NASHVILLE ORAL SURGERY - WISDOM TEETH
HARRY R. (JOE) MACK, DDS, MD - RYAN F. THOMAS, DDS
BOARD CERTIFIED ORAL AND MAXILLOFACIAL SURGEONS
PREOPERATIVE and POSTOPERATIVE INSTRUCTIONS BELOW
Visit the American Dental Association Patient Library and choose the article tab for a discussion about wisdom teeth, also called third molars. You may also visit MyOms.org The American Association of Oral and Maxillofacial Surgeons website for information on a wide variety of topics related to oral surgery including a discussion about the management of wisdom teeth and wisdom teeth surgery.
NASHVILLE ORAL SURGERY
ORAL | MAXILLOFACIAL | IMPLANT SURGERY
Harry R. (Joe) Mack, D.D.S., M.D.
Ryan F. Thomas, D.D.S.
(615) 873-4495 Nashville (615) 221-0012 Cool Springs
PREOPERATIVE INSTRUCTIONS FOR WISDOM TEETH SURGERY
For the best and most comfortable recovery period, please read your postoperative instructions carefully with your caregiver when you arrive home---and again the next morning!!!
Your caregiver should read the instructions and help you follow them as carefully as possible. It is common for patients and caregivers to have questions and issues that are easily resolved by carefully reading and following the written postoperative instructions that we give to patients on the day of surgery. We care about you and want you to have the best, most comfortable recovery possible. Please call us if you have questions or concerns. We are here to help.
FOR PATIENTS HAVING I.V. SEDATION, DO NOT EAT OR DRINK ANYTHING EIGHT (8) HOURS BEFORE YOUR SURGERY. This includes water, candy, gum, and mints. You can brush your teeth as long as you do not swallow any water. If you eat or drink anything during the designated fasting period, your surgery will have to be rescheduled.
If you are taking medications prescribed by your physician, most medications can be taken later in the day after your surgery, but this is not always the case. If you have any history of high blood pressure, diabetes, kidney, liver, heart, lung, or breathing problems, as well as any other medical conditions, we will discuss your specific medication needs during the consultation visit. Do not take any medications before the surgery unless otherwise instructed by Dr. Mack or Dr. Thomas.
You must be accompanied to your surgery appointment by a responsible adult who will drive you home, as you will be unable to drive for 24 hours after being sedated. We ask that the adult accompanying you to your appointment remain in the office until the surgery is complete, which is usually forty-five (45) minutes to one (1) hour depending on the complexity of the surgery. We will explain the postoperative instructions to the responsible adult accompanying you before we discharge you into their care. You will also need to arrange for a responsible adult to take care of you until: the anesthesia has worn off, you are fully alert and recovered from the anesthesia, and you are able to take care of yourself without assistance (generally the next day). You should not make any important decisions or sign any contracts for at least 24 hours after your surgery.
Please wear loose fitting, comfortable clothing with sleeves that can be rolled up above the elbow easily.
Please do not smoke on the day of surgery as well as 3-5 days after surgery if at all possible. Smoking increases your risk of developing a painful condition called a dry socket.
Please notify the office if you start to run a fever or become sick the night before or morning of your surgery.
Anticipate a softer diet for the first few days after your surgery. We recommend softer, mushy foods such as Jell-O®, pudding, mashed potatoes, scrambled eggs, soup, ice cream, yogurt, etc…
You will need ice packs after surgery to help reduce swelling, especially for wisdom teeth extractions or more extensive procedures. If you do not have access to an ice pack you can also try ice in a zip-lock bag or an unopened bag of frozen vegetables.
Plan for a relatively inactive period for the first few days after surgery. Avoid strenuous activities that require an excessive amount of energy or movement.
We generally schedule an hour for sedated patients. If for some reason you are unable to make it to your appointment, we ask that you kindly give us at least a twenty-four (24) hour notice so we may devote this time to another patient.
If you have any questions before your surgery, please do not hesitate to contact our office as soon as possible so we may assist you. Again, the number to our Nashville office is (615) 873-4495 and our Cool Springs office is (615) 221-0012. We look forward to seeing you on your surgery day!
Postoperative Surgical Instructions
We are committed to providing the highest quality care possible and we feel that the postoperative care is vitally important to getting our patients back to their usual daily routines as quickly as possible.
Please read these instructions carefully. Sometimes the after effects of surgery are quite minimal, which means that not all of these instructions will apply. Common sense will often dictate what you should do; however, when in doubt follow these guidelines. If you have any questions please feel free to contact our office.
Bleeding, bruising and swelling are NORMAL EVENTS in the healing process and ARE TO BE EXPECTED following surgery. Bleeding typically subsides within 24 hours after your procedure and is typically well controlled by biting firmly on a piece of gauze over your surgical site. Gauze should be changed every 20-40 minutes until bleeding stops and should be removed before meals and while sleeping. Bruising may occur several days after the procedure and will resolve within 7-14 days. Swelling is a natural component of the healing process and typically peaks at 36-48 hours after surgery. Swelling can be decreased by the use of ice packs, Ibuprofen and limiting your physical activity for the first few days after your procedure. As your swelling increases, you may develop limited jaw opening. This is typically an effect of swelling and will resolve with time. If limited opening persists after your swelling subsides, please call us. Ice rotated every 20 minutes from side to side help the most for the first 12 hours.
Nausea and vomiting may occur after surgery. It is most frequently associated with taking pain medication on an empty stomach. If nausea and vomiting occur, please discontinue your prescribed pain medication and take Ibuprofen/Naproxen (Advil, Motrin, Aleve) or Tylenol for your pain control. If the nausea continues, please call us.
Please do not worry about sutures (stitches). Sutures may have been placed to close very small incisions within your mouth. Sutures typically dissolve between 2-5 days depending on the type of suture placed. If a suture loosens or comes out, there is no need to panic as the surgical site will heal fine. Some sutures will have to be removed.
We may prescribe an antibiotic depending on your procedure performed. Antibiotics should be discontinued immediately and our office contacted should a rash occur after the administration of antibiotics. Should any life-threatening swelling develop after the administration of antibiotics, go directly to the hospital. Note that antibiotics may interfere with the effectiveness of oral contraceptives (birth control).
The Day of Surgery
1. Some degree of discomfort and pain is expected. If you are an adult patient, you may take 600-800 mg of Ibuprofen (Advil, Motrin) when you get home unless prohibited by your physician. Pediatric patients should take age and weight appropriate Ibuprofen as described on the children’s Ibuprofen package. If you cannot take Ibuprofen/Aspirin products, you may substitute Tylenol for Ibuprofen. If you are still uncomfortable after taking Ibuprofen, you may take the prescribed pain medication. Please ensure to take the prescribed pain medication and antibiotics (if prescribed) as directed and with food and water. As pain medication and antibiotics may cause nausea and vomiting, it is very important to not take them on an empty stomach. Do NOT take pain medications with alcohol or other sedatives.
2. TO REPEAT: Please take Ibuprofen before your numbness wears off and please take your prescribed pain medication ONLY if needed and after eating a small meal.
3. Do not disturb the area of surgery. Avoid straws, rigorous chewing, talking, spitting and rinsing that could delay healing, restart bleeding and loosen a suture if one was placed.
4. Minor bleeding or oozing from your procedure site is normal. Light bleeding or oozing may continue throughout the day of your surgery. For the first 2-3 hours after your surgery, please keep firm, even pressure on the surgical site (s) by biting down firmly on gauze. The gauze should be folded and placed directly over your extraction site (s) and firm pressure should be applied for 30 minute intervals by biting on the gauze. Replacing the gauze every few minutes WILL NOT place sufficient pressure on the site to stop or slow bleeding. If heavy bleeding persists that is not slowed with biting on gauze, please call our office for further instructions. Spitting will increase bleeding, let oral fluids drain out by gravity.
5. TO REPEAT: In most instances, biting firmly on gauze placed directly over the extraction site (s) for a period on 30 minutes will stop bleeding.
6. Adequate nutrition is essential for healing. We encourage you to eat a small meal as soon as possible after your procedure. Please remove your gauze, eat a soft meal (soup, yogurt, shakes, mashed potatoes, pasta, macaroni and cheese, grilled cheese sandwich, oatmeal, toast, pancakes, eggs, soft donut, etc.) and then replace your gauze over your extraction site and bite down with firm pressure. Avoid citrus and seeds or nuts.
7. Fluid intake is important after your procedure. PLEASE AVOID USING STRAWS FOR THE FIRST 5 DAYS AFTER YOUR PROCEDURE. Using a straw may dislodge a blood clot and could stimulate a dry socket.
8. LIMIT PHYSICAL ACTIVITY FOR THE NEXT 7 DAYS. Overexertion may lead to increased pain, bleeding and swelling to the surgical site
9. Please refrain from drinking alcoholic beverages during your post-operative period and while taking the prescribed pain medication.
10. Please take all of your regularly scheduled medications (diabetes, high blood pressure, etc.) at their normal time and dose after your procedure unless specifically directed otherwise.
11. If your procedure was performed with IV sedation (general anesthesia) or with oral sedation, please do not drive an automobile for 24 hours after your procedure.
12. AVOID SMOKING (cigarette, cigar, vaping) AFTER YOUR PROCEDURE. Smoking will essentially increase all post-op complications associated with oral procedures. Smoking promotes increased pain, dry socket formation, infection, graft and implant failure, communications between your oral cavity and overlying sinuses and delayed healing. Smoking with gauze in place does not prevent problems.
The Day Following Surgery
1. On the morning after your procedure, please begin brushing your teeth as you normally would. Please avoid brushing the surgical site as it may stimulate bleeding or premature suture loss.
2. Please begin salt water rinses. Add ½ teaspoon of salt to a large glass of warm water and carefully rinse your mouth. Please repeat 3-4 times a day until complete healing of your tissues. Please AVOID the use of hydrogen peroxide, mouthwash, Water Picks and syringe irrigations as they may dislodge developing blood clots and lead to delayed healing and dry socket formation.
Day #3 After Your Surgery and Thereafter
1. Peak pain and swelling typically occurs on post-operative day #3 or 4.
2. If your procedure was the removal of wisdom teeth and if you were given an irrigation syringe, PLEASE BEGIN SYRINGE RINSES WITH SALT WATER ON DAY #3 AFTER YOUR WISDOM TEETH EXTRACTION PROCEDURE. Please rinse your mouth with salt water and draw up the additional salt water into your irrigation syringe. Irrigate one syringe per lower wisdom tooth extraction site. Do not irrigate upper wisdom tooth extraction sites. Please repeat after each meal until total tissue coverage over your extraction sites. Total tissue coverage typically takes between 10-14 days to heal depending on the degree of impaction of the wisdom teeth. Please DO NOT rinse with anything other than salt water. If food debris is not removed from your extraction sites, it can lead to pain, swelling and infection at the site.
3. On post-operative day #4, please begin to advance your diet from a soft diet to your normal diet. Please continue to avoid straws, smoking and extremely hard foods such as nuts, hard candy, peanut brittle, etc.
What are dry sockets?
Dry sockets are the number one most common post-operative issue that patients face following wisdom tooth extraction. They are believed to occur as a result of premature blood clot loss to the wisdom tooth extraction site. Dry sockets typically affect one if every five patients and are more common in smokers, older patients and wisdom teeth that are severely impacted. Dry sockets typically occur within the lower jaw and usually occur between the 3rd or 4th day after wisdom teeth are extracted. Dry sockets are not an infection and typically present with a foul odor and increased deep, dull and throbbing pain that can occasionally radiate to the ear. Should a dry socket occur, they can be treated by placing a medicated packing within the extraction site to decrease pain and discomfort. The sole purpose of the medicated packing is to decrease pain. If a medicated packing is not placed, the area will still heal.
What can I do to decrease my chances of developing a dry socket?
1. Follow all post-op instructions given by our office
2. Avoid smoking; 3x increase in dry socket
3. Avoid the use of straws
4. Begin salt water rinses the day after your procedure
5. If you were given an irrigation syringe following your procedure, please begin to irrigate the site with salt water on post-operative day #3. DO NOT irrigate the site if a bone graft was placed as this will remove the bone graft material and delay the healing of the site.
REMEMBER, WE ARE HERE FOR YOU
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call our office at (615)873-4495 or (615)221-0012. Please try call during office hours, which are Monday through Friday 8:00 a.m. to 5:00 p.m. If for some reason you are unable to call during our business hours we have a 24-hour answering service available for after-hours contact. If you need to reach the doctor on call after hours please call (615)-866-0593. Calling during office hours will afford a faster response.