By Dr Yao Xu DDS (Minnesota) General Dental Surgeon
Top 10 Questions After Wisdom Tooth Surgery
- What to expect after extraction?
- What should I do immediately following surgery?
- How to manage the pain?
- How do I keep the wound clean?
- How many days should I rest?
- Anything I should avoid doing?
- What foods can I eat?
- What foods should I avoid?
- What if my wound becomes really painful?
- When will the “hole” close up?
1. What to expect after extraction?
- Numbness: Numbness from the local anesthesia generally subsides in 2-3 h after surgery. If you continue to feel numbness/tingling, it may require attention, please contact your dentist immediately.
- Discomfort:Pain or discomfort following surgery is usually at its worst 24 48 hours after surgery, after that it should subside more and more every day.
- Bleeding: Slight bleeding, oozing, or redness in the saliva is not uncommon.
- Swelling & Bruising: swelling and mild bruising is normally expected and is usually proportional to the surgery involved. This is the body’s normal reaction to surgery and eventual repair. Many times the swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs.
- Suture removal: You may need to return in 1-2 weeks time to have your sutures removed or for a simple follow up review by your dentist. Please contact your dentist if you have:
- Uncontrollable pain even with the help of painkillers
- Excessive or severe bleeding
- Fever or excessive warm swelling occurring a few days after the extraction
- Allergic reaction to medications, especially rash, itching or breathing difficulties
- Prolonged numbness/tingling sensation
2. What should I do immediately following surgery?
- The gauze pad placed over the surgical area should be kept in place for 30-60 min to control bleeding. Bite down on the gauze with firm pressure, do not chew on the gauze as it increases the risk of more bleeding. Try to keep your mouth closed, swallow your saliva, do not spit.
- After this time, the gauze pad should be removed and discarded. Your dentist would likely have given you sterile gauze to take home; if you find that blood is dripping, apply new gauze and bite for 30 min, DO NOT keep changing gauze as this draws out the blood clot.
- Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
- Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished, 1-2 h after extraction.
- Restrict your activities the day of surgery, get plenty of rest, and resume normal activity when you feel comfortable.
- Place ice packs on the side of your face where surgery was performed.
3. How to manage the pain?
Pain or discomfort following surgery is usually at its worst 24-48 hours after surgery, after that it should subside more and more every day. Along with the pain, you will also experience swelling around the gingiva, which is usually proportional to the surgery involved, and not reach its maximum until 2-3 days post-operatively.
Take the painkillers prescribed as instructed, especially at night before bed to prevent yourself from waking up from pain. Most painkillers take 30 min to kick in. Ibuprofen (e.g. Perofen, Nurofen) and Acetaminophen (e.g. Paracetamol, Panadol) help with reducing pain and swelling. Taking the medication on an empty stomach may result in nausea.
If your dentist prescribed antibiotics, you need to finish the course as prescribed, if you stop the antibiotics mid-course, you may develop antibiotic resistance. Discontinue antibiotic use in the event of a rash, diarrhea, or other unfavorable reaction. Please contact your dentist if you have any questions.
4. How do I keep the wound clean?
Protect the blood clot, no vigorous rinsing should be performed until the day following surgery in case the clot is dislodged. You can brush your other teeth the night of surgery, but rinse gently. The day after surgery you should begin rinsing at least 4-5 times a day, especially after eating, with either your prescribed antiseptic rinse, or a cup of warm water mixed with a teaspoon of salt. Sometimes food gets trapped in the open sockets, be sure to rinse frequently to prevent infection and discomfort from the debris.
5. How many days should I rest?
After having your tooth extracted, you should get ample rest and avoid strenuous sports & activities. Be a couch potato! The high blood pressure and high body temperature from exercising can cause excessive bleeding. So the trick is to stay cool. We recommend for patients to take off for the day of the surgery. In Singapore, you are entitled up to 5 days of M.C. post wisdom tooth extraction, most patients are back to their normal routine after a week.
6. Anything I should avoid doing?
You are strongly advised to refrain from smoking for 3 days after the extraction. Smoking constricts blood vessels, reduced blood supply to the healing gums will delay the healing process. You are also strongly advised to stay away from alcoholic drinks if taking painkillers.
7. What foods can I eat?
After you’ve had your wisdom teeth removed, it’s very important to ensure you’re getting the right nutrition. A nutritious diet minimizes the risk of complications, helps reduce swelling, provides nourishment and aids the wound-healing process.
The foods you eat after surgery should be soft and easy to chew. They should also be abundant in vitamins, minerals, energy and protein to assist wound healing. Some suggestions are as follows:
- Protein: Salmon, tofu, soya beancurd, steamed/scrambled eggs, chicken/bone broth, yogurt
- Carbohydrates: Porridge (not too hot), mashed potatoes, soft noodles
- Vegetables: Avocado, blended soup e.g. tomato, pumpkin, corn, cream of mushroom
- Fruits: Banana, juices, smoothies
- Treats: Ice cream, flan, pudding, mousse, milkshake, jelly
8. What foods should I avoid?
The rule of thumb for food post extraction is less hot, more cold.
Food too high in temperature can cause pain to your wound, food that is too spicy may irritate your oral mucosa. Fried food is often crispy and may irritate your wound upon contact. On the other hand, cold items such as ice cream and smoothies are akin to icing your wound, therefore soothing it.
Here are some foods to avoid after wisdom tooth removal.
- Spicy foods: May cause pain and irritation.
- Crunchy and crumbly foods: Foods like chips and cookies may get lodged in the wound area and disrupt healing.
- Most grains and seeds: Can also get lodged in the wound and disrupt healing.
- Chewy foods: Can increase your risk of biting your cheek, lips and tongue, especially soon after the surgery while your senses are still numb.
- Alcohol: Avoid alcohol during the recovery period after wisdom tooth removal. It may irritate the wound or interact with any prescribed medication.
It’s also important to avoid using a straw while you recover from wisdom tooth removal. Straws create suction in the mouth that increases the risk of developing a dry socket.
A dry socket is a painful condition in which the clot that was protecting the area where the tooth was removed becomes dislodged. As a result, the underlying bones and nerves are exposed to air, which causes pain and delays healing
9. What if my wound becomes really painful?
While pain and swelling is expected for 3-4 days after extraction, during normal recovery, your pain should steadily decrease over time. However, if you feel that the pain is incrementally worsening, and/or accompanied by foul smell/taste, you might have developed a “dry socket”.
After tooth extraction, a blood clot usually forms at the site to heal and protect it. With dry socket, that clot either dislodged, dissolved too early, or it never formed in the first place. So, dry socket leaves the bone, tissue, and nerve endings exposed.
Dry socket isn’t very common, up to 5% of people get dry socket after a tooth extraction (Columbia University). Dry socket pain usually starts a day or a few days after surgery. If you’ve made it about a week after surgery and your mouth is mostly healed, then chances are you won’t get dry socket.
Dry socket must be treated by a dentist. This means you’ll need to make a return trip to your dentist’s office after your surgery. Your dentist will clean and medicate the site to help it heal. They’ll also likely recommend over-the-counter or prescription painkillers.
- Cleaning the site. Sometimes food or debris get stuck down in the empty hole.
- Medicated gauze. This should immediately relieve some pain. Your dentist will provide directions for cleaning and replacing the gauze at home.
10. When will the “hole” close up?
By the end of the 3rd to 4th weeks after your tooth extraction, most of the soft tissue (gum) healing will have taken place. You’ll probably still be able to see at least a slight indentation in your jawbone that corresponds with the tooth’s original socket (hole). Where large teeth have been removed (or a lot of bone was removed during the extraction process like with impacted wisdom teeth), a relatively significant indentation may still remain. It may persist, even for some months.
When you have a tooth extracted, it’s the healing of your jaw’s bone tissue (as opposed to your gums) that takes the greatest amount of time. After about 8 weeks your tooth’s extraction socket will have substantially filled in with bone. It takes on the order of 6 to 8 months of further healing for the extraction site to fully recontour and smooth out.
Consult your dentist or oral surgeon if you have any questions before or after your wisdom tooth surgery!