Wisdom Teeth

If you have been scheduled to have your wisdom teeth removed, it will be important to follow these instructions exactly as they are presented.

Pain
Discomfort is normal after the extraction of teeth. You should begin taking pain medication prior to the local anesthetic wearing off. For moderate pain, ibuprofen (also known as Advil or Motrin) may be taken if you are not allergic or intolerant to non-steroidal anti-inflammatory drugs. Ibuprofen bought over the counter comes in 200 mg tablets: 3 tablets may be taken every 6 hours as needed for pain (no more than 3200 mg/24 hour period). If you are asthmatic, do not take ibuprofen unless you have tolerated it in the past. If your pain is not controlled by the ibuprofen alone, take your prescribed narcotic in addition. Ibuprofen and your prescribed narcotic can be taken together. For severe pain, the prescribed medication should be taken as directed. (Please note: if this prescription has Tylenol [APAP] in it, do not take any other Tylenol/acetaminophen-containing medications.) Do not take any of the above medication if you are allergic or have been instructed by your doctor not to take it. This may include patients with liver or kidney disease. Be certain to take your pain medicines with food; this will help prevent nausea. Remember, narcotic pain medicine will impair your judgment and reflexes.

Antibiotics
If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.

Bleeding
Gauze pad(s) should be placed directly over the extraction site(s) and held in place with firm biting pressure; proper placement will help you not swallow blood, which can make you nauseated. Replace the gauze pad(s) every 20 to 40 minutes. When the gauze pads have little or no blood on them, they are no longer necessary. The amount of bleeding will vary from person to person. Most of your bleeding will slow within 3 to 4 hours, but a small amount of bleeding is common for up to 24 hours.

Do not rinse on the day of surgery; it may prolong your bleeding. Begin saltwater rinses the day after surgery and continue for 1 week. Rinse with warm salt water 6 to 8 times each day. To make the saltwater solution, dissolve 1/2 teaspoon of salt in a small glass of warm tap water.

If you have been given an irrigating syringe, start irrigation on the fifth day following surgery. Fill the syringe with warm salt water, and place the tip of the syringe into the extraction site to clean. Do this 3-4 times a day for 2 weeks and lessen as the surgical site heals.

Swelling
Swelling is normal after surgery and is a major cause of post-extraction discomfort. Swelling typically peaks by the second to third day and then starts to resolve; it can be reduced by the use of an ice pack. Apply the ice pack to the side of your face for 10 minutes; transfer it to the opposite side for another 10 minutes. Continue icing the face for the first 24 hours. Do not freeze the skin. Ice packs are useful for the first 24 hours only. Also, keep your head elevated on 2 pillows for 3 to 4 days. These measures will not eliminate swelling, but they help to reduce its severity.

Diet
To allow blood clots to form undisturbed, do not eat for 2 hours after surgery. Start with clear liquids, such as apple juice, tea, or broth. Gradually ramp up your diet as tolerated. Always cool down any hot foods or liquids during the first 24 hours. If you were sedated for surgery, do not eat fatty, creamy, or oily foods; these foods may cause nausea. You should eat only soft food for the first week: for example, soups, eggs, mashed potatoes and meatloaf are fine. For 2 weeks (8 weeks if you had lower wisdom teeth extracted), do not eat hard, crunchy, or very chewy foods, such as European breads, pizza crust, steak or jerky, nuts, or popcorn. To help prevent dry socket, do not use a straw for the first 3 days after surgery.

Oral Hygiene
Begin brushing your teeth the day after surgery. It is important to brush all of your teeth, even if the teeth and gums are sensitive. Bacterial plaque and food accumulation near the extraction site will delay healing.

Do not smoke for at least a week. Smoking will increase your bleeding. The nicotine and tar in tobacco impair healing and may cause a dry socket.

Actvity
Unless told otherwise, do no vigorous physical activity for 3 days following your surgery. Physical activity increases your blood pressure, which will cause an increase in your swelling, pain, and bleeding. You may gradually increase your activity, such as jogging or tennis, 5 to 7 days after your surgery.