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After Wisdom Tooth Removal

surgical instructions

     
   
     

Follow "suggestions for post operative care" above with this addendum...

When you get home from surgery, sit down, remove gauze bandages, have a sweetened light beverage and put ice packs on the face. Sit in a semi-reclining position on your recliner chair or couch with several pillows, put your feet up. Avoid laying flat for several hours after surgery, this keeps pressure from building up in the face which would promoting bleeding and swelling. Remove all gauze packs, have a sweetened light beverage like Gatorade or sweetened iced tea or a Coke. During surgery and anesthesia, your stomach produces acid and combined with the fact that you haven't eaten or drank anything can make your stomach upset. Check on your pain-reliever's directions, often the doctor has medicated you after your surgery and there may not be any need to rush into taking your prescription. Stay quiet, avoid pressures on the mouth, avoid spitting, avoid sucking on a straw, avoid talking, avoid getting up and down. Only apply gauze pressure bandages on the surgery sites if they are frankly bleeding, a little pink oozing from the gums is normal and drinking cold fluids helps offset this effect. Avoid hot beverages and hot food, luke-warm is fine. Begin oral hygiene the day after your surgery.

Over the next few days, swelling will normally occur, the amount 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 the day following surgery and will not reach its maximum until the third day. The only way to reduce the third day's swelling is by the immediate use of ice packs when you get home from surgery. Two baggies filled with ice, or bags of frozen peas should be applied to the sides of the face where surgery was performed. A convenient way to apply ice packs is to use a hooded sweat shirt or light jacket, put the hood over the head and slide the ice packs inside the hood against the face, cinch-up the hood and that should hold on the ice. Use scarfs as needed. The ice packs should be left on enough so the face is cold to the touch, After 24 hours, ice has no beneficial effect. You may use the ice if it makes you comfortable. Slight massage of the swollen areas after the third day will help the swelling drop more rapidly. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Call the office if you think your progress is unusual.

Pain control is important, you probably have been instructed in two levels of medication, an NSAID (non-steroidal anti-inflammatory drug) like Advil, Alieve, or prescription Ketorolac and an opiate drug prescription (a narcotic). If your needs are special or different, the doctor and post-op assistant has instructed you on your regimen. Call the office if you can't remember. Take the NSAID regularly for the first day or two, never exceed the limit of dose written on the bottle. Add in the opiate as you need, the NSAID and the opiate combine in your system with good effects. Caution using the opiate drug, you will be drowsy and not able to drive, or do anything requiring co-ordination. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, or is increasing, it may require attention and you should call the office.

You must eat and drink after surgery, use care and go slowly. If you only take pain killers and pills, you will vomit (and damage your surgery). Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. While you are still numb in the first few hours, liquids only. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. After all the numbing wears off, you may eat anything really soft that requires no chewing.

Liquid Foods

  • Ice cream
  • Jello
  • Yogurt
  • Broth
  • Smoothies
  • Milk shakes
  • Sherbert
  • Juices
  • Eggdrop soup
  • Instant breakfast
  • Anything through a blender/strainer or juicer.

Soft Foods

  • Mashed potatoes
  • Oatmeal, eggs
  • Pastina
  • Cottage cheese
  • Pudding
  • Applesauce
  • Pasta
  • Fish
  • Creamed spinach
  • Soups
  • Bananas
  • Hot cereals (grits, farina, cream of wheat)
  • Mac & cheese
  • Egg salad
  • Tuna salad
  • Matzo balls
  • Dumplings
  • Peanut butter
  • Omelets
  • Anything you mash up without lumps.

Caution: After anesthesia, if you suddenly sit up or stand from a lying position you may become dizzy. If you are reclined following surgery, make sure you sit-up for one minute before standing.

Oral hygiene helps you heal, after the first 24 hours, begin to cleanse the mouth, start with rinses, if you needed a prescription rinse, the label tells you to use it twice a day, AM and PM, gently soaking the fluid over the stitches area for 30 seconds, spit it out and don't rinse with water or drink for half-an-hour. Otherwise, use salt water, a cup of warm water mixed with a half-teaspoon of salt. Gentle brushing with a soft bristle toothbrush or q-tips should knock loose plaque, a sticky germ film that can slow your healing. Limit the force of hygiene in the first few days, and gradually become more aggressive until you return to full brushing and flossing. It is normal to have muscle stiffness (trismus) after mouth surgery, this will pass in a few weeks.

Take antibiotic medications till all finished if they were prescribed for you. If you get a rash or itchy, stop taking the medications. Many antibiotics interfere with the normal way you digest foods and could promote diarrhea. To avoid this, consume some live-cultured yogurt (or acidophilus capsules) daily while on antibiotic. If you are prone to urinary-tract infection, take a glass of cranberry juice daily while on antibiotic. Try to take different medications separately, that is one kind of drug and then wait half an hour before taking another drug. This allows them to be absorbed nicely, and if one type of drug is causing bad effects, we can tell which one it was.

Nausea following oral surgery and anesthesia can be from different causes, if this occurs in the first few hours after anesthesia, it may be an effect of the anesthesia and medications you have taken since you got home. Sip a cold sweet fluid, like Coke or ginger ale over a 15 minute period. You can use Pepto-bismol and similar over-the-counter medications if you want to try them. Avoid moving the head from side to side as this will stimulate the inner ear to cause nausea. Avoid bright lights and loud sounds. If nauseous later in the day, it can be from swallowing some blood into the stomach. This can be prevented by consuming dairy products or soy milk. The calcium in these products will counter-effect the blood in the stomach. If nausea is repeating and unable to control, call the office.

Numbness after oral surgery is expected. 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. So be careful. Call the office if you have any questions.

Fever is expected. Slight elevation of temperature immediately following surgery is not uncommon. Expect it around 100 degrees. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.

Final details... Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by the doctor.

  • 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 throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
  • Stiffness (Trimus) 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.

Sutures are placed 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 and discard it. The sutures will dissolve by themselves in a few days, or will be removed approximately one week after surgery. You were told which type you had, if you can't recall, just call the office. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. Call the office if this occurs.

If you are involved in regular exercise, resume light activity on the fourth day, resume stronger exercise at 10 to 14 days after surgery. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.