After Wisdom Tooth Removal

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully for immediately following surgery and during the ensuing week.

Immediately Following Surgery

  • The gauze pad placed over the surgical area(s) should be kept in place for at least a half hour. After this time, or prior to  the time you take your pain medication, the gauze pad should be removed and discarded. New gauze may be placed after taking your pain medication, however moisten it prior to placing it in the surgical areas.
  • Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take the prescribed pain medications before your local anesthetic wears off and you begin to feel discomfort.
  • Restrict your activities the day of surgery and resume reasonable normal activity when you feel comfortable. No strenuous activity or sports for at least 7 days.
  • Place ice packs to the sides of your face where surgery was performed only on the day of surgery. Refer to the section on swelling for explanation.


A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by placing a moistened gauze pad over the area and biting firmly for one hour. Repeat if necessary. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.


The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 24 hours, ice has no beneficial effect and do not use ice or heat. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. If swelling or jaw stiffness continues beyond several days, please contact Dr. Hishmeh for instructions.


For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Do not consume alcoholic beverages or smoke. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.


After general anesthetic or I.V. sedation, clear liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important and nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited to a soft diet for the first week after your surgery. At least 5-6 glasses of liquid should be taken daily. However, do not consume any carbonated or highly acidic soups or beverages or alchoholic beverages the first week after surgery. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. and drink properly. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the day after surgery but rinse gently. Also the day after surgery you should begin rinsing at least 6-8 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt. Do not use any over-the-counter mouth rinses for one week after surgery. The only rinsing should be with the salt water mixture.


In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.


If you have been placed on antibiotics to prevent infection, take the tablets or liquid as directed. If you have undergone general anesthesia for your surgery, please begin taking your antibiotics the day after your surgery.Discontinue antibiotic use in the event of a rash or other unfavorable reaction and please call our office for further instructions and if you have any questions.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should sip water slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. Please call our office for further instructions if you experience nausea and vomiting.

Other Concerns

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call Dr. Hishmeh if you have any questions.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify our office. Tylenol or ibuprofen should be taken to reduce the fever.
  • You should be careful moving from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications also can make you dizzy. Additionally, you can become light-headed when you stand up suddenly. Before standing up, you should sit for one minute then stand.
  • Occasionally, patients may feel hard projections in the mouth with the tongue. These are not roots, they are the bony walls which supported the tooth which was extracted. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Hishmeh. Please call our office if you have concerns.
  • If the corners of your mouth are stretched during surgery, they may dry out and crack. Your lips and these corner areas should be kept moist with an ointment such as vaseline.
  • A sore throat and pain when swallowing are not uncommon after surgery.The muscles in the oral cavity may become swollen and the normal act of swallowing can then become painful. This will subside in 2-3 days. If it does not, contact our office.
  • Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time. If it does not, call our office.

    A dry socket occurs if your blood clot becomes dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. Call the office if this occurs.


Often, sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures normally dissolve or fall out approximately a week after surgery. You may or may not observe this occurrance. If instructed at the time of surgery, please return to our office for your follow-up appointment for suture removal. This is a short visit and does not entail local anesthesia.

The post-surgery pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions.

There will be a cavity where your tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, keep the area clean especially, after meals, with salt water rinses or a soft toothbrush.

Your case is individual, no two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the person best able to effectively help you regarding your post-operative situation: Dr. Hishmeh. Do not hesitate to call our office regarding your concerns or questions.

Brushing your teeth is okay – just be gentle at the surgical sites.

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you become light headed, stop exercising. Do not undertake strenuous exercise until approximately one week after your surgery. Please call our office if you are uncertain as to when to begin exercising after surgery.