After Wisdom Tooth Removal

The aim of the following information is to give you key details about recovery from your surgical procedure and the effects on your life style during the healing phase. Please read the instructions and follow the directions carefully. This will help to minimize your discomfort, speed up your recovery, and help to prevent complications.

IMMEDIATELY FOLLOWING SURGERY:

• The gauze pad placed over the surgical area should be kept in place for at least an hour. You can change the gauze every hour until the bleeding has slowed down then you can remove and discard it.
• Vigorous mouth rinsing 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 Ibuprofen (Advil) or the prescribed pain medications as soon as you get home BEFORE the local anesthetic starts to diminish and you begin to feel discomfort.
• Restrict your activities the day of surgery.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.

RECOVERY TIME FOLLOWING SURGERY:

Recovery time is difficult to predict as each person reacts differently to the surgery. Make sure to take time off from work or school after your surgery to recover fully before returning to your daily routine. Let your employer or teacher know that you may need one week off. If you feel that you are making good progress, you may choose to return to light duties. Returning too soon might delay your recovery. Do not expect to lead a normal life for the first few days following surgery. Make sure to REST. You may want to cancel social engagements, fitness classes, participation in sports, and yard work so you can concentrate on your recovery.

DIET:

Proper nutrition is important for healing as well as for your general health. Make sure to drink plenty of liquids after GA or IV sedation. For 24 hours after the surgery you may have clear fluids such as juice, pop, water, jello, popsicles, and clear broth. For the first 4-5 days you will be on a modified diet of soft foods: ice cream, milkshakes, yogurt, pudding, custard, congee, smoothies, jello, popsicles, clear broth (e.g. chicken, beef, vegetable, miso), puree soup, apple sauce, slurpees, water, and juice. Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot.

Avoid hot drinks, avoid spicy or acidic foods as they might upset your stomach. Also avoid eating any foods with small seeds such as poppy, sesame, and raspberry seeds as they get trapped in the extraction site. Use a blender to prepare soups and puree other foods. You can use Boost or Ensure, which you can purchase at the pharmacy, to add nutrients to milkshakes and smoothies. By the 5th day after surgery you can add soft nutritious foods like eggs, soft bread, mashed potatoes, soft meats, tofu, and fruit to your diet. You can return to a normal diet after one week if the surgical area feels comfortable. It will be uncomfortable to eat firm, chewy, or crunchy foods (such as nuts, carrots, corn chips, gum, etc) for about two weeks.

ORAL HYGIENE:

Good oral hygiene is important for fast healing.

No rinsing of any kind should be performed until the day following surgery. You may gently brush your teeth as usual using a soft toothbrush. You can also run your brush under hot water to soften the bristles. It may be uncomfortable to brush near the extraction site(s) for a few days. Don’t worry, it will soon be possible to give your teeth a thorough cleaning and if necessary, you may book a hygiene appointment with your dentist.

The day after surgery you should begin rinsing at least five to six times a day with a cup of warm water mixed with a teaspoon of salt especially after eating. We do not recommend over the counter antiseptic mouth rinses as they do little to aid oral hygiene. Peridex (Chlorhexidine) mouth rinse is effective and will be prescribed post operatively. Be sure to brush and floss your teeth twice daily while using Peridex to avoid staining of the teeth.

STITCHES:

For most routine surgery, dissolving stitches are used and will disappear quickly and are normally gone in 7 days. In cases where stitches need to be removed, you will be informed at the time of surgery and an appointment will be scheduled.

WHAT SIDE EFFECTS OR COMPLICATIONS MAY ARISE?

None are expected but as with any surgery, there are some that you may or may not experience. These are described below:

BLEEDING:

Bleeding after surgery may occur and is usually considered normal. Blood does occasionally ooze gently from the wounds, and when mixed with saliva it can appear to be far worse than it actually is. If you have constant oozing you cannot control or if it seems excessive then contact our office. Change your gauze every hour (we will provide you with a pouch of gauze to take home). Once the bleeding has slowed down and you feel comfortable you can stop using the gauze. Teabags may be substituted if you run short of gauze pads. If you feel the gauze pad soaks through within the hour, just add another piece to the original gauze instead of changing it. Changing the gauze too frequently will remove the clot that is trying to form.

Make sure the gauze is folded over and tucked in right over the extraction sites. It will not be effective if it is merely clenched between the teeth as it needs to apply pressure directly to the site of surgery.

BRUISING:

You may notice some discoloration or bruising of the skin that typically affects the cheek area. It may take up to 14 days for the bruises to fade. Some people bruise more easily than others do and cosmetic foundations and powders can help mask the bruises. Rarely there may be bruising at the site of the IV on your arm or hand and this will also fade with time.

JAW STIFFNESS:

Occasionally patients find that their jaw stiffens after surgery and sometimes you may find it difficult to open your mouth as widely as before surgery. This will gradually improve and will return to normal with time but this may take several weeks.

ALTERED SENSATION IN LOWER LIP/CHIN/TONGUE:

This will have been discussed in detail before the surgery during the consultation appointment. The nerve supplying sensation to the lower lip area passes through the jaw beneath the roots of the lower molars and although all precautions are taken, the nerve may be bruised as the molar tooth is removed. The nerve may not function normally for a while, and this may manifest as a ‘pins and needles’ sensation or as ‘numbness’. It may take several weeks or even months for the sensation to return to normal. If this occurs please notify our office and we will book a follow up appointment for you.

INFECTION:

As it is normal for the mouth to be full of bacteria, you may be prescribed antibiotics to prevent infection of the wounds. Reduce the chances of infection by daily saltwater rinses starting the day AFTER surgery. Dissolve 1 teaspoon of salt in 1 glass of boiled water. Once cooled enough to avoid burning the mouth, hold the warm saltwater in your mouth next to the extraction sites for 3 minutes, then repeat four times a day for up to 7 days. Smoking delays healing and impairs the body’s capacity to heal. Try to avoid smoking for several days before surgery and for one week after surgery. If there is any doubt about your healing, call the office and we will book a post-operative appointment for you.

PAIN:

Severe pain is usually not experienced, but some pain and discomfort is to be expected after surgery. The pain is the worst in the first 24 hours. Pain varies from person to person. Pain medication will be prescribed for you and should be taken to manage discomfort. The pain will gradually settle. Ibuprofen (Advil) or Tylenol 3 is usually sufficient. If Ibuprofen (Advil) fails to take away all the pain, consider taking Tylenol 3 alternating with the Ibuprofen (Advil). If you are still in pain and the medication seems inadequate, call our office and a stronger analgesic can be prescribed. Be sure to have your Carecard and pharmacy phone number on hand when you call our office.

SWELLING:

Various degrees of swelling may occur following surgery. To minimize swelling, steroids are often prescribed and the use of ice packs is recommended. Apply an ice pack (frozen gel packs or frozen peas or corn work well) to the affected side of your face for a maximum of 10 minutes ON then 10 minutes OFF. Place a cloth or tea towel between your face and the ice pack. Use the ice pack during the first day of surgery. After 36 hours, ice has no beneficial effect.

As every person reacts differently to surgery it is impossible to predict just how much swelling will develop. It takes approximately 7-10 days to resolve. If it doesn’t disappear or goes away and returns, please call our office.

NAUSEA AND VOMITING:

Nausea, although not very common after surgery can be caused by certain anesthetic agents or stronger pain medications.

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on Coke, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking the prescribed medicine. Gravol can be beneficial to overcome nausea.

MEDICATION:

Follow the instructions on the bottle of your prescription carefully. If you experience a rash or any side effects, stop taking the medication and contact our office. If you had oral sedation, IV sedation, or General Anesthetic, DO NOT drive, ride a bike, operate machinery, or engage in any hazardous activity for 24 hours after surgery. Even though the drugs may seem to have worn off, your reflexes and judgment may be impaired. Do not drink alcoholic beverages until you have stopped taking the pain medication. For women on oral contraceptives: If you were prescribed an antibiotic it is recommended that an alternative method of contraceptives be used for the duration of the cycle.

EMERGENCIES:

In case of emergency, you can contact the office 24 hours at #604.439.7874. During regular office hours your call will be answered by office staff, but after hours you may still call the above number and listen to the message with a pen and paper handy to note down how to contact Dr. Gumplinger’s after hours number. Leave a message for the doctor on call; make sure to speak slowly and clearly with the detail of why you are calling so that we can call you back. Please include your name and phone number.

FINALLY

• 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. Gumplinger
• 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.

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call the office for instructions.

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.

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 two to three days following surgery. Call the office if this occurs.

FOLLOW UP:

You will be informed if a follow up appointment is required. Please be sure to call our office to let us know how you are doing. If all is well then no appointment is required, however, if you experience any unusual symptoms, we would be happy to book you for a follow up appointment.

Please call the office if you have any questions or concerns and we would be happy to help.