Post-Operative Instructions: Wisdom Teeth Removal

After extraction of teeth, a blood clot forms in the remaining socket. To prevent post-operative inflammation and infection, it is important to keep this blood clot in place.

FOR THE FIRST 48 HOURS AFTER EXTRACTION:

• DO NOT vigorously rinse your mouth as this may rinse away the blood clot.
• DO NOT use drinking straws.
• DO NOT smoke.
• DO NOT disturb the extraction site with tongue or fingers.

BLEEDING

After tooth removal, it is normal to ooze blood from the tooth socket for approximately 24 hours. To minimize bleeding, do the following:

• Bite on damp gauze for 1 hour after extraction.
• Repeat with fresh gauze every 20 minutes as needed.
• DO NOT lie flat. Elevate your head with a pillow.
• Limit activity for the first 2-3 days.

SWELLING

It is normal to swell after tooth removal. The swelling is greatest 2-3 days after surgery, and may remain for an additional 3 days before it starts to resolve.

• Immediately after surgery, place ice packs over the area.
• Leave the pack on for 20 minutes and then off for 20 minutes for the rest of the day.
• After the first 24 hours, it is not necessary to continue cold packs.

POSTOPERATIVE DISCOMFORT

After removal of teeth, it is normal to experience some amount of discomfort when the anesthesia wears off. Taking prescribed medication as directed should control discomfort, but may not eliminate it.

• DO NOT operate a motor vehicle or machinery while taking pain medication. It can make you drowsy.

INFECTION

After surgical procedures, there is always a chance that infection might develop. This does not happen in most cases. A prescription may be written for you after a procedure that has a higher incidence of post-operative infection.

• Take all prescribed antibiotics until finished.
• Women taking oral contraceptives (birth control pills) are recommended to use other methods of contraception while taking antibiotics. Penicillin and penicillin-like medications temporarily decrease effectiveness of birth control pills.

SUTURES

Depending on the extent of the procedures, sutures (stitches) may be placed in order to help wound healing. If you have sutures, the doctor will inform you of this after the procedure.

• Sutures that dissolve should fall out in about 1-7 days.
• The non-dissolvable sutures need to be removed as early as 7 to 10 days. However, most are removed at 3 weeks.

OTHER INSTRUCTIONS

If you have had IV sedation or general anesthesia for your procedure, you should rest at home with moderate activity as tolerated.

For the next 24 hours following anesthesia:

• DO NOT drive a car or operate machinery or power tools.
• DO NOT drink any alcoholic beverages including beer.
• DO NOT engage in any moderate to high intensity physical activity (e.g., running, weight-lifting).

BRUSHING

• Begin normal hygiene the night of surgery or the next day, brush lightly as you get closer to the area of surgery.
• DO NOT spit.

DIET SUGGESTIONS

• Begin with clear liquids, such as apple or cranberry juice, 7 Up^®, or ginger ale.
• Advance diet the first day as tolerated, such as Jell-O^®, applesauce, or milkshakes.
• Soft, non-chewy foods are recommended for 1 week after surgery, such as mashed potatoes, scrambled eggs, or pasta.
• DO NOT eat popcorn, peanuts, seeds, or chips for at least 2 weeks after surgery to prevent an infection in the surgical site from impacted food debris.
• DO NOT rinse your mouth for the first 24 hours after surgery. After that, rinse gently with the oral rinse, if prescribed by your doctor, or with warm salt water (1/2 teaspoon salt dissolved in 8 ounces of warm water) 2-3 times a day for 1 week. Brush your teeth gently, but avoid the area of surgery for the first 24 hours.

WARNING SIGNS

If any of the following should occur, do not hesitate to contact us during regular office hours at (702) 660-5574. During the evening or night hours call (702) 660-5574 and follow the prompts.

• Bleeding that cannot be controlled by firmly biting on a gauze for 60 minutes.
• Pain which is not controlled by the prescribed dose of medication. DO NOT take higher doses.
• Persistent nausea or vomiting.
• An increase in swelling after the first 72 hours or swelling that interferes with swallowing.
• A very foul-tasting discharge that is unrelieved by normal oral hygiene.
• Fever greater than 101 degrees Fahrenheit.

FAILURE TO FOLLOW INSTRUCTIONS MAY BE LIFE-THREATENING.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but please contact our office if you have questions about your progress.

Home care instructions / answers to common questions:

BLEEDING

• After your teeth were removed, a gauze compress was placed on the wound and you were asked to keep your jaws closed firmly for approximately 30 to 45 minutes. You will likely need to replace the gauze every 30 to 45 minutes as needed to control bleeding. Please use gauze for several hours after surgery to ensure bleeding is controlled. Bleeding should be very minimal when you retire to bed (gauze should not be required when you sleep).
• If it appears the bleeding is not slowing or stopping, ensure the gauze is placed directly over the area of bleeding and firm, uninterrupted pressure should be maintained for at least 45 minutes. This will resolve the vast majority of bleeding.
• Additional measures could include utilizing a tea bag in the standard form. Place this over the extraction site and biting firmly as indicated above. The tannic acid in the tea will help with clotting. If heavy bleeding continues, phone the doctor at the office.

DRY SOCKET

Dry socket is the premature breakdown of the blood clot. This typically occurs between the third and fifth day after surgery. It is more common in females. It is more common in patients that smoke or have medical conditions that affect healing. If you overexert yourself physically then you are more likely to get a dry socket. Symptoms that may indicate you have a dry socket are increased pain and a bad taste in your mouth. Typically, the pain radiates to your ear. If you have these symptoms, please call our office and we can schedule a time to see you.

DIET

We encourage you to drink lots of liquids and maintain a soft diet. Avoid hot liquids as this may prematurely dissolve the blood clot. Do not drink alcohol as this can have compounding effects with pain medicine and may alter the effects of other prescribed medications. We recommend foods that are soft, thick, and creamy for the first 5 to 7 days. Avoid popcorn and all seedy type food (e.g., raspberries) and any other food that may easily get caught in the extraction sites. Avoid spitting, using straws for liquids, and smoking for at least one week following the surgery.

IRRIGATION SYRINGE

Beginning 5 days after surgery, use the enclosed syringe to clean out the extraction site.

To use: stand in front of a mirror and pull back your cheek to see the surgery site. With warm water in the syringe, place the tip near the surgery site and rinse. This should be done after meals and at bedtime as long as debris accumulates in the area.

MEDICATIONS

Prescriptions should be taken as directed. They are prescribed to provide pain control. As healing occurs the pain will decrease. As the pain decreases you may decrease the frequency of taking the pain medication.

PLEASE NOTE: IF YOU ARE TAKING BIRTH CONTROL PILLS AND ARE PRESCRIBED ANTIBIOTICS, STUDIES HAVE SHOWN THAT ANTIBIOTICS CAN DECREASE THE EFFECTIVENESS OF BIRTH CONTROL PILLS FOR UP TO 30 DAYS.

ORAL HYGIENE/MOUTHWASH

As soon as possible, brush your teeth gently. Brush on the tops of teeth only as you near the surgical sites with your toothbrush. Continue to brush your teeth and keep your mouth as clean as possible. A prescription-strength mouth rinse has been prescribed. Start the mouth rinse 48 hours after surgery.

PHYSICAL ACTIVITY

No activity that increases your heart rate should be performed for the first 5 days following surgery. The incidence of "dry socket" increases when physical activity is performed that raises your heart rate.

STITCHES (SUTURES)

Your stitches have been placed to control bleeding and encourage healing. These dissolve on their own in 10 to 14 days.

SWELLING

Swelling to some extent follows nearly every tooth extraction. This is nature's way of beginning the healing process. The swelling is often quite severe after the removal of impacted wisdom teeth. An ice pack applied intermittently for up to 48 hours may help to reduce the swelling. The swelling will usually reach a maximum in 36 to 48 hours. Note: Please do not blow your nose for one week after having upper wisdom teeth removed, as this can lead to healing complications.

IF YOU HAVE ANY QUESTIONS ABOUT THESE INSTRUCTIONS OR ANY CONCERNS, PLEASE CALL OUR OFFICE (406) 752-4375.

PLEASE NOTE THAT PRESCRIPTIONS WILL BE FILLED OR REFILLED DURING OFFICE HOURS ONLY SO WE ARE ABLE TO VERIFY OFFICE RECORDS.