Wisdom Teeth

• Wisdom teeth, also called third molars, are the last permanent teeth to develop. They are located in the back of the upper and lower jaws and usually develop between the early teenage years and early twenties.

• Not all people need wisdom teeth removed if they are in a healthy position. Also, some people do not develop wisdom teeth at all.
• Although most people develop 32 permanent adult teeth, many times their jaws are too small to accommodate the four wisdom teeth. When inadequate space prevents the teeth from erupting they are called impacted. This indicates their inability to erupt into the proper position for chewing and cleaning. 
• When there is inadequate space for wisdom teeth to come in to a healthy position, it can cause several problems which indicate their removal.
  • Inflammation or infection of the surrounding soft tissue
  • Cavities on the wisdom teeth or adjacent healthy teeth
  • Bone loss surrounding the teeth
  • Cysts/Tumors
  • Crowding

• All patients will have local anesthesia to numb the area. Many patients are also sedated to increase their comfort during the procedure. A discussion with your doctor will be needed to review your health history and determine if sedation is recommended for the procedure.

• Discomfort during the procedure and several hours thereafter is minimal due to the surgical area being numb.
• Although everyone responds differently, most discomfort is experienced during the first 2-3 days following the procedure. You will likely be given pain medication to help reduce your pain during this time. The goal with pain medication is reduce your pain and make your recovery more comfortable. No pain medication will completely eliminate your discomfort. Although some discomfort is expected, most patients do very well will pain management during recovery.
• Swelling is expected to gradually increase for the first few days and maximize about day 3 or 4. This is expected to fade after about 1 week. 

DIET: Advance diet as tolerated, meaning you may begin eating and drinking as desired.  Drink lots of fluids. 

GAUZE PACKS: Gauze packs have been placed over the surgical sites.  Continue to bite on the gauze for one hour.  DO NOT CHANGE the gauze frequently as this may cause continued bleeding.  After the first 30-60 minutes, remove the gauze packs.  A small amount of oozing from the surgical area is normal, and may persist until bedtime that night.  You have been given additional gauze and this can be changed every hour as needed.

SUTURES:  If sutures were placed, they are resorbable and dissolve anywhere between 48 hours to 10 days after surgery.

MOUTH RINSE: If your surgeon has prescribed an antimicrobial mouth rinse, use it as directed.

ANTIBIOTICS:  If your surgeon has prescribed an antibiotic course, finish the antibiotic until the course has been completed.  DO NOT stop taking the antibiotic early.

SWELLING:  Expect the swelling and discomfort to peak on post-operative days 3 and 4 then gradually improve over the next several days.

ICE PACKS:  Apply ice packs directly to the outside of both cheeks.  Ice is most useful to decrease swelling the first 24 hours following surgery.  You may rotate use, 30 minutes on, 30 minutes off. Changing ice packs is not necessary at night while sleeping. Restart ice upon waking in the morning.

PAIN MEDICATION:  Take any medication as needed and as directed.  Begin taking the pain medication before all the numbness goes away.

• If you were prescribed 600mg Ibuprofen, start with that as soon as you get home and take every 6 hours as directed.
• Between the doses of 600mg Ibuprofen, take 650mg Tylenol (if there are no medical contraindications in your specific case).
• Use the narcotic pain medication only as needed for breakthrough pain, as directed.
• Note that the limit of Acetaminophen/Tylenol in a 24-hour period is 3000mg.
• Make sure to eat BEFORE taking pain medication, as most pain medications can cause nausea/GI upset when taken on an empty stomach.
• DO NOT DRIVE A VEHICLE OR OPERATE HEAVY MACHINERY WHILE TAKING NARCOTIC PAIN MEDICATION.

ACTIVITY AFTER SURGERY:  Rest as soon as you get home.  It may be helpful to keep your head slightly elevated for the first 24 hours (sleep on extra pillow if necessary.). Refrain from strenuous physical activity for 5 days.

SMOKING:  Smoking impairs healing of the tissue at any stage of recovery, but smoking is ABSOLUTELY CONTRAINDICATED FOR 7 DAYS FOLLOWING SURGERY.

DAY AFTER SURGERY CARE:

• Continue to use ice packs
• Continue to rest and keep head elevated
• Begin irrigation of the bottom surgical sites twice daily. Place the tip of the provided syringe into the extraction socket and flush with warm salt water. It is important the tip be placed directly into the socket to effectively flush debris out of the site. This may need to be done for 2-3 weeks until the sites heal.
• Brush your teeth at least two times a day; it is important to keep your mouth clean

THIRD DAY AFTER SURGERY AND BEYOND:

• Remember that the third day is usually the peak for swelling and discomfort
• It is normal to develop some bruising on the cheeks, chin, and/or neck that will resolve in several days
• Continue irrigation of the bottom surgical sites for 2-3 weeks.