What to expect after the operation
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Helping you make a speedy recovery after removal of wisdom teeth
What to expect after the operation
Recovery after wisdom-tooth surgery is generally quite straightforward, but you are likely to experience pain and swelling, particularly in the first 2 days. Rarely, complications can occur, such as poor healing of the tooth socket or nerve injury. If you have had adult intravenous sedation or a general anaesthetic, you will require someone to escort you to and from surgery, and it is important to take it easy for a day or two after the operation.
You are likely to experience pain for the first 48 hours, although your mouth may well be sore for up to a week or so after the operation. Local anaesthetic injections given during the procedure ensure that you have no pain for the first 3–4 hours after surgery, but once the anaesthetic wears off, you need to take the painkillers given to you. You should take these regularly to ensure that you sleep well on the first night; this will maximise your recovery. You will normally be prescribed paracetamol and ibuprofen. When these two drugs are taken together, they enhance the effect of each other because they work in different ways. Be sure to follow the directions given to you by your surgeon or the pharmacist. Some patients may not be able to take these medications due to medical problems, but in these cases, alternatives will be provided.
The area around the extraction sites will be sore and you may find it difficult to clean your teeth. Follow the instructions for good oral hygiene as this is very important to minimise the risk of infection. Antibiotics will only be prescribed if there is active ongoing infection.
Swelling, particularly in the cheek area and both inside and outside the mouth, is common. Again, it is worse for the first 2 days, after which it will gradually subside. It can be relieved by using ice packs, starting shortly after surgery. Bruising to the skin of the face may also occur.
You may have difficulty opening your mouth and experience pain or stiffness of the jaw joint. This will normally disappear after a couple of days, but can occasionally last for up to 2 weeks. You may need to eat a soft diet for a week or so.
Be careful not to force your jaw open before it is ready and do allow time for the swelling to go down. Ibuprofen will help to relieve this pain.
Sensitivity of the teeth next to the wisdom-tooth socket is common; good oral hygiene will resolve this, although it may last for several weeks.
You may experience bad breath; this is unlikely to last more than a week.
Stitches will dissolve by themselves and do not need removing, but it is important that 3–4 days after surgery you start brushing the sutures away to minimise food trapping.
When the tooth is removed the roots leave a ‘socket’ in the bone. This hole in the gum may last for up to 3 months. As your wound heals, blood clots form over the empty tooth sockets; it is important not to dislodge these.
If later bleeding occurs from the extraction site, you will need to bite on a cotton gauze or handkerchief for 3–5 minutes to stop it. Avoid drinking or eating food that is hot or very cold as this may restart bleeding.
Follow-up appointments are not usually booked after wisdom-tooth surgery. However, if you have complications or your bleeding does not stop, you should contact your surgeon.
Your body is using energy to heal itself, so you may feel more tired than usual – this is perfectly normal.
Exercise and sport
It is important to avoid strenuous activity and exercise for the first few days. While you’re building up your activities, you probably won’t feel like doing much, but walking is the best way to return to fitness. If you play rugby or do martial arts, you should discuss returning to these activities with your surgeon before the operation.
Dry socket happens in 5–10% of patients; it presents as intense and persistent pain occurring 3–5 days after the initial pain has subsided. If this occurs, it is important that you contact your surgeon as soon as possible, who will wash out the socket and remove the trapped debris that is causing the pain.
Nerve injury is far less common and is normally caused by bruising of the nerve(s) that lie very close to the roots of the lower wisdom teeth. Rarely, it can be caused by the injections given during surgery. Nerve injury occurs in up to 2% of patients and is generally temporary, but it can be permanent in 0.5% (1 in 200) of patients.
Nerve injury can cause pain, tingling, altered sensation (pins and needles) or numbness, and may occur to the inferior alveolar nerve (the sensory nerve supplying your lower lip, inside and outside, and your lower gums and teeth) or lingual nerve (the nerve that supplies feeling to one or other side of your tongue and adjacent gums).
If your lower wisdom tooth is positioned close to the ‘lip’ nerve, you will be advised that the likelihood of nerve injury is more common (20% of patients are likely to experience temporary injury and 2% permanent injury). If this is the case, you may need an additional special X-ray investigation (cone beam CT scan) and be offered a different surgical approach to minimise the injury (coronectomy).
Damage to adjacent teeth may also occur if they are heavily restored.
It is very important that you maintain good oral hygiene and brush your teeth as usual as best you can, gradually brushing nearer to the wound day by day, eventually brushing away the stitches after several days. You may be recommended to use an antimicrobial mouthwash and often you will be prescribed salt-water rinses to help with wound healing. Do this gently on the first postoperative day to avoid dislodging the clots that will have formed over the wounds.