After Wisdom Tooth Removal

Dear Patients and Care-givers,

We want your recovery from oral surgery to be as comfortable and rapid as possible.  That is why we have provided this step-by-step guide to help you care for yourself after surgery.  We urge you to follow it carefully.  Having teeth removed is a significant surgical procedure that affects your whole body.  It will take your body several days to recover.  Following these procedures can help you to reduce your discomfort and promote more rapid, uncomplicated healing.  We appreciate the trust you have placed in us by selecting us to perform your surgery.  Because we are committed to providing you with the best care possible, we welcome your comments and questions about any aspect of your treatment.  If at any time, you feel that something you are experiencing is not normal, or you have questions, please feel free to contact our office.

Sincerely,

Dr. Jack Neal
Dr. Craig Neal
Dr. Galia Leonard

Day 1:  The first 24 hours

On your way home

1. Have you filled your pain medication prescription?  If not, do so now. Wait to take the medication until you have completed steps 2-6.

When you first arrive home

2. Keep firm, continuous pressure on the gauze to help slow bleeding.  Be aware you will bleed throughout the day; this is normal.  Change the gauze every hour until the bleeding stops. There is no bleeding that pressure on the gauze will not stop.  You may notice some oozing after the gauze is removed and a pinkish tinge to your saliva, this is normal.  For additional information, see the commonly asked questions below.
3. Rest with your head elevated, as you would in a recliner.  Expect to sleep for most of the day.
4. Apply ice packs to your face over the surgical area to reduce swelling.  Begin ice during the first hour and continue for 24 hours.  Follow a schedule of 15 minutes on and then 15 minutes off.  The ice is most effective in reducing swelling during the first 24-36 hours, although the swelling may continue for several more days.

In the first few hours after surgery

5. Drink a carbonated beverage to help settle your stomach.  Do not use a straw.  A straw creates suction which could break down the blood clot at the surgical site, prolonging bleeding and delaying healing.  Smoking causes a similar problem.  Please do not smoke.
6. Drink a cold milk product about 30 minutes after the carbonated beverage.  We recommend a milk shake.  This helps minimize the nausea that pain medication can sometimes cause.  If you’re allergic to milk products, or you’re lactose intolerant, you can try fruit juice or soup.
7. Take the first dose of pain medication as directed on the label after you drink the milk product recommended above.  Continue to take your medication as prescribed throughout the day.  Report any adverse reactions to drugs, such as rashes, itchiness, or difficulty breathing by calling us immediately.
8. Drink fluids frequently.  Wake younger children every hour to have them drink fluids.  This will minimize nausea and promote good hydration.
9. Begin eating very soft foods today.

Days 2 and 3:  48-72 hours

1. Eat a soft diet.  Choose nutritious foods such as: scrambled eggs, yogurt, oatmeal, mashed potatoes, mashed bananas, applesauce, fruit juices, and soup.  Consider juicing vegetables and processing meats in a blender or food processor. 
2. Avoid hard foods that require vigorous chewing or that have small pieces which could enter the surgical site and break the forming blood clot.  Such foods include, but are not limited to granola, nuts, rice, popcorn, and small candy.  A dislodged clot can lead to a dry socket, which causes severe pain, delayed healing, and may require additional treatment.
3. About 24 hours after surgery, start to rinse your mouth gently with warm salt water.  Use ½ teaspoon salt dissolved in a glass of very warm water.  Rinse about once each hour while you’re awake, roughly 10-12 times daily.  Brush very gently around areas where incisions have been made or stitches have been placed.  Brush the rest of your mouth thoroughly in your regular manner.
4. Continue to rest and drink 2-3 quarts of fluid per day.
5. Reduce swelling with gentle warm rinses and take your anti-inflammatory medication as prescribed.  Take the medication only after eating or drinking.  Swelling is normal during this time and usually reaches its peak on days two or three.

Until your follow-up visit

1. Continue to eat a soft diet.  Avoid vigorous chewing or small, hard foods.
2. Continue warm salt water rinses and regular oral hygiene.
3. Maintain good fluid intake.

At your follow-up visit

About a week after your surgery, we will remove any non-dissolvable stitches and inspect the surgical site to assure that proper healing is occurring.

Commonly asked questions

How long should I keep pressure on the gauze?

We recommend that you leave the gauze over the surgical site until the bleeding stops, changing it once every hour.  Bleeding may last all day and sometimes into the evening hours.  You may notice a pink tinge to your saliva for several days following surgery.  Do not continue use of the gauze once the bleeding has subsided.

What should I do if I still notice blood on the gauze?

Remain calm, and evaluate whether you have been keeping firm, continuous pressure on the gauze.  If not, do so for another hour.  Do not talk or spit.  Remain at rest during this time.  You may try using a moistened non-herbal tea bag wrapped in gauze over the surgical site.  Tea contains tannic acid, which promotes clotting.  After one hour, remove the tea bag and gauze.  If, after several efforts at continuous pressure, blood from the site remains bright red, contact our office.

What should I do if I feel nauseated?

Pain medication may cause some mild stomach upset.  We recommend you drink something like a milkshake before your first dose of medication.  Carbonated water or soda may also relieve an upset stomach.  If the nausea continues, or you are repeatedly vomiting, please contact our office.

When can I begin taking my pain medications?  How long should I keep them?   

Begin taking prescribed pain medication as soon as possible after surgery, but we recommend that you first eat something to alleviate the nausea that pain medication can sometimes cause.  Continue taking the medication on the prescribed schedule for the first day or two.  After that time, take pain medication as needed in accordance with prescribed directions.  If pain increases and you think you need more medication, please contact our office.

How long will my recovery take?  When can I return to work or to my normal routine?

You have undergone significant surgery and your body needs time to recover.  Plan to rest for 3-4 days before you return to normal activity.  How quickly you recover depends on how you cooperate with your body’s healing process (resting, drinking liquids, taking your medications, avoiding hard foods, vigorous chewing, rinsing gently, etc.)  By following these guidelines, you will minimize complications such as infection and the breakdown of the blood clot (dry socket) and return to your usual routine sooner.

Other Complications

• If after your local anesthetic wears off, you still have numbness in your lip, chin, or tongue, there is no cause for alarm. This is called parasthesia and 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. We will evaluate your condition at your follow up visit.  Call our office if you have any questions.
• A slight elevation of temperature immediately following surgery is not uncommon. If the elevated temperature persists, please notify our office. Tylenol or ibuprofen should be taken to reduce the fever.  Use caution if you’re taking prescribed pain medication; many of them already contain Tylenol (acetaminophen).
• Occasionally, patients may feel hard projections in their mouths following surgery. What you’re feeling is likely the bony walls, which previously supported the extracted tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Neal or Dr. Leonard when necessary.
• 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 with time.
• Frequently, dissolvable stitches are placed in the area of surgery to minimize post-operative bleeding and to aid in healing.  Occasionally, the stitches become dislodged or untied soon after surgery.  If this occurs, do not be alarmed.  As long as your bleeding is under control, there is no need to have the stitches replaced.  If your stitches have not dissolved by the time you return for your follow up appointment, we will be happy to remove them for you.

If at any time you experience something you think is not part of a normal post-surgical recovery, or if you have concerns, please call us and we’ll be glad to assist you.

Downtown Seattle	206-621-9047
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