Tossing Pizza After Surgery

Some Patients Are Back To Work Tossing Pizzas The Day Of Surgery (image courtesy http://www.flickr.com/photos/kubina/)

Recovery After Wisdom Tooth Removal

You’ve just had your teeth removed and immediately, you are wondering now, how long is it going to take to recover? As you can imagine, with people being as different as they are, there will be a wide variance in recovery times.

As a general rule you’ll be back to work within 2 to 4 days after having wisdom teeth removed. I remember one particular young man, who at 18 years old, asked if he could go back to work that afternoon.  He was having all four of his wisdom teeth removed in the morning using local anesthetic only so I cautioned him to take at least a day off.

It was a typical surgery including the need for sutures or stitches. We told him to take it easy. But he was young athletic and motivated to work. So he did not letting a little discomfort and some facial swelling get in his way. Less than six hours after surgery he was back flipping pizzas in the afternoon. He told us about this a week later when he was having a healing check and his sutures removed. I am sure he was being a bit macho with his friends, but said it was easier than he thought it would be.

He was not your typical wisdom tooth surgery patient. He’s an exception. Most patients will find themselves within a day or two feeling better even though they still have a little visible swelling.

We will often recommend that you have surgery done near the end of the week, so that you can have the weekend to rest before going back again to work on Monday.  Depending on the nature of your job and the physical demands it places on your body you may elect to take a few extra days off before returning to work. Heavy physical exertion can prolong bleeding so it’s good to take it easy for the first couple of days.

Your recovery will also depend on the difficulty of your surgery, the number of teeth removed, and you following post-operative instructions carefully.

I expect concerns about pain, swelling, infection, bad breath, bleeding, difficulty opening,  and residual numbness.

Even if infection is one of your biggest concerns, it’s relatively uncommon. The things you would look for with infection would be a fever of 100° or more, unusual swelling, persistent pain or persistent bad taste.  Infection is serious, so please contact your doctor right away if you suspect this is the case.

Pain occurs to some degree after wisdom tooth surgery. Usually the first few hours following wisdom tooth surgery are the ones during which pain is most extreme. Your doctor may choose to use a long acting local anesthetic that will usually keeps you numb during this period. Your doctor will usually encourage prescribed pain medications be taken before the initial anesthetic numbness wears off too, providing a buffer of pain relief as the local anesthetic effects disappear.

Swelling is also expected after wisdom tooth surgery. The amount of swelling that you experience will depend upon the difficulty of the surgery and your reaction to it. If a window is made into the soft tissue and bone to allow wisdom tooth removal, there will generally be more swelling. As a rule the less involved the surgery, the less swelling you will have. Usually it’s the lower wisdom teeth removal that creates the most swelling.

Friends and family will usually chime in and tell you that you look a little like a chipmunk, with bulging cheeks after your surgery. Just smile, say thanks, and ignore them. Placing cold packs on the side of your face right after surgery, as well as taking anti-inflammatory medications, as your doctor recommends, will minimize your swelling. Your doctor will provide you with specific recommendations for your surgery. It may take up to a week or more for much of your facial swelling to subside.

We nursed two of our teenaged grandchildren, in the last two years, after their respective wisdom tooth surgeries and provided a little good-natured family ribbing too.  That did not stop either of them from getting out and enjoying their visit to Colorado within a day or so of their respective surgeries.

Bleeding occurs after wisdom tooth surgery. Your doctor will encourage you to place moist gauze over the surgical site for one or more hours and maintain some mild pressure to help form a solid blood clot. It is so critical that a good blood clot forms and remains that your doctor will provide you with some precautions to follow.

I recall a visitor who had recently arrived from Hawaii a few years ago. This gentleman, after having several teeth removed, was still experiencing substantial bleeding, three days after his surgery.  He came into my office with a 64 oz. drink cup filled with red gauze complaining about how he was still having problems with bleeding.

I asked him how he was using the extra gauze he purchased. He said he placed the gauze in his mouth just like the surgeon had told him to do and then took it out again when soaked with blood. I asked if he was told to keep the gauze in place, with biting pressure on it for at least one hour each time it was used. He said no. I reminded him that the pressure for one hour was very important and to not release the pressure even to talk. I told him, if you have to talk, do it with your teeth together. He promised to follow my directions.

When we called him the next day to check on him, he said it was almost miraculous, there was no bleeding. My bet is that he did not remember the instructions given to him by his surgeon.

Your doctor may also tell you that he doesn’t want you to spit, rinse, smoke or even drink liquids with a straw for the first 24 to 48 hours. That’s because all of those activities create suction within your mouth that could lift the blood clot out of a socket where the tooth root was and allow bleeding to continue or to start again.

I caution my patients, when they lie down during the first 24 hours or so after surgery, to protect their pillows or couch cushions. I recommend they take a terry cloth towel and fold it in half and in half again making four layers and use this as a protective barrier to catch potential blood tinged saliva as they rest or sleep. After a couple of days most patients will only have hints of bleeding.

Muscle soreness is also a common complaint. The muscles of the jaw near the surgery sites will also often become sore and make opening difficult for several days to several weeks. It’s usually worse immediately after surgery with gradual improvement over time. All this  depends on the surgical difficulty and your response to it. Anti-inflammatory medications can assist you with this if necessary. And in more severe cases muscle relaxant medications are also helpful. Talk to your doctor.

No Symbol Over Chips and Salsa

Avoid Chips and Salsa After Wisdom Tooth Removal
(image courtesy-http://www.flickr.com/photos/jeffreyww/6261410471/

When you’ve just had surgery, and it’s difficult to open you will have to modify your diet. Look for foods that are nutritious and easily digestible. Protein drinks are also helpful and as a rule soft foods that are not too spicy would be good choices. You need to keep up your fluid intake but avoid any carbonated beverages. Soups and broths would be ideal. Avoiding nuts and chips for a while would also be a good idea as pieces could lodge themselves in the sockets and cause pain or delay healing.

Bad breath is also a common complaint for several days after surgery. Ask your doctor for specific instructions regarding cleaning near the surgery sites. I generally recommend diluted, alcohol-free mouthwashes not be started until at least 48 hours following surgery. Warm saltwater rinses are also helpful and the use of an ultra-soft toothbrush.  Alcohol in either mouthwashes or beverages will tend to make the surgical site more painful and so avoid it for at least a week.

Sutures are often placed at the time of surgery to aid in healing. Some types of suture material are dissolvable and they will start to fall out 3 to 4 days after surgery.  Other suture types will require removal by your doctor during a post operative visit scheduled about a week or so after your surgery.  Your doctor will recommend which is best for you.

You are on your way toward healing, and hopefully with few if any adverse effects.  You are now armed with much more information than the average dental patient will acquire before your upcoming procedure.

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