Associates In Facial and Oral Surgery
Oral Surgery
Monroeville PA
412-374-9030

After Wisdom Tooth Removal

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of 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 by biting down on it for a half hour. After this time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing, spitting 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 local anesthetic becoming diminished.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.

Control of Bleeding

Immediately after surgery, gauze packs are placed in your mouth, and you are asked to bite down firmly on them for at least 30-minutes. This is to insure that your blood will form a healthy clot in the area of surgery. A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. If you sense blood in your mouth do not spit it out; simply swallow the blood so that you do not disturb the normal clot forming in your mouth by the vacuum created by the spitting process. 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 again for 30 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. When the time period is up, wash hands thoroughly and remove the gauze pack. Usually this is when you arrive at home after discharge from the office. If your mouth is dry, nothing more need be done. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If simple bleeding persists after these maneuvers and/or you can see a bleeding area “pumping” or “squirting” blood, call Dr. Catone’s office. This bleeding is usually easily controlled by the doctor with appropriate instruments.

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 the day following surgery and will not reach its maximum until two to three days post-operatively. In most cases, (unless you had some condition preventing it) you will have been given special medications to control postoperative swelling. Note that the majority of patients have facial swelling after oral surgery. However, the swelling may be minimized 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 surgery was performed. After 36 hours, ice has no beneficial effect. 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. To avoid injury to the skin, place the cold or heat on for 20-minutes then discontinue for 10-minutes and then resume. In any case, first coat the skin with petroleum jelly (Vaseline) then put on a thin towel, then finally the heat or cold application.

Do not sleep on your stomach as the swelling will preferentially increase in your face. Sleep on your back with elevation of your upper body from 2 or 3 pillows.

Pain

  • Dr. Catone has prescribed pain control medications for you to be taken exactly as he directs and as it appears on the prescription bottle. Do not take more than indicated or take another person’s pain medication. Do not use out-dated pain pills.
  • Pain medication is most effective when taken at the initial onset of pain sensation. Do not wait until the pain reaches maximum intensity before using the medication.
  • Note that the sedation and/or anesthesia and pain medication may make you feel drowsy or dizzy. Therefore, do not drive your car, operate dangerous machinery or engage in potentially hazardous activities after taking your pain pill or for 24-hours following your surgery.
  • Don not place pain medications in easy reach of children or at work where there may be potential drug abusers.
  • Most pain medications are narcotics so that they also have a tendency in sensitive persons to cause nausea. Thus, after you have taken your medication, lie down and rest. Do not engage in physical activity for at least 2 hours. This will help prevent nausea. It is recommended that you drink a warm beverage (weak tea) after taking pain medication. This will assist in removing it from the stomach and increase absorption into the blood stream.
  • Dr. Catone will prescribe only those analgesics or narcotics that he feels would be appropriate to control your pain for the kind of surgery you have experienced. Remember that most narcotics and sedatives are addictive/habituating and must be used prudently. If pain persists despite the prescribed medications, call Dr. Catone for advice. Most narcotics cannot legally be prescribed over the telephone; therefore, it will be necessary for Dr. Catone to see you again before issuing new or different medications. This is important because persistent pain may indicate an underlying problem that may be easily corrected after an appropriate examination.
  • If your sedative dressing or “oral bandage” has fallen off in a particular segment of your teeth (usually not after wisdom teeth extraction), please call the office. It may or may not be necessary to return to the office to have the dressing reapplied.
  • 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 to four 200 mg tablets may be taken every three to four hours.

Control of Nausea

  • Nausea is not an unusual consequence of oral surgery and can occur after sedation, anesthesia, taking pain pills, use of antibiotics, or not eating adequately.
  • You can control nausea by Coke syrup or over the counter Emetrol (a non-prescription medication obtained at a drug store) or taking one ounce of carbonated drink, such as ginger ale, every hour for 5 or 6 hours, or a pinch of salt with bicarbonate of soda in a glass of water.
  • The use of antacids (Riopan, Gaviscon) can also be used to control upset stomach.
  • Persistent nausea and vomiting after stopping pain medications and 24 hours after sedation or anesthesia must be addressed by Dr. Catone. It is important that you call him with the details.

Control of Diet

  • The most important procedure that your must carry out after oral surgery is to gradually resume a normal diet. After oral surgery, the tendency is to discontinue normal eating because of the presence of an area of surgery in your mouth. This will result in fatigue, headache, nausea, dehydration, and delayed wound healing. A high calorie, high protein intake is very important
  • In some cases Dr. Catone will order a dietary supplement in powder or liquid form to be taken 2 or 2 times per day. The powder is usually placed in milk, water or juice and can be shaken in a tumbler or blender with the addition of a scoop of ice cream. (Boost, Ensure)
  • In the hospital your receive a clear liquid diet then a full liquid diet (eggs, custard, Jell-O, ice cream, soup, mashed potatoes, pasta etc.) Meats, vegetables and fresh fruit can be blenderized if preferred. After 48 hours, begin eating ground meat, fish etc, and gradually increase your diet to normal consistency after 72 hours. Do not skip meals. If you are a diabetic, maintain your normal caloric diet and the medication as usual.
  • Drink at least 5 to 6 glasses of liquid daily.
  • Take a one-a-day multiple vitamin and 3,000 mg of Vitamin C per day.
  • As a precaution, do not bite down on hard food (well-done meat, nuts, etc.) for as least 5-6 weeks after impacted teeth (wisdom teeth) surgery of the lower jaw. This is especially true in those impacted lower teeth that are deeply positioned. This will decrease the possibility of jaw fracture. In the majority of instances, jaw fractures do not occur as a direct result of dental surgery.
  • Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical site(s).

CAUTION: If you suddenly 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.

Control of Oral Hygiene

KEEP YOUR MOUTH VERY CLEAN!

  • Do not stop brushing your teeth. Moisten your toothbrush in hot water to make the bristles soft and brush with your regular toothpaste. You can use your electric toothbrush in the same manner.
  • After brushing and after meals (3-4 times per day), mix ¼ teaspoon of salt in 8-oz water and rinse gently. Begin rinsing with salt water 24 hours after oral surgery. Use an entire glass of salt water for rinsing and hold water in your mouth for 20-30 seconds at a time. Rinse like this for 5 days to one week. Rinsing flushes away food particles which may be lodged around the surgery sites.
  • If you have a Water-Pik or similar device at home, set it in the range of 4-6 or medium and use as you would normally. Do not apply the nozzle directly to the surgical sites.
  • Make sure that you also brush your tongue to remove any debris present.
  • If the oral surgical wound opens up, do not become alarmed. Follow the same rules for cleaning as above. Dr. Catone may give you a plastic syringe to irrigate the wound as directed. The wound will heal from the bottom and sides.
  • If you have an immediate or temporary denture(s) remove the denture(s) and clean thoroughly with a denture brush and denture cleaner three times per day in addition to rinsing your mouth. Insert the denture(s) in place immediately thereafter.
  • Dr. Catone may elect to prescribe an antimicrobial mouthrinse (Chlorhexidine, Peridex, Perioguard) for you. Please use only as directed on the label or as advised by Dr. Catone.
  • After significant oral surgery, it is important that you see your own dentist’s hygienist or ask Dr. Catone for information regarding timing of a dental cleaning appointment at your primary care dentist.

Control of Infection

  • In most cases, if it is specifically appropriate, Dr. Catone will prescribe medication to control infection (antibiotics). It is important for you to take the medication exactly the way it is directed on the prescription bottle. Do not take another person’s antibiotics; it may not be appropriate for your condition or be effective. Remember, antibiotics do not necessarily prevent infection so that they may not be given to you after your specific oral surgery.
  • If a rash, skin itching, hives or difficulty breathing occurs after taking the antibiotic, contact Dr. Catone’s office immediately. If giant hives, wheezing or difficulty with closure of your throat occurs, have someone call 911 or take you immediately to a hospital emergency room.
  • If, after 48 hours following oral surgery, the swelling increased significantly combined with fever, chills, night sweats, shakes, malaise, and foul drainage and odor in your mouth, this may indicated an associated infection. Contact the office immediately.
  • If 4-5 days after tooth extraction or third molar surgery, a severe toothache-like pain develops in your mouth associated with a foul taste and odor, this may indicate a “dry socket” or a breakdown of the normal clot at the site of the extraction or surgery. Call the office at once for an appointment to have a dressing placed in the wound which will immediately alleviate the symptoms. Thereafter, you may have to present to the office for a short time on a regular basis to have the dressing changed until Dr. Catone determines that the site has healed appropriately.

Sutures (stitches)

  • In most cases Dr. Catone will use dissolvable or resorbable stitches to close the mucosal incisions after oral surgery. These stitches will dissolve over a period of 5-10 days postoperatively. If the stitches begin to fall out and you happen to swallow one, do not be alarmed as they are harmless. Early loss of stitches is usually by those stitches that were placed at surgery to control bleeding.
  • On your first postoperative visit, Dr. Catone may or may not want to remove persistent stitches. If they are to be removed, there is no discomfort, they are simply cut and slid out of the tissues.
  • If non-resorbable stitches are used, they will have to be removed 7-14-days after your surgery. They may be left in place longer if so determined by Dr. Catone.

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 may speed up the removal of the discoloration.

Other considerations

  • 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 Dr. Catone if you have any questions. Dr. Catone may elect to perform a nerve conduction study on the affected area of numbness or paresthesia. This is done in his office and it is important that serial tests be done to periodically assess the nerve issue. It is important that you follow up when these tests are scheduled. This provides a prognosis on the future healing of the nerve in question.
  • A slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
  • You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and then get up.
  • 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 Dr. Catone.
  • 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 two to 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.

Finally

  • Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Catone or your family dentist.
  • Upon discharge, please call the office at which you where you had your original procedure to schedule a postoperative visit for approximately one week after the day of your operation.
  • Emergencies: If any untoward or inexplicable reaction occurs during your convalescence, immediately call the office which answers 24 hours day 7 days a week at (412) 374-9030. After the office closes, a professional answering service will answer and put you in touch with Dr. Catone. Dr. Catone can also be reached by calling the page operator at Allegheny General Hospital at (412) 359-3131. Ask the operator to page Dr. Catone and give them your name and telephone number.
  • 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, stop exercising.

Do not drive, operate machinery, engage in sports, or use any alcoholic beverages for 24 hours following your surgery or while taking sedative or pain medications.