Care of the Mouth After Extractions or Wisdom Tooth Removal

Medications
If you are presently using birth control pills and taking antibiotics, it is advisable to use an additional method of birth control as antibiotics will lessen the effectiveness of the oral contraceptives.

Take the remainder of your medications as per your normal instructions. Typically, patients are given pain medications to help with any pain or discomfort. Follow the directions for these pain medications and take medication as needed for pain or discomfort. Take the first dose of pain medication as soon as convenient and before the local anesthesia begins to wear off. If you experience any problems with your medication discontinue its use immediately and call our office at (415) 401-7380.

Bleeding
Following oral surgery, bleeding is normal for up to 24 hours. Gauze will be placed at the surgery site before you leave our office and should be changed every 30 minutes as needed. If bleeding persists, soak gauze in a glass of ice water. Place the cold gauze over the surgery site and bite firmly. The pressure and coldness of the gauze should aid in clotting the blood. Notify our office if bleeding continues and cannot be easily controlled.

Do not spit, rinse, smoke or use straws. They increase bleeding. If the above measures fail to slow or stop the bleeding, please notify our office.

First Hour
Bite down gently, but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not being controlled. If active bleeding persists after one hour, place enough new gauze to obtain pressure over the surgical site for another 30-60 minutes. The gauze may be changed as necessary and may be dampened and/or fluffed for more comfortable positioning.

Exercise Care
Do not disturb the surgical area today. DO NOT rinse vigorously or probe the area with any objects or your fingers. You may brush your teeth gently, DO NOT SMOKE for at least 48 hours, since it is very detrimental to healing.

Swelling
Following the removal of impacted wisdom teeth or other extensive surgery, it is expected that patients will swell. Swelling is worse the first day after surgery and typically increases until the third postoperative day. Sometimes swelling lasts seven to fourteen days. To minimize swelling, it is recommended to place ice packs (cubes in a washcloth) over the area of the surgery for twenty minutes, with ten minute rest intervals. This can be done for up to 12-36 hours.

Diet
For patients having general anesthesia or with extensive surgical procedures, the stomach may be upset for one to two days postoperatively. Nausea and vomiting are not uncommon problems. Patients are encouraged to eat as soon as possible after surgery. Clear liquids and broth are excellent to start. As the patient is able to tolerate more food, cooked cereal, mashed potatoes, gelatin desserts, puddings, and similar foods may be added. You should only eat soft and cold foods the first day following surgery.

For patients having had local anesthetics, or after the initial period of stomach upset passes, it is suggested that a regular diet be eaten. All patients should avoid food with small particles such as chips, nuts, seeds, etc., which can become trapped in open sockets and surgical wounds.

Discomfort
It is normal to experience pain following most oral surgery. The amount of discomfort and its duration will relate to the nature of your surgery and your ability to tolerate pain. Do not ingest the pain medication on an empty stomach. This may cause nausea.

Sutures
Sutures are often placed following surgery. Resorbable sutures will become loose and fall out after several days. Do not let this concern you.

Oral Hygiene
Patients who have had oral surgery should not rinse their mouths for the first twelve hours. After that it is important to rinse the surgical area very gently with warm salt water (one half teaspoon salt in eight ounces of water). This needs to be done three times a day for 2-4 weeks. The use of a soft toothbrush and toothpaste in the area is desirable starting the second postoperative day. Small amounts of bleeding at this time are normal. If commercial mouthwashes are used to rinse, they should be mixed with equal amounts of water before using.

Postoperative Visits
In most cases, patients are given appointments for postoperative visits. The purpose of these visits is to check the progress of healing, remove stitches if necessary, look for signs of infection and treat as needed, etc. Some patients will be given a monoject syringe for postoperative cleaning. It is important that these appointments be kept in order to provide the absolute best care to our patients.

Sharp Edges
If you feel sharp edges in the surgical areas with your tongue, it is probably the bony walls which originally supported the teeth. Occasionally small slivers of bone may work themselves out during the first week or two after surgery. They are not pieces of tooth and, if necessary, we will remove them. Please call the office if you are concerned.

Nausea
Nausea is not an uncommon event after surgery, and it is sometimes caused by stronger pain medications. Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with a large volume of water. Try to keep taking clear fluids and minimize the pain medication, but call us if you do not feel better or if repeated vomiting is a problem. Cola drinks that have less carbonation may help with nausea.

Instructions for the Second and Third Days

Mouth Rinses
Keeping your mouth clean after surgery is essential. Use one-quarter teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two to three times daily for the next five days.

Brushing
Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.