The following will cover important post-operative information to follow after the exposure of an impacted tooth. If you are undergoing this procedure, it is important to follow these instructions exactly to ensure optimal healing and quick recovery.

After your surgery, do not disturb the wound or the packing that is placed inside your mouth. If a packing is used, this packing is temporarily in place to keep the tooth exposed; however, do not be alarmed if this packing falls out or moves from its original positioning. If your surgeon has attached a small gold chain to the impacted tooth, your orthodontist will activate the chain soon after your surgery. If this chain becomes dislodged from the tooth, please contact our office immediately to have the chain replaced.

To minimize discomfort following surgery, please follow the below directions.

Do not take pain medication on an empty stomach. It is wise to swallow some fluid, ice cream, or yogurt before pain medication is taken to reduce the incidence of nausea. Take your pain medication as prescribed. Usually, take one of the prescribed pain pills within 1 hour following surgery. This will allow the pain pill to dissolve and get into the bloodstream by the time the local anesthetic is wearing off. If prescribed, narcotic pain medications are generally needed only on the first day or two.

• If you have been placed on any antibiotics, please take ALL of the medication as directed in order to reduce the risk of recurrent or resistant infections.
• Although most patients benefit from the prescribed drugs, occasional side effects such as dizziness, rash, nausea, agitation, constipation, or diarrhea can occur. Should any of these occur, stop the drug immediately and notify the office.

You must guard against dehydration after oral surgery. Drink a total of at least eight glasses of water, milk, ginger ale, sports drink, milkshake, or soup the first day. Sucking on ice chips or crushed ice and ginger ale or 7-Up® usually aids in masking some of the local discomfort. Avoid using a straw since the pressure involved could possibly dislodge the blood clot. Avoid smoking because it slows healing and increases pain and complications. Eat soft foods such as scrambled eggs, mashed potatoes, applesauce, yogurt, and ice cream. Begin gradually returning to a normal diet a few days after surgery unless otherwise instructed. Good nutrition is important for healing and recovery. If you are diabetic, maintain your normal caloric requirements and take your medication as usual.

Do not rinse until the morning after surgery. On the day following surgery, brush as many teeth as best you can as soon as you can. Do not be overly intimidated by the pressure of the sutures. Brush very lightly over the stitches. Good hygiene is imperative to good wound healing. Food left in the wound retards healing and invites infection. A mouth rinse comprised of ¼ teaspoon salt in a glass of warm water will soothe the wound and can be used several times daily.

Do not blow up balloons, play a wind instrument (trumpet, flute, etc.), etc., for 2 weeks.

If an opening into your maxillary sinus was noted at the time of the surgery (you will be told of this), do not blow your nose; if you have to sneeze, open your mouth. The object is to avoid forcing pressure back through the sinus and out into the wound—this will cause the soft tissue closure over the socket to open up. Please see additional instructions titled “Sinus Precautions.”

Continue to take any prescription medications you were on before surgery normally unless you are advised otherwise.

The presence or absence of side effects vary from patient to patient and certainly vary with the difficulty of the surgical procedure. The following conditions may occur, all of which are considered normal:

• The face and jaw will probably swell. Swelling is the worst within 24 to 72 hours and may take a week to disappear.
• Stiffness of the jaw muscles is a protective reflex that attempts to keep the jaw from moving until wounds are healed. This tightness of the jaws should resolve spontaneously within 7-10 days after surgery.

• Prolonged or recurrent stiffness may be a warning of underlying infection. Please notify the office of stiffness if it seems prolonged or recurrent.

• Numbness of the lower lip, chin, and tongue should occur on the day of surgery due to the administration of the local anesthesia and is normal. Prolonged numbness extending to the next day usually indicates nerve damage; however, most patients will recover some or all of the lost sensation in a few weeks to several months. Please call the office as soon as this is noticed for a nerve function evaluation to determine severity of injury and if any other treatment is recommended.
• The appearance of bruising is caused by seepage of blood beneath the cheeks, chin, or under the eye (black eye). This may appear initially as swelling but often by the second or third day, it may discolor the face. The color may progress from black and blue to yellow and green, and the color may progress down your face and onto your neck. It will gradually disappear over a week or two. Moist external heat can assist in resolving the surgically created bruise.
• You may have a sore throat.
• Other teeth will possibly ache. This is sympathetic or referred pain and is only temporary.
• Your “bite” may seem to have shifted. This usually resolves within a week to 10 days.
• If the corners of the mouth are stretched, they may dry out and become cracked. The lips should be kept moist with a cream or ointment.
• There will be a hole (socket) where the tooth was removed. This area should be rinsed with warm water after each meal. In some cases, even vigorous rinsing is ineffective. An irrigation syringe will be provided for your use at our post-operative visit if it is needed. The syringe may be filled with warm salty water, then the surgical sites are irrigated to remove food and debris from the area.
• During the healing process, small sharp fragments of bone may work up through the gum tissue. This is especially true after multiple extractions, very hard bone, or in smokers. This process of “shedding” slivers of bone may occur days, weeks, or even months after extractions. If there is difficulty with some of these bone chips, please call the office and arrange for an appointment. Impressions for bridges, partial and full dentures should be postponed until the surgical sites are well healed as determined by your surgeon or family dentist.
• There may be tenderness and a stiff feeling to the vein used to administer the sedative at the time of the surgery. This is usually self-limiting. Local heat and elevation of the arm will help.

• In time (2-4 months), the vein will soften and blood will flow through it again, or it will shrink and become thread-like and unnoticeable. If the area becomes swollen, red, warm, and very tender, the concern then turns to an active phlebitis in the vein. Please notify the office if you have these symptoms.

• You may have a slight temperature elevation for 24-48 hours. If fever persists, it can be a warning of infection or dehydration. Drink plenty of fluids and if your fever persists (greater than 101 degrees F), notify the office.
• On occasion, a localized abscess occurs in the surgery site up to 2 months after the surgery. If you have a sensation of pain, swelling, stiffening of the jaw, or fever, please contact the office.
• Return to the office for your post-operative evaluation if scheduled. Feel free to contact us if any doubt arises concerning your progress and recovery from surgery.