MANAGEMENT OF THE WISDOM TOOTH EXTRACTION PATIENT

This document provides guidance on how to manage care of the third molar extraction patient over the next week. These recommendations, refined over thirty years of experience and based on currently recommended therapy, are designed to speed recovery, minimized post-operative discomfort, and avoid post-operative complications. Please review the instructions several times as there is a lot of information that make a big difference to recovery that are easily glossed over.  Please do not rely on “Dr. Google”, your family home remedy or your friend’s advice as they are not specific to your particular case and may be detrimental to your recovery.

It will typically take 7 to 10 days to return to the preoperative state. Minimizing swelling and maintaining good hygiene are the keys to recovery.  Failure to achieve these two things will result in a prolonged and uncomfortable recovery.

DAY OF SURGERY

DIET:
When you arrive home:  Remove the head wrap and gauze from the patient’s mouth and, provided they have not experienced nausea from the car ride, let them eat a small meal of any nourishing food that can be taken with comfort and requires little or no chewing.  As a long acting local anesthetic has been used, which will prevent the patient from feeling their lips, cheeks and tongue, soft and cool foods are the best for the first meals to prevent burning or biting of these tissues. It is sometimes advisable, but not absolutely required, to confine the first two days intake to liquids or pureed foods such as soups, puddings, yogurt, Jello, milk shakes, etc..  Pancakes are great for the first few days because you can flavor them with butter, syrups, fruit compotes as well as mashed potatoes which can be augmented with butter, gravy, garlic, sour cream, cheese, the list goes on. Overcooked small pasta noodles are also an easy food to manage. Soft, starchy and filling, you won’t feel like you’re missing out on solid foods with these! Italian ice makes for a good snack. Smoothies are good for snacks provided they do not contain seeds or grains.   During the first week avoid eating any foods containing sharp edges or small particles, such as potato chips, small cereals, popcorn, nuts, seeds, or salad components as they are hard to chew and may become lodged in the surgery sites.  Avoid acidic foods and beverages, such as vinegars and fruit juices, as they may cause discomfort. Over the next several days you may gradually progress to solid foods.  It is important not to skip meals and to eat something prior to taking any medication!  If you take nourishment regularly you will feel better, gain strength, have less discomfort and heal faster.  It is also very important to increase your fluid intake during the first few days after surgery.  You can increase your diet as tolerated over the next several days. If you are a diabetic, maintain your normal eating habits and check your blood sugar frequently. Do not use a straw, spit or smoke for the first few days after surgery as these things can lead to the loss of blood clots causing a painful condition of “dry socket” which is refractory to pain medications. You should also avoid carbonated and alcoholic beverages for the same reason. Our practice does not endorse the use of plastic irrigating syringes because, if used improperly, increase the incidence of dry sockets, due to dislodging of blood clots, and infections, due to forcing food debris deeper into the wound.

MEDICATIONS:
After waiting approximately 30 minutes to ensure that there is no post-surgical nausea, the patient should begin taking their medications.  Unfortunately most oral surgery is accompanied by some degree of discomfort, but, following these instructions, the degree of discomfort can be limited in both duration and intensity as well as limiting the need for narcotic analgesics. The key is getting ahead of the pain curve and, if a pain cycle develops, being aggressive in interrupting it. The primary medicine for pain and swelling is Ibuprofen.  This non-steroidal anti-inflammatory drug was designed to reduce inflammation and swelling and the FDA has confirmed that this drug is effective in testing against the third molar surgery pain model. This prescription should be taken every 6 hours for the first three days.  It is not necessary to awaken the patient during the night to take a dose, but, instead place a dose nearby on a nightstand in case it is needed at night.  Continue this medication beyond the initial three days if discomfort persists or there is significant swelling.  If you should run out of this medication, over the counter Ibuprofen (Motrin or Advil) should be used.  The best dose is 600mg (three 200mg tabs) every six hours.  Allow the Ibuprofen to work for 45 minutes, if at that time the patient is experiencing mild discomfort you can add two tablets of Extra-Strength Tylenol as long as the patient does not have significant liver or kidney disease.  The combination of the Ibuprofen and Extra-Strength Tylenol has been shown to be as effective as a mild narcotic without the side effects. If, at the 45 minute point, the patient is experiencing severe pain, administer a dose of the narcotic prescription.  After 6 hours repeat this process.  This should minimize the amount of narcotic required.  The narcotic should not be used as a sleep aid as it will affect REM sleep patterns and hamper restful sleep.

 [Note: the vast majority of our third molar surgery patients do not require any narcotic medication postoperatively, but it is recognized that each patient has different pain threshold / tolerances and that the surgeries vary in their complexity.]  If the narcotic medication is used be aware that it can cause dizziness, disorientation, drowsiness, nausea and that the patient cannot engage in driving a vehicle, operate machinery, engage in dangerous activities or make legal decisions for 24 hours after the last dose.  If prescribed, the