After Wisdom Tooth Removal
The proper care of surgical sites by the patient will hasten recovery and possibly prevent complications.
Please review the following recommendations.
Diet: Fluids are encouraged as soon as tolerated, but avoid hot liquids, such as coffee, until the numbness has resolved. Soft and solid foods are permitted as tolerated.
Hygiene: Avoid rinsing the mouth the first day. On day two brush unaffected areas as usual and rinse the surgical site with either prescribed mouthwash (Peridex twice daily) or warm water every 4 hours. Your customary mouthwash is acceptable, but may cause pain if it contains alcohol. This can be diluted with water to reduce discomfort.
Antibiotics: Post operative antibiotics are usually not prescribed after third molar surgery, as a single preoperative dose only has been shown to lower infection rates in several studies.
Swelling: After surgery, swelling is normal and expected. Peak swelling normally occurs 48-72 hours after surgery and then gradually subsides. To minimize swelling, apply ice to the face, as much as possible during the first 48 hours, after which application of heat will enhance resolution of swelling. Staying upright also helps with swelling, so when lying in bed use an extra pillow under your head to elevate it.
Bleeding: The surgical site may continue to bleed or ooze slightly for a day or two. This is
generally no cause for alarm. If severe bleeding occurs, the place a folded gauze directly on the site and apply firm pressure for 30 minutes. If this is unsuccessful, then apply a moistened tea bag in the same manner for 30 minutes. If this fails then call the office for assistance. Avoid frequent gauze changes as this may actually encourage bleeding. Limit vigorous physical activity for the first 48 hours after surgery as this may encourage bleeding.
Limited mouth opening:
Limited mouth opening or tightness of the jaw is expected after surgery and usually lasts more than one week. This is cause by irritation of some of the muscles that are used for chewing. These muscles spasm in response and become tight. The tightness usually resolves spontaneously within two weeks after surgery.
Nausea: Occasionally patients will experience nausea. This is usually due to prescription pain medication. Taking your pain medication with meals can reduce the chance of this. If nausea persists, then eating a bland diet (toast, bananas, rice, and applesauce) can help. Drinking ginger ale is also helpful. If you are able to reduce the amount of pain medication you are taking this may also help. If your nausea persists in spite of these measures then you should call the office for assistance.
Activity: Avoid vigorous physical activity during the first 48 hours as this will be uncomfortable and may cause bleeding. Rest is encouraged at first. After the first 48 hours activity may be pursued as tolerated. Most patients return to work or school after 3-4 days of recovery.
Sutures: Sutures may or may not be used for your surgery. Resorbable sutures which fall out in 5-7 days are normally employed for your procedure. They do not require removal. If they come loose early, it is usually not a problem as a redundant amount is usually placed. If a suture comes loose and is dangling in the mouth causing discomfort, then you may clip it if you feel comfortable doing so.
Opioid medication refills are rarely required and generally discouraged. Any refill requests for controlled substances must be made during office hours.
Smoking: Smoking places patients at increased for healing delay and painful inflammation of the bone of the tooth sockets (dry socket). Abstaining smoking for two day prior to the procedure two after can lower your risk of this problem. If you pain does not improve after four day or even becomes more severe then you may have dry socket. Please call the office for assistance if this should occur.
Steroids: A preoperative dose of steroids is usually given just before 3rd molar surgery through your IV to help with post operative swelling. A Medrol Dose Pak is usually prescribed for use after surgery to reduce swelling, pain and limited mouth opening. This is an oral medication with clear instructions for use on the package insert.
Pineapple Extract: There are several studies showing that the pineapple extract Bromelain used after 3rd molar surgery can result reduction in pain, swelling, and limited mouth opening. VitaMedica sells a Bromelain and Quercetin supplement that can be used three days before surgery and continuing through seven days after surgery. It is available through Amazon.com