Third Molar (Wisdom Tooth) Surgery

Post-Operative Instructions Following
Third Molar (Wisdom Tooth) Surgery

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The removal of impacted wisdom teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized by following the instructions carefully.

IMMEDIATELY FOLLOWING SURGERY Keep the gauze pad, over the surgical area, in place for one hour. After this time, the gauze should be removed and discarded.
DO NOT:

  • Rinse your mouth for 24 hours.
  • Touch the wound area, following surgery.

This may initiate bleeding by dislodging the blood clot that has formed.

Restrict your activities the day of surgery and resume normal activity when you feel comfortable. Place ice packs on your face where surgery was performed. Ice has its greatest effect in the first six hours. Refer to the section on Swelling (below) for a further explanation.
AFTER 24 HOURS You can rinse gently three times a day with a ½ teaspoon of salt water dissolved in a glass of warm water.
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 over the area and biting firmly for 60 minutes. Repeat if necessary.If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding:

  • Avoid excitement.
  • Sit upright.
  • Avoid exercise for the first 24 hours.
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 days following surgery, and will not reach its maximum until two to three days post-operatively. Swelling may be minimized, however, by the immediate use of ice packs. Two plastic bags filled with ice, or ice packs, should be applied to the sides of the face where the surgery was performed. The ice packs should be left on continuously while you’re awake. After 36 hours, ice has no beneficial effect. Ice has its greatest effect in the first six hours. 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 is beneficial in reducing the size of the swelling.
Pain Pain and swelling should subside more and more each day, following the surgery. Take prescribed medications as directed. Following the prescribed schedule will minimize your discomfort and swelling. You may also take Extra Strength Tylenol (acetaminophen 500 mg) every four hours. Tylenol works in a different manner than Ibuprofen (complementing it) so you can consume both medications at the same time.DO NOT EXCEED THE MANUFACTURERS DOSAGE RECOMMENDATIONS. ACETOMINOPHEN IN AMOUNTS GREATER THAN 4 GRAMS (8 TABLETS) WILL DAMAGE YOUR LIVER. If these medications do not control your pain, or if swelling worsens, call the office for instructions (604-882-0887).
Antibiotics If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office at 604-882-0887 if you have any questions.
Dry Socket If the pain starts getting worse after three days, and is not controlled by medication, you may be developing a “dry socket”. This is where the clot in the wound breaks down leaving a denuded tooth socket.Dry socket is painful. Pain radiates to the ear and the temple on the affected side. It is more common with lower extractions than upper. It is often also associated with an odour and a bad taste in the mouth.If you think you have developed a dry socket, call Dr. McFarlane or Dr. Stroup at: 604-882-0887.
Diet Drink liquids for the first six hours after surgery. Do not use a straw as the suction may dislodge the blood clot.You may eat anything soft away from the surgical site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. You should prevent dehydration by taking fluids regularly.Suitable liquid foods are:

  • Milkshakes, Smoothies
  • Ensure, Boost
  • Instant Breakfast Drink
  • Fruit Juices
  • Lukewarm Soup

Appropriate soft foods include:

  • Eggs (omelets, quiches, custard, etc…)
  • Cooked Cereal
  • Pancakes
  • Pasta, Noodle Casseroles
  • Meatloaf
  • Baked Fish
  • Soft Breads, Dumplings
  • Ice Cream, Frozen Yogurt

Your food intake may be limited for the first few days. You should compensate for this by increasing your fluid intake. At least five to six glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal fast if you continue to eat.

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 postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area starting 36 hours after the surgery may speed up the removal of the discoloration.
Nausea and Vomiting In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least one hour – including the prescribed medication. You should then sip on Coke, tea or ginger ale. Sip slowly over a 15 minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.
Other Complications:

  • Numbness
  • Hard Projections
  • Cracked Corners of Mouth
  • Sore Throat
  • Stiffness
If numbness of the lip, chin or tongue occurs, there is no cause for alarm. As stated before surgery, 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.  Please be careful.  Call the office at 604-882-0887, if you have any questions.

Occasionally patients may feel hard projections in the mouth with their tongue.  These projections are not roots; they are the bony walls which supported the tooth. Usually, projections smooth out spontaneously. If not, they can be removed by your surgeon.

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 throat and pain when swallowing are not uncommon. The muscles get swollen and swallowing can then become painful. This will subside in two or three 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 that will resolve in time.

CAUTION Your case is individual. No two mouths are alike. Everybody responds to surgery differently. Do not accept well-intended advice from friends. Discuss your problems with our clinical staff, Dr. McFarlane or Dr. Stroup.Dizziness
If you sit up or stand from a lying position, you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

Oral Hygiene: Keep The Mouth Clean
No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery, but rinse gently and avoid the surgical sites with the toothbrush.The day after the surgery, you should begin rinsing at least five to six times a day with a glass of warm water mixed with one teaspoon of salt, especially after eating.

Sutures (Stitches)
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.

Sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needle. It takes a minute, or so, and there is no discomfort associated with the procedure.

There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean especially after meals with salt-water rinses or a toothbrush.

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