Post-Operative Instructions: Wisdom Teeth Extraction

Please read these instructions carefully

Sometimes the after-effects of oral surgery are quite minimal, so all these instructions may not apply. Common sense will often dictate what you should do. However, when in doubt, please follow these guidelines or call the office for clarification. We can be reached at (415) 397-1400.

AFTER-HOURS CONTACT

If you are having a problem after regular office hours and need to speak with Dr. Rayher, please call (415) 397-1400. Please follow the prompts or wait on the line and an operator will assist you. The operator will take your name and phone number that will be forwarded to Dr. Rayher. He will return your call. Please turn off any caller ID blocking.

BLEEDING CONTROL

• Do not use a straw or spit for 48 hours after surgery. This will encourage bleeding.
• Most bleeding stops or decreases to a slow oozing on the first day. Occasionally, bleeding persists to the next day.
• Gauze packs provide pressure on the extraction sites which helps to slow and stop bleeding. This is accomplished with constant, firm biting pressure on the gauze pack.
• Gauze packs must be properly placed to be effective. After surgery, your surgical assistant will review the proper technique with you before discharge home. To exert the necessary pressure, the gauze pack must be behind the last teeth, positioned towards the cheek (not the tongue), and large enough that when biting down, all the teeth are prevented from touching.
• Ideally, gauze packs should not be changed more frequently than every 2 hours. Heavily saturated or contaminated gauze may be changed before 2 hours. Try to minimize frequent gauze changes as this only disrupts the blood clot and stimulates more bleeding.
• Leave gauze packs in place while consuming clear liquids with a cup or spoon. A change of gauze after consuming anything but water is recommended. Try to time your consumption of these liquids with scheduled gauze changes.
• With each gauze change, the amount of blood on the pack should be subsequently less. The general progression should be from darker to lighter red with increasing areas of gauze staying white.
• Keep replacing the gauze packs until bleeding appears to have minimized. You should expect small amounts of oozing and discoloration of saliva until the next day. If unsure, continue with gauze until about an hour before bedtime.
• Although unusual, it is sometimes necessary to use gauze overnight. Although unlikely, if bleeding resumes, the process should be restarted.
• For persistent bleeding, a moistened non-herbal tea bag may be used. Place the tea bag in water, squeeze out excess water, wrap in single gauze, and use in the same fashion as a gauze pack.
• For bleeding that is not slowing or has not resolved by early the next day, please call the office for advice.

SWELLING CONTROL

• Facial swelling will slowly develop over the first 48-72 hours. Not much swelling will be evident on the first day. Swelling is always worse after sleeping. The peak swelling will be on the second or third day. The swelling will then slowly resolve. It usually lasts 5-7 days.
• Keep your head elevated (head above the heart) for the first 48 hours. Sleep with head elevated for the first 2 nights if possible. Use extra pillows or a recliner chair.
• Use ice early and often. Ice the face for a maximum of 20 minutes at a time and then take at least a 20-minute break before reapplying ice.
• Icing is most effective when done early after surgery. Its effectiveness decreases with time from surgery. Use ice up to 48 hours after surgery.
• You will be sent home with one-time use ice packs. At home, you may use ice in a plastic bag covered with a thin towel. Alternatively, a bag of frozen peas covered with a thin towel works well. Commercial gel ice packs are also very effective. Please have the proper supplies at home before your surgery.
• Ice packs should be applied to the cheek(s) in front of the ears. If surgery was done on both sides, you may ice both sides simultaneously or alternate.

PAIN CONTROL

• You will be prescribed medications for pain relief by Dr. Rayher. Please have all of your prescriptions filled in advance and bring them to your surgical appointment. We will review them with you. Take your medication as directed. Please inform Dr. Rayher of all prescription and non-prescription medications that you take. Do not take any other prescribed or non-prescribed medications without discussing with Dr. Rayher. Please see our MEDICATION INSTRUCTIONS if you have any questions.

DIET

• Your diet will be altered after surgery.
• A clear liquid diet is recommended for the first day. The next day, a soft diet is usually well tolerated. Clear liquids are liquids you can see through and are free of pulp. Examples include broth, apple or cranberry juice, Jell-O, Gatorade, or tea. Good soft food examples are yogurt, ice cream, eggs, pancakes, mashed potatoes, and protein drinks.
• Drink plenty of fluids after surgery. This helps prevent an upset stomach and dehydration.
• As healing progresses over the next few days, resume your normal diet within the bounds of your comfort.
• If your jaw is stiff, remain on a very soft (limited chewing) diet until the jaw muscles begin to relax. This helps decrease the chance for jaw muscle spasms.
• Avoid hard, crunchy foods such as chips, seeds, nuts, and popcorn until the wounds are healed. This may take up to 6 weeks. These foods are prone to stick in the wounds and may lead to infection.
• Please obtain the appropriate foods in advance of your surgery.

ORAL HYGIENE

• DO NOT rinse your mouth or brush your teeth the first day.
• The day after surgery, if the bleeding has stopped, begin warm saltwater rinses (use only 1/2 teaspoon of salt per glass of warm water). At a minimum, rinse after every time you eat or drink anything that is not water and at bedtime. You may also rinse between meals if desired. If salt water is not available, use plain tap water. Continue rinsing until the wounds are healed. This may take up to 6 weeks.
• Resume tooth brushing with toothpaste the day after surgery. Common sense dictates to use care when brushing near the wounds for the first 2-3 days. Resume flossing the day after surgery as you are able.
• Do not use commercial mouth rinses such as Listerine or Scope for the first 2 weeks.
• If you had lower wisdom teeth removed, you will usually be given a plastic irrigation syringe and shown how to use it at your post-operative visit. If you were given a syringe before your post-operative appointment, you can begin use of the syringe on the third day after surgery. Fill the syringe with salt water or plain water, whichever you prefer. Insert the plastic tip of the syringe into the lower extraction sites and gently rinse. Repeat until the water comes out clean and clear.
• It is not unusual for some bleeding to occur after rinsing with the syringe. It will quickly stop. Do this on the lower extraction sites after every meal and at bedtime. Continue to rinse with the syringe until the wounds have healed. This may take up to 6 weeks.

ACTIVITY

• Avoid over-exerting yourself. Use common sense in resuming your normal activities.
• If you had IV anesthesia, go home and stay there for the remainder of the day. IV anesthesia may cause prolonged drowsiness. You should not operate an automobile or any other equipment or machinery, nor should you plan to be responsible for children or make important personal or business decisions.
• Be careful not to sit or stand quickly as this may produce dizziness and cause a fall.
• Keep your head elevated as much as possible for the first 2 days.
• Most people can return to work or school in approximately 3 days. Some will take longer. Swelling may take 1 week to resolve. Possible complications may prolong the recovery.
• Avoid strenuous exercise for at least one week, longer if you are still having pain or your jaw is stiff.
• Do not swim for 2 weeks.

SUTURES

• Sutures are often placed to aid in wound healing.
• The sutures appear as small yellowish-white knotted string near the areas where the teeth were removed.
• Although you may feel them with your tongue, it is best to leave them alone.
• The sutures are self-dissolving and will come loose and fall out. The time varies from person to person. Typically sutures last from 2-10 days. Do not be worried when the sutures come loose or fall out.
• Rarely, sutures do not fall out and need to be removed. Please contact the office if sutures persist for longer than 2 weeks.

POST-OPERATIVE VISITS

• After your surgery, you will need to return for evaluation and further instructions. It is important to attend this visit. Typically, one visit after surgery is all that is required.
  Should any problems or complication arise, additional visits may be necessary.
• If you are having any problems or have questions, you are encouraged to contact the office before your scheduled post-operative visit.

POTENTIAL POST-OPERATIVE CONCERNS

• Following any oral surgical procedure (particularly the removal of impacted lower wisdom teeth), several undesirable effects may occur.
• You may have pain that becomes worse after a few days and does not respond to the medication you are taking. This may indicate an inflammation of the bone socket. This is known as “dry socket.” It may be necessary for you to call the office and arrange to come in for evaluation and placement of sedative dressing.
• Your lips and corners of your mouth may be chapped, cracked, or sore. Keep them lubricated with petroleum jelly.
• Do not be alarmed if bruising (black and blue discoloration) appears on your face or neck after surgery. This will resolve without any intervention. This usually takes 1-2 weeks.
• Other teeth in your mouth may ache temporarily.
• You may have a sore throat for several days.
• Sometimes the medication you are taking provides inadequate pain relief. If you are unable to manage your pain adequately, please call the office (or Dr. Rayher, if after hours).
• Removal of wisdom teeth causes inflammation of the jaw muscles. This often results in jaw stiffness which will usually resolve in 1-2 weeks. It may be necessary to do jaw stretching exercises after surgery. This will be covered at your post-operative visit.
• Occasionally, jaw muscle inflammation can lead to jaw muscle spasms and pain. This is more likely if you have a habit of nighttime tooth clenching or grinding. It is important to maintain jaw rest with limited talking and chewing. Warm compresses on the sides of the face can help relax the muscles. You may need to return to the office for evaluation and further treatment.
• Removal of wisdom teeth may trigger headaches.
• You may experience nausea or vomiting. This can be from the IV anesthetic medications, narcotic pain relievers, or antibiotics. It is important to continue to drink plenty of fluids to prevent dehydration, which can lead to serious illness. If you are unable to keep anything down, you need to call the office (or Dr. Rayher, if after hours).
• You may develop a low-grade fever on the night after surgery. If this persists or you develop a fever later, please measure it with a thermometer and call the office.
• If you develop new swelling, pain, or jaw stiffness after these symptoms had previously resolved, please call the office. This may indicate infection.
• Numbness of the lower lip or chin may persist after surgery. Mention this at your post-operative visit.
• You may notice a “hole” in your gums after surgery. This is the tooth socket, and it will fill in over the next 4-6 weeks. Food may become lodged in the sockets (especially the lower). If this happens, wound healing will be compromised, and you will be at risk for developing dry socket and even infection. It is very important to follow the above oral hygiene instructions to keep the sockets clean. You will need to do this until the sockets have filled in.

Please call our office if you have any questions.