Wisdom Tooth Extraction Post-Operative Instructions

Wisdom tooth removal is a surgical extraction, not a simple one. Unlike a visible tooth that can be lifted out, wisdom teeth often require an incision into the gum, removal of overlying bone, and suture placement. Recovery is more involved than a standard extraction, and swelling is typically more dramatic. Healing progresses in predictable stages -- these instructions walk you through each one so you know what is normal and when to call us.

Day of Surgery

• Gauze management: Bite firmly on the gauze pads placed at the surgery site. Apply steady, even pressure -- do not chew or adjust the gauze. Change the gauze every 30 to 45 minutes. Active bleeding should slow significantly within 1 to 2 hours. Light oozing and pink-tinged saliva can continue for 24 hours and is normal.
• Do NOT use a straw, spit, smoke, or rinse today. All of these create suction or pressure that can dislodge the blood clots protecting the surgical sites. The clots are the foundation of healing. Losing them causes dry socket -- the most common and most preventable complication after wisdom tooth removal.
• Ice pack protocol: Apply an ice pack or cold cloth wrapped in a towel to your cheek. Use a 20-minutes-on, 20-minutes-off cycle throughout the day of surgery and into the following morning. Ice is most effective within the first 24 hours.
• Keep your head elevated. Rest with your head above the level of your heart -- use two or three pillows if sleeping. Lowering your head increases blood pressure at the surgical site and prolongs bleeding.
• Begin pain medication before the anesthetic wears off. Ibuprofen 400 to 600 mg taken before numbness resolves provides significantly better pain control than waiting for pain to begin. If prescription pain medication or a longer-acting local anesthetic was used, follow those specific instructions.
• Eat and drink as soon as you feel ready, but stay with cool or lukewarm soft foods. Do not skip meals -- eating supports healing and helps you tolerate medications. See the diet section below.
• Rest for the remainder of the day. Physical activity elevates blood pressure and increases the risk of prolonged bleeding. Light activity -- walking to the bathroom, sitting at a table -- is fine. Avoid anything strenuous.

Days 1 and 2

• Swelling will increase throughout Day 1 and peak at 48 to 72 hours. This is normal and expected. The degree of swelling depends on how many teeth were removed, their position, and individual variation. Significant facial swelling -- even a "chipmunk" appearance -- is common after all four wisdom teeth are removed. Bruising on the cheeks, jaw, or upper neck typically appears around Day 2 to 3 and is also normal.
• Pain management: Alternate ibuprofen 400 mg every 6 hours with acetaminophen 500 mg taken between those doses for continuous coverage. This combination (not taken simultaneously) provides better pain control than either drug alone. Follow prescription instructions if stronger medication was provided.
• Begin gentle salt water rinses on Day 2. Dissolve 1/2 teaspoon of salt in 8 oz of warm water. Gently let the solution rest in your mouth and allow it to fall out -- do not swish actively or spit. Repeat 4 to 6 times daily, especially after meals, through the end of the first week.
• Jaw stiffness (trismus) is normal. The jaw muscles were stretched during surgery. You may have difficulty opening your mouth widely for several days. Gentle opening exercises -- slowly opening and closing as far as comfortable -- can help restore range of motion by Days 3 through 5.
• Antibiotics: If prescribed, begin taking them as directed and complete the full course. Do not stop early even if you feel better.
• No smoking for at least 72 hours -- ideally 7 to 10 days. Tobacco smoke introduces nicotine and carbon monoxide that impair clotting and healing, and the suction involved in smoking significantly increases dry socket risk.

Days 3 through 7

• Swelling and bruising should begin improving by Day 3 to 4. If swelling is still increasing after Day 3, call our office -- progressive swelling after this point can indicate infection.
• Pain should be improving by Day 3. If your pain is worsening -- particularly with a bad taste, bad breath, or the sensation that a socket feels empty or "bony" -- you may have dry socket. Call us immediately. Dry socket is treatable but requires in-office care.
• Suture care: Most sutures used in wisdom tooth surgery are dissolvable and begin loosening around Day 5 to 7. You may notice small threads in your mouth -- this is normal. If non-dissolving sutures were placed, your removal appointment is already scheduled.
• Begin socket irrigation if a syringe was provided. Starting Day 3 (or sooner if instructed), fill the syringe with warm salt water and gently flush each lower wisdom tooth socket to dislodge food debris. Point the tip into the socket opening and depress the plunger slowly. Do not apply pressure -- gentle flushing is all that is needed.
• Increase salt water rinse activity. By Day 3 you can rinse more actively -- swish gently and allow the solution to fall from your mouth. Continue after every meal and before bed.
• Resume light normal activity by Day 3 to 4 if pain and swelling are improving. Avoid strenuous exercise, contact sports, or anything that significantly raises your heart rate for 7 to 10 days.

Diet Guidelines

Recommended foods (Days 1 through 7):

• Yogurt, pudding, applesauce, smoothies (no straw), and protein shakes
• Mashed potatoes, soft scrambled eggs, soft-cooked oatmeal, cream of wheat
• Soft fish, soft pasta with sauce, soft-cooked macaroni and cheese
• Lukewarm soups and broths (avoid chunks that could enter the sockets)
• Bananas, avocado, soft-ripe melon, soft canned fruit
• Ice cream and frozen yogurt (no cone) -- the cold also provides mild numbing benefit

Avoid for at least 7 to 10 days:

• Straws -- the suction is the primary cause of dry socket
• Seeds, rice, popcorn, nuts, and small particles that lodge in sockets
• Hard or crunchy foods: chips, crackers, raw vegetables, crusty bread
• Chewy foods: bagels, tough meat, gummy candy, jerky
• Hot foods and beverages for the first 48 hours
• Alcohol -- interacts with medications and impairs healing
• Spicy foods that may irritate surgical sites

Warning Signs -- Call Our Office

• Dry socket: A deep, throbbing, or radiating ache beginning on Day 2 through Day 5, often reaching into the ear or jaw on the affected side, frequently with a bad taste or bad breath. Pain is worsening rather than improving. This is the most common complication after wisdom tooth removal and is treated in-office -- do not try to manage it at home.
• Uncontrolled bleeding: Active bleeding (not light oozing) that does not slow after 60 minutes of firm, constant gauze pressure. Bite on a moistened black tea bag -- tannic acid promotes clotting -- and call us.
• Signs of infection: Fever above 101 degrees F, swelling that is increasing rather than decreasing after Day 3, warmth or spreading redness, or pus drainage from a socket.
• Persistent numbness or tingling beyond 8 hours after surgery in the lower lip, chin, or tongue. This can indicate temporary or rarely permanent involvement of the inferior alveolar nerve (more common with deeply impacted lower wisdom teeth). We need to evaluate it promptly.
• Difficulty swallowing or opening your mouth that is worsening rather than improving after Day 2 -- beyond the expected jaw muscle soreness.

Questions at any stage of your recovery are welcome. Call Smile Science Dental Spa at (480) 530-3663 or visit us at 20118 N 67th Ave Ste 308, Glendale, AZ 85308.