How long to keep gauze in after wisdom tooth extraction

Post-Operative Instructions:Wisdom Teeth Removal

The following will cover important information regarding proper post-surgical care for a dental extraction. If you have had a tooth extracted, it will be important to follow these instructions exactly as we present them.

Discomfort is normal after the extraction of teeth. If you are not allergic or intolerant to nonsteroidal anti-inflammatory drugs, start taking ibuprofen (also known as Advil® or Motrin®) as instructed by your doctor at the time of your surgery. If you are asthmatic, do not take ibuprofen unless you have tolerated it in the past.

Gauze pad(s) should be placed directly over the extraction site(s) and held in place with firm biting pressure; the pressure from biting is what helps to stop the bleeding. Replace the gauze pad(s) about every 25 minutes. When the gauze pads have little or no blood on them, they are no longer necessary. The amount of bleeding will vary from person to person. Most of your bleeding will slow within 3–4 hours, but a small amount of bleeding is common for up to 24 hours. Please do not spit after surgery as it can prolong bleeding.

Do not rinse on the day of surgery; it may prolong your bleeding. Begin saltwater rinses the day after surgery and continue for 1 week. Rinse with warm salt water 3–4 times each day. To make the saltwater solution, dissolve a ½ teaspoon of salt in a small glass of warm tap water. Swelling is normal after surgery and may be a cause of post-extraction discomfort.

Swelling typically peaks by the third or fourth day and then starts to resolve; it can be reduced by the use of an ice pack. Apply the ice pack to the side of your face for 10 minutes; transfer it to the opposite side for another 10 minutes. Continue icing the face for the first 24 hours. Do not freeze the skin. Ice packs are most useful for the first 24 hours. Also, keep your head elevated on 2 pillows for 3–4 days. These measures will not eliminate swelling, but they will help to reduce its severity.

To allow blood clots to form undisturbed, do not eat for 1 hour after surgery. Gradually ramp up your diet as tolerated. Always cool down any hot foods or liquids during the first 24 hours. You should eat soft foods for the first week: for example, soups, eggs, mashed potatoes, and meatloaf are fine. To help prevent dry socket, do not use a straw for the first 3 days after surgery.

Begin brushing your teeth the day after surgery. It is important to brush all of your teeth, even if the teeth and gums are sensitive. Bacterial plaque and food accumulation near the extraction site will delay healing. Do not smoke for at least a week. Smoking may increase your bleeding, impair healing, and cause a dry socket.

Unless told otherwise, do no vigorous physical activity for 5 days following your surgery. Physical activity increases your blood pressure, which will cause an increase in your swelling, pain, and bleeding. You may gradually increase your activity, such as jogging or tennis, 5–7 days after your surgery.

• Bite hard on the gauze for 30 minutes if you are dismissed with gauze in your mouth. Remove the gauze after 30 minutes and do NOT place new gauze in your mouth if bleeding has stopped. A trail of blood in your saliva is NOT bleeding. Residual bleeding can last up to 36 hours. Bleeding is saturated blood constantly oozing out of the extraction site and it would outflow when you try to speak. If you have bleeding, then place new gauze over the extraction site (NOT between the teeth) and bite hard on it for one hour. Make sure that you swallow your saliva as you bite on the gauze during that time. (Only about 5% of our patients have to apply new gauze after leaving our office.) If you still bleed after doing this, contact our office immediately.

• SWALLOW YOUR SALIVA!!!!!!! Swallowing your saliva will create enough pressure to stop the residual bleeding and stabilize the blood clot. Swallowing your saliva will prevent DRY-SOCKET PAIN.

• To reduce swelling, apply a cold compress in the area—10 minutes on, 10 minutes off in the first hour after surgery. It is normal to develop swelling after the surgery. Just know that the peak of the swelling is around noon the next day. The swelling should resolve slowly after the afternoon the next day. If the swelling gets worse after the next day, you must contact our office immediately. We would like to bring you in for evaluation.

• Do not spit, suck on extraction site, smoke cigarettes, rinse your mouth vigorously, or drink through a straw for at least 4 days. These activities or anything you do to disturb the blood clot will lead to delayed healing and DRY-SOCKET PAIN.

• Take pain medication and other medications as directed. We recommend taking pain medication before the surgery. But if you did not, then it is very important that you take pain medication ASAP before numbness wears off. Just remember that when you have pain, it takes longer for pain medication to take effect. So take pain medication ASAP.

• Wait for numbness to wear off before you eat. This may take a few hours.

• Eat soft food. Chew on the opposite side if appropriate. Do NOT eat temperature hot and spicy food. Return to normal diet as you feel comfortable.

• Limit strenuous activity and exposure to the hot sun heat for two days after the extraction surgery.

• Brush and floss your teeth without disturbing the extraction site. Do NOT use the Waterpik for one week after surgery.

• Rinse your mouth with Chlorohexidine if dispensed you. Rinse with Chlorohexidine for 30 seconds twice daily after you brush your teeth in the morning and at night. You can substitute Chlorohexidine with warm salt and water as well.

• Nausea is not uncommon after surgery. It is sometimes caused by the pain medication. To reduce nausea, you must eat before you take the pain medication and take the pill with a lot of water. If you do not feel better or vomit repeatedly, please call our office immediately.

• If you feel sharp edges in the surgical areas with your tongue, it is probably small slivers of bone working themselves out during the first week or two after surgery. They are not pieces of the tooth. If they bother you, we will remove them. Please come in for an evaluation.
• Do not disturb or touch the wound.

• Avoid rinsing or spitting for 2 days (48 hours) to allow blood clot and graft material stabilization.

• Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.

• Do not lift or pull on the lip to look at the sutures. This can actually cause damage to the wound site and tear the sutures.

• Do not smoke.

• For mild discomfort, take Tylenol® or ibuprofen every 3–4 hours.

• For severe pain, use the medication prescribed to you.

• If you develop DRY-SOCKET PAIN, you need to come in for treatment. DRY-SOCKET PAIN is noticeable, distinct, persistent, throbbing pain in the jaw often radiating toward the ear. DRY-SOCKET PAIN can develop days after you have been feeling better. DRY-SOCKET PAIN can easily be treated in the office so don’t wait.

EXTRACTION SITE 101

After the tooth is extracted, the bony extraction socket is exposed. Blood fills up the bony socket and solidifies into a clot. The clot is the healing tissue. This clot is necessary for healing. Anything you do to lift or dislodge this clot, you will develop DRY-SOCKET PAIN. Just how painful is DRY-SOCKET PAIN? How do you rate pain when your bone socket is exposed to the air? Let’s avoid developing DRY-SOCKET PAIN.

TOP THREE MISTAKES LEADING TO DRY-SOCKET PAIN

3. Smoking cigarettes

2. Spitting

1. Placing dry gauze over extraction site after bleeding has stopped. The blood clot will stick to the gauze and you will remove it. Just bite, we mean really bite hard on that same gauze that we dismiss you with for 30 minutes and then toss it. Swallow your saliva after that. Swallowing your saliva will create enough pressure to stop the rest of the bleeding and swallowing your saliva will ensure that the precious blood clot is intact and stable.

SHOULD YOU FORGET WHAT YOU JUST READ SO FAR, JUST REMEMBER ONE SIMPLE RULE AND YOU ARE FAR BETTER OFF AFTER EXTRACTION SURGERY – SWALLOW YOUR SALIVA!!!!!!

If you have prolonged or severe pain, swelling, bleeding, or fever contact our office immediately. We will give you exact instructions on how to care for your problem.

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