Tips for a Speedy Recovery
Wisdom teeth, or 3rd molars are the last teeth to develop, usually in the late teens or in early adulthood. Sometimes, our jaws are not always designed to accommodate 4 extra teeth at the back of the mouth. When there is inadequate spacing, these teeth remain trapped under the gum and bone, so for most people the best solution is to have them removed to prevent future dental problems.
Here, at Your Smile Dental Care we do many wisdom teeth extractions. Knowing how to care for your mouth after surgery will make the healing process go much smoother. Below are the aftercare guidelines that we recommend for most of our patients. With many patients, the after effects of oral surgery are minimal, so not all of the instructions below may apply. Common sense will often dictate what you should and should not do. When in doubt, you should call your dental office for clarification.
* It is important to know that, like any surgery, the tooth removal procedure can be simple or more challenging and can involve any number of special circumstances. Always adhere to the advice of your own dentist as your own situation will be specific to you and may require different considerations. Any complications that you may develop after surgery should be brought to the attention of your dentist so they can address your individual needs.
* AFTER CARE
DAY OF SURGERY
Until you are ready to be taken home, you will rest under the care and supervision of your dentist in their office. You will need someone to accompany and drive you home from your surgery. We recommend that you allow someone to assist you when getting up from a lying position and help guide you if you need to walk or move around. Do not try to operate vehicles, machinery or appliances for the remainder of the day.
Your dentist will provide you with a care package for you to take home. It will contain after-care instructions, extra gauze and perhaps some pain relievers. You will leave the office with some gauze wads that have been folded and placed over the surgery sites to help stop the bleeding. Be sure to bite down gently but firmly on this gauze to make sure they remain in place – your other teeth should not be touching. Continue to apply pressure without “chewing” on the gauze. Try not to change them for the first hour unless the bleeding can not controlled. If the active bleeding persists after one hour, place enough new gauze over the surgical site for another 30-60 minutes in order to obtain pressure. Change the gauze as necessary or refold it for more comfortable positioning.
During the normal healing process, your blood will begin to clot to form a scab over the extraction site. This can take up to 8 hours to form and is why your dentist will advise that you not disturb the area at all during this time. Do not interfere with this healing process by rinsing vigorously or probing the area with your fingers or objects. Do not attempt to clean your teeth during the first day. Stay away from the surgery area except to determine bleeding. If you have stitches, do not disturb them.
Using a straw, a wind instrument, whistling, cigarettes (smoke and smokeless varieties), blowing your nose or sneezing can all cause enough pressure to dislodge a forming blood clot. Try to avoid these activities for at least 72 hours. If you need to sneeze, do so with an open, relaxed mouth and throat.
If you experience any intermittent bleeding or oozing, this is normal. You can control this degree of bleeding by putting fresh gauze over the surgical sites and then biting down firmly on the gauze for 30-60 minutes. Your bleeding should never be severe. If it is, it usually means that you are not applying direct pressure over the surgery site while biting on the gauze. Check to make sure that the gauze is placed in the correct position and not being clenched between your nearby teeth. If your bleeding persists or becomes too heavy, sometimes a dampened teabag will be more effective. Just substitute a tea bag that has been soaked in hot water then squeezed damp-dry and wrapped in a moist gauze. Position over the surgery site for another 20 or 30 minutes. You should call your dental office if your bleeding remains uncontrolled.
Bleeding may continue on and off for up to 8 hours after surgery as the blood clot forms. Limit your talking, physical activity and manage your pain as prescribed to reduce blood pressure. When the bleeding has stopped you should discontinue using the gauze. It is normal to have the taste of blood in your mouth and notice some trace bleeding that comes and goes. Your saliva may even be tinged with an orangey/red colour. Do not place any gauze back into the surgery areas once the bleeding has stopped. It is not necessary and may even stick to the blood clot causing it to dislodge when you try to remove the gauze.
Swelling of the surrounding mouth and face tissues is normal after surgery. You can minimize the effects of swelling with anti-inflammatory medications and by using ice packs. Cold packs can be purchased at most pharmacies or you can fill a zip-lock type of plastic baggie with ice. Wrap the ice pack in a small tea or hand towel and apply it firmly to your face or cheek adjacent to the surgery area. Do this in a 20 minutes on and 20 minutes off fashion for the first 48 hours after surgery. After 48 hours, we recommend that you switch from ice to moist heat and apply it to the same areas. If your dentist has prescribed you medication for the control of swelling, be sure to take it as directed.
Unfortunately, you may experience some degree of discomfort and swelling over the next 36 hours. If your dentist has prescribed any medication, have it filled by your pharmacy as soon as possible and begin taking it before your anaesthetic has had a chance to wear off. Some offices will call in your prescription to your pharmacy ahead of time so that it will be ready when you arrive after your appointment to pick it up. Ibuprofen products have anti-inflammatory characteristics and will help to reduce the swelling that usually intensifies pain. Most severe discomfort happens within the first 8 hours after the dental freezing has worn off. You can manage your pain by taking your medication as directed and refraining from activities that increase blood pressure.
You will probably just want to lie down and rest for the first day after surgery and this is the recommended post-operative protocol. Avoid all strenuous activities like exercise, heavy lifting or extended walking for the first 24 hours and limit your talking. When you rest, make sure that you recline in a position that allows your head to be elevated above your heart to help reduce bleeding and swelling. Using an extra pillow should take care of this. Protect your pillow from blood and saliva by placing a towel over it before you rest your head upon it. Do not fall asleep with gauze in your mouth.
Whether you return to work or school after 24 hours will depend on your health, recovery and how complicated your procedure was. Be sure to speak with your dentist about this and if you require an absentee note make sure you ask for one before your leave the office.
Any nausea that you may experience after surgery can be caused by the strong medications you are taking, hunger or by anxiety. You may not feel like eating, but some pain medications, such as ibuprofen, requires that you consume a small amount of soft food 15 minutes before taking them to avoid any stomach upset. Take your medication with an adequate amount of water and try to avoid dehydration as much as possible with clear liquids or non-carbonated soft drinks. Contact your dentist if your nausea or vomiting gets progressively worse.
Wait until you are alert and the numbing affect from the dental anaesthetic has worn off before you eat or drink anything to prevent choking or accidently biting your tongue, lips or cheek. Maintaining an adequate and nutritious diet is very important in your healing process and should not be avoided. Eat any nourishing food that can be taken with comfort, but remember to remove any gauze that you may still have in your mouth. Your diet during the first 48 hours following surgery should be restricted to liquids or pureed foods, such as creamed soups, puddings, plain yogurts, milkshakes, liquid meal replacements, etc. Avoid very hot foods and any type of smaller food items, like nuts, seeds, fruits with pectin/seeds, popcorn, etc. that can become lodged inside the surgery site.
Your level of comfort and tolerance will improve over the next several days allowing you to progress to more solid foods. It can take up to 7 days before you feel comfortable eating a regular diet. If you are diabetic, it is important for you to maintain your regular eating habits as much as possible and consult your family doctor about your insulin schedule.
SECOND AND THIRD DAYS
There is a normal course that should accompany your healing process. The first day will usually be the most uncomfortable and you should be content just to rest, and manage the pain and bleeding. Taking in clear liquids will be difficult, but you should get something nutritious into your system to avoid nausea and dehydration. Although the second day brings some feeling of comfort and allows you to return to a more substantial diet, you will probably experience more swelling. Continue to take any anti-inflammatory medication that has been prescribed to reduce this swelling and the pain that usually accompanies it. Limit your physical activity. Although your swelling may peak on the third day, you should begin to notice gradual improvement in comfort and appetite. Continue keeping your head elevated, using the ice packs for 24-48 hours after surgery and limiting your activity.
Keeping your mouth clean will help you avoid infection, mouth/throat irritation and bad breath. You can begin your normal oral hygiene routine as soon as the next day after surgery using minimal or no toothpaste. Any soreness and swelling may not allow you to brush all areas of the teeth as effectively as you would normally, but try to make an effort within your bounds of comfort. Do not use a water pik for at least 1 week following surgery.
Do not attempt to rinse your mouth during the blood clot formation – usually 8 hours. Rinsing with warm salt water is then permitted as long as your mouth actions and spitting are not vigorous. You can make this salt/water rinse by dissolving 1 teaspoon of salt in an 8 ounce glass of warm water. Slowly and gently rinse with a small amount of the solution, stirring the mixture in the glass before taking the next mouthful. It should take about five minutes to use the entire glassful. You can repeat this 2 to 3 times daily for the next 5 days unless bleeding begins again. If this should occur, stop rinsing immediately and return to the Bleeding instructions above. Do not use commercial mouthwashes until day 8 after surgery.
After 48 hours you can begin using hot applications by compressing a warm, moist towel, heating pad or hot water bottle to the skin adjacent to any remaining areas of swelling or tenderness in the same 20 minutes on and 20 minutes off manner as with the icepacks. This will help to relieve and soothe tender areas and help decrease any remaining swelling and stiffness.
Dry socket (alveolar osteitis) is a painful condition that occurs when the blood clot forming over the surgery site has been dislodged or has not healed properly. Without this clot, the tooth socket does not fill in with new growth tissue and the underlying bone and nerve endings are exposed to things in the mouth. This condition can only be relieved by special medication that is placed over the wound by your dentist. If you are not experiencing gradual and steady healing over the next week after surgery and you have pain that radiates towards the ear and along your jawline that is becoming increasingly more severe, contact your dental office immediately.
Sometimes, small pieces of tooth or sharp slivers of bone can penetrate and emerge through the healing gums overlying the surgery site. This can happen in as little as a week or so following surgery or many months later and will feel like a small lump under the gum area. They are not unusual, especially following a more complicated extraction, but can cause swelling and be uncomfortable as they begin to protrude through the gum. If you suspect that some of these bone fragments are beginning to emerge over the extraction area, do not hesitate to make an appointment with your dentist for an examination and quick removal.
There are other discomforts that may or may not occur. Knowing this ahead of time will reduce the anxiety that often accompanies the unexpected.
1. You may develop other pains such as ear, throat and toothaches which are usually temporary and should begin to lessen as normal healing progresses.
2. You may develop an slight fever during the first 48 hours. Stay hydrated and consult your dentist if an elevated temperature continues past this time.
3. Your lips or corners of your mouth may become dry, chapped and sore. You can moisten the area with lip balm or a petroleum-based cream like Vaseline.
4. The tissue forming over the extraction site may appear greyish, whitish or even yellow in colour. This does not always indicate infection so do not disturb the tissue area during the healing process.
5. As your stitches dissolve, remnant pieces my be annoying, but do not try to remove or pull at them.
ANTIBIOTICS and BIRTH CONTROL
It is important to know, that if you are a female taking an antibiotic as part of your dental treatment and you are also taking oral contraceptives, occasionally, the antibiotic may interfere with the way the oral contraceptive pill works, making it less effective.
Accordingly, you are advised to speak with your family doctor about the use of any additional methods of contraception while taking antibiotics and for 7 days after completing them.
Wisdom Teeth Removal Process
If your dentist has told you that you need to have your wisdom teeth removed you may wish to view our video below for further information on the removal process.
Your dentist would like your recovery to be as smooth and as uneventful as possible. Following these instructions above will assist you, but if you have questions about your progress, you should call your dental office. Most dental offices will provide you with an emergency number to call if you need to speak with someone after business hours.
Yours in Better Health,
The Your Smile Dental Care Team