Keep the mouth clean

No vigorous rinsing should be performed until the day following surgery. You can brush your teeth the night of surgery, but rinse and spit gently if you have to do so. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of lukewarm water mixed with a teaspoon of salt. If the doctors prescribed a mouth rinse for you, follow the instructions on the bottle.

Discoloration

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

Antibiotics

Not all patients and not all procedures require antibiotics. If you have been placed on antibiotics, take the tablets or liquid as directed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions (510-797-9100).

Nausea and Vomiting

In the event of nausea 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; carbonated beverages help many patients. You should take frequent, small sips over a fifteen-minute period. When the nausea subsides you can gradually begin taking solid foods and the prescribed medicine. If the nausea or vomiting does not resolve, call the office (510-797-9100).

Other Complications

If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As explained before surgery during the consultation and on the surgical consent form, this can occur and 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 us if you have any questions (510-797-9100).

Slight elevation of temperature immediately following surgery is not uncommon. If the temperature elevation persists, notify the office (510-797-9100). Tylenol or ibuprofen should be taken to reduce the fever. Be aware that following surgery in the mouth, the oral temperature will be elevated. Post-operative temperature should be taken ideally under the arm or in the ear canal.

You should be careful going from the lying down position to standing. Taking pain medications can make you dizzy, and not having taken enough fluids after surgery can also make you dizzy. You could get light headed when you stand up suddenly. If you have been lying down, make sure you sit upright for a few minutes before standing.

Occasionally, patients may feel hard projections in the mouth with their tongue. This is usually part of the bony wall which supported the tooth. These projections usually smooth out as healing progresses. If not, they can be easily removed by Dr. Minkin.

It is not uncommon for the lips and corners of the mouth to be dry and to crack. It is helpful to keep these areas moist with an ointment such as Vaseline or other products intended for the lips.

A sore throat and pain when swallowing are not uncommon. The muscles and tissues in the mouth 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 normal post-operative event which will resolve in time.

And finally……………

Sutures are frequently, but not always, 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 form your mouth if it is loose and discard it. In most types of surgery in the mouth, we will use dissolving sutures; this saves the patient the trouble of having sutures removed. These dissolving sutures will usually get loose and fall out within a week, which is a sign that the tissue underneath is most likely healing normally and that the sutures have performed their function and are no longer needed. There is no need for alarm when this happens. If non-dissolving sutures are required for your procedure, their removal typically requires no anesthesia or needles. It takes only a minute or so, and there is minimal if any discomfort associated with this procedure. So it’s really nothing to worry about.

The pain and swelling should subside gradually each day following surgery. If the post-operative pain or swelling does not improve or if your condition worsens, or, if unusual symptoms occur, call our office for instructions (510-797-9100 or 498-946-9100).

There will be a cavity where the tooth was removed. The cavity will gradually decrease in size over the next month and fill in with the new tissue. During this time, the area should be kept clean with salt water rinses or a toothbrush, especially after meals.

Just as no two individuals are the same, your postoperative healing will not be the same as another individual. Be cautious in accepting well intended advice from friends. Discuss your problem with the person best able to effectively help you: Dr. Minkin, or your family dentist.

Brushing your teeth is okay - just be gentle at the surgical sites and don’t be surprised if some bleeding occurs, even a number of days after the surgery.

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, or, if there is a throbbing sensation at the surgical site, stop exercising.

The Art and Science of Oral and Maxillofacial Surgery


Dale Minkin DDS


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