After Wisdom Tooth Removal

The removal of impacted wisdom teeth is a surgical procedure. Proper post-operative care is essential to promote healing and minimize pain, swelling, bleeding, and infection. Please follow these instructions carefully.

Immediately Following Surgery

  • Gauze:
    • To help control bleeding, bite firmly on the gauze placed at our office. Replace the gauze when you get home and every 20 minutes for the first hour. Then continue biting on gauze and changing every 20-30 minutes as needed until the bleeding is controlled.
    • It is normal to continue bleeding throughout most of the first day. Mild oozing or blood-tinged saliva is normal and may occur for up to 36-48 hours after surgery.  
  • Do NOT:
    • Rinse vigorously
    • Spit forcefully
    • Touch the surgical area with fingers or tongue
    • These actions can dislodge the blood clot and prolong bleeding or increase chances of a dry socket.
  • Hydration:
    • Start drinking water from a cup as soon as you can tolerate it.
  • Pain control:
    • Begin taking over-the-counter medications even before you begin to feel discomfort. The pain will usually occur as the local anesthetic wears off. See “Pain” below for further details on how to control your pain.
  • Activity:
    • Rest the day of surgery. Resume normal activity when you feel comfortable.
  • Ice packs:
    • Apply ice packs to the sides of the face where surgery was performed. See “Swelling” below for further details.

Bleeding

Bleeding is to be expected following surgery.

  • Bite firmly on the gauze placed over the surgical sites and change the gauze every 20-30 minutes.
  • Continue this until it appears the bleeding has mostly resolved. It is normal to bleed for most of the first day.
  • Blood will mix with saliva and make the bleeding appear far worse than it is. It is normal for blood-tinged saliva to be present for up to 36-48 hours after surgery.
  • For persistent bleeding:
    • Fold an extra gauze or two to the gauze dressing to put more pressure on the sites
    • Place a moistened black tea bag directly against the sites with the worst bleeding. This can be done along with the gauze dressing. The tannic acid in the tea helps to control the bleeding faster.

If bleeding is excessive and does not improve despite these measures, contact our office.

Swelling

Swelling is a normal response to surgery and part of healing.

  • Swelling usually begins the day after surgery
  • It commonly peaks 2-3 days after surgery.
  • Improvement is gradual over the following several days.

To Minimize Swelling:

  • Apply ice packs to sides of the face during the first 24-36 hours while awake:
    • 20 minutes on
    • 20 minutes off
  • Keep your head elevated
  • Take the Medrol Dosepak (methylprednisolone) as instructed
  • After 36 hours, warm compresses may be used to help reduce swelling and jaw stiffness.

Bruising or discoloration of the face, neck, or jaw may also occur and is a normal part of healing. 

If you experience any swelling that continues to increase beyond the first few days, contact our office.

Pain

Begin taking pain medication before the numbness completely wears off.

You may take:

  • Ibuprofen (Advil, Motrin): 600-800 mg every 6 hours as needed
  • Acetaminophen (Tylenol): 500-1,000 mg every 6 hours as needed
    • Use the lowest dose that adequately controls your pain
  • Rotate between ibuprofen and acetaminophen every 3 hours for more level pain control as described in the “ladder” instruction sheet.
  • You can substitute Aleve for ibuprofen for the last dose before bed. This will allow you to not interrupt your sleep to take more medicine.
  • Patients under 18 should stick to the lower recommended doses. Further adjustment may be needed for younger adolescents and children.
  • 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.

For severe pain that is not controlled with the above medications, you may have been prescribed a pain medication.

  • Take prescribed pain medicine as directed.
  • We typically prescribe Ultram (tramadol) which does not contain acetaminophen and can be taken along with ibuprofen and acetaminophen.
  • Some prescribed pain medications may contain acetaminophen. This will require adjusting the acetaminophen dosing to not exceed 1,000 mg every 6 hours.
  • When taking prescribed pain medicine, do not drive an automobile or work around machinery. Avoid alcoholic beverages.

Pain or discomfort following surgery should peak 3-4 days after surgery and gradually improve from there. If your pain significantly worsens after initial improvement, contact our office.

Diet

Maintaining good nutrition and hydration is important for healing and helping you feel better.

Initially After Surgery:

  • Start with clear liquids (water, gatorade, juice, Jell-O)
  • Drink out of a glass (avoid straws)
  • Avoid hot foods
  • Once you have tolerated clear liquids, advance to:
    • Yogurt, pudding, applesauce, smoothies (use a spoon)

The First 72 Hours:

  • Advance your diet as tolerated to foods that require minimal to no chewing. Be sure to eat foods that have a good amount of protein.
    • Eggs, Greek yogurt, cottage cheese, oatmeal, mashed potatoes
    • You may have coffee and soup that isn’t excessively hot
    • Avoid straws

Beyond the First 72 Hours:

  • Continue to advance your diet as tolerated
  • Start with foods that require some chewing. Be sure to chew away from the surgical sites.
    • Tender meat, soft-cooked pasta and vegetables, bread with soft crust, pancakes
  • You may use large-bore straws with thin liquids.
  • Avoid for two weeks:
    • Hard, crunchy, or sharp foods
      • Nuts, seeds, popcorn, chips, and similar foods
      • They may traumatize or become trapped in the surgical sites

Drink plenty of fluids throughout the day (at least 5-6 glasses of liquid)

Oral Hygiene

Keeping your mouth clean helps prevent infection, minimizes inflammation and pain, and promotes healing.

Day of Surgery:

  • Brush your teeth carefully, avoiding the surgical sites
  • Do not rinse or forcefully spit

Beginning the Day After Surgery:

  • Gently rinse with warm salt water after meals and before bed
    • 1 teaspoon salt in 8 ounces of warm water
  • You may have been prescribed Peridex (chlorhexidine) mouthrinse
    • Use this in the morning and before bed (after you brushed your teeth)
  • Continue brushing normally while avoiding aggressive brushing directly over the surgical sites

Activity

Day of Surgery:

  • Be sure to rest.
  • Do get up occasionally to walk around your home.
  • CAUTION:
    • If you suddenly sit up or stand from a lying position you may become dizzy or faint.
    • Be sure you sit up for one minute before standing.
    • Have someone with you.

The First 72 Hours:

  • You may increase your activity level and get out of the house.
  • Still avoid sports and exercise.

Beyond 72 Hours:

  • Return to normal activity as tolerated
  • It may take a week or two to fully resume your normal activity level.

Sutures

Sutures may be placed to help stabilize the tissues as they heal.

  • Most sutures used in our office are dissolvable
  • They commonly loosen and fall out within 7-10 days.
  • If a suture comes out early, it is usually not a cause for concern.

Things you may notice while healing 

The following are common and usually temporary:

  • Jaw stiffness (trismus) or difficulty opening
    • May last for several weeks with gradual improvement
  • Sore throat
    • Usually resolves in 2-3 days
  • Ear discomfort
  • Fatigue
  • Nausea and vomiting
    • This is typically a response to the general anesthesia or prescribed pain medicine.
  • Small bony edges felt with the tongue
    • These edges usually smooth out spontaneously.
  • Mild elevation of temperature
  • Stretched, dry, or cracked lips
    • Keep moist with Vaseline
  • Temporary numbness from local anesthesia throughout the entire first day
    • If numbness of the lip, chin, or tongue lasts beyond the first day, there is no cause for alarm. As reviewed in your consultation, this is usually temporary in nature. Call our office if you have any questions.

Dry Sockets

Dry Sockets Are:

  • Significantly painful bone healing
  • More likely to happen when the blood clot becomes dislodged from the surgical site.
  • Significantly more likely to occur with smoking and vaping.

Dry Sockets Are Not:

  • Always preventable
  • Present when your pain is adequately controlled
  • Present just because of a foul odor or taste
    • All healing sites have this due to bacteria and food debris
  • Present just because bone is visible

Symptoms typically develop 5-7 days after surgery and may include:

  • Increasing pain despite initial improvement
  • Pain radiating along the lower jaw or toward the ear

If you believe you may have a dry socket:

Contact our office. 

  • We can have you follow up at the office and place topical dressings that significantly relieves your pain.

Control your pain in the meantime:

  • Use clove oil (natural remedy)
    • Drop a few drops into the surgical sites OR dip a clean cotton-tip applicator into the oil and gently rub/apply in the sockets.

when to contact our office

Please call if you experience:

  • Excessive bleeding that does not improve despite persistent measures
  • Swelling that continues to worsen after 3-4 days
  • Fever greater than 101°F
  • Persistent nausea or vomiting
  • Severe pain not controlled by medication
  • Any other concerns regarding your recovery

Healing expectations

Most patients begin feeling noticeably better within several days. Swelling and discomfort usually peak around the third day and then gradually improve. The extraction sites will continue to heal over the following weeks and months.

Every patient heals differently. If you have any questions, please contact our office. We are happy to help guide you through your recovery.