Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.
They may position themselves horizontally, be angled toward or away from the second molars, or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. Wisdom teeth also can be impacted -- they are enclosed within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Partial eruption of the wisdom teeth allows an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum diseas,e because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.
The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position and stage of development. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction exam. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Often, for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.
Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anesthetic -- the same type used to numb a tooth prior to having a cavity filled. In addition to the local anesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control any anxiety. Sedating medications that could be selected include: nitrous oxide (otherwise known as "laughing gas"), an oral sedative (for example, Valium), or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment.
After having your wisdom teeth removed, the speed of your recovery depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone). In general, here's what to expect.
A certain amount of bleeding is to be expected following surgery. A slow oozing of blood is common for 24 - 48 hours following surgery. Maintain gauze pads over surgical site(s) with constant gentle pressure for 60 minutes after leaving our office. Check gauze approximately every 60 minutes and replace when saturated. Continue to use gauze until the bleeding subsides. Gauze usage may be necessary for 24 - 48 hours after surgery. Gauze may be left in place while drinking fluids, however should be removed prior to eating soft foods.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is common. This is the body's normal reaction to surgery and eventual repair. The swelling may 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. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be used for 30 minutes on and 30 minutes off the day of surgery. After 24 hours, ice has no beneficial effect on swelling, however if it helps control pain, feel free to continue to use it. Swelling and jaw stiffness may persist for 7 -14 days. A limited mouth opening may persist for up to two weeks. This is a normal reaction to surgery.
For mild to moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen (Motrin or Advil) two to four 200 mg tablets may be taken every 4 - 6 hours. Patients with allergies to the above medications should avoid taking them. For severe pain, take the prescribed pain medicine as directed. The prescribed pain medicine can make you groggy and can slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain and discomfort following surgery often peaks around post operative days 3 -5. After this, the pain should subside more and more every day. Post operative pain in some cases, may last up to 7 - 14 days before completely subsiding.
After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. It is important to keep food away from the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment should be taken regularly. To prevent dehydration you should continue to drink plenty of fluids. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 8 - 10 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.
Keep the mouth clean
No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin gently rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt, or Peridex mouth rinse (if you were prescribed this).
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Frequently bruising will migrate into the neck and chest region during the week following surgery. Moist heat applied to the area may speed up the removal of the discoloration.
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the dentist if you have any questions.
Nausea and Vomiting In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on water, coke or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. If nausea and vomitting continues past the first post operative day, call our office for further suggestions.
If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call our dentist if you have any questions. Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen may be taken to help reduce the fever. You should be careful when you go from the lying down position to standing. Due to the fact that you were not able to eat or drink prior to surgery, your body is moderately dehydrated. This makes you more succeptible to fainting. In addition, pain medications can make you feel light headed. You could get dizzy when you stand up suddenly. Before standing up, you should sit for thirty seconds and then get up. Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. Often these bone spicules do not develop until several weeks following surgery. They most frequently occur in the area of lower molar extractions adjacent to the tongue. If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as vaseline, caramex, or blistex. Sore throats and pain when swallowing are common. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 3 - 5 days. Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a up to 2 weeks following surgery. This is a normal post-operative event which will resolve in time.
Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures will slowly dissolve over time. Usually the sutures dissolve to the point where the knot becomes unraveled. At this point just carefully rinse your mouth and the suture should come out easily. The pain and swelling should subside more and more each day following surgery. As mentioned previously, pain and swelling often peak 3 or 4 days after the surgery. There may be a cavity where the tooth was removed. The cavity will gradually fill in with the new tissue over the next month. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush.No two mouths are the same. Some patients may heal fast with little or no pain, while others may have a more prolonged recovery with significant pain. If you have any concerns about your healing call our dentist. Brushing your teeth is okay - just be gentle at the surgical sites. A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 3 - 5 days following surgery. Call the office if you have questions concerning possible dry sockets. Limit your activities, (no working out or exercising) for 7 days after surgery.
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