Wisdom teeth or any teeth not visible above the gum line, such as severely broken teeth or teeth with long, curved roots, may require a more complex surgical extraction. IV sedation or anesthesia is often implemented to keep the patient calm and comfortable. To obtain access to the impacted tooth, the surgeon may need to cut through bone, gums, and tissue. Sometimes, the surgeon will need to cut the tooth in pieces in order to fully remove it. The area will then be sutured closed following extraction.

Here are some important reminders for the treatment site after tooth extraction:

• We will ask you to bite on a gauze pad for 30 – 45 minutes after the removal to help with the formation of a blood clot that will begin the healing process.
• Patients may have to bite on several gauze pads for another 30 minutes if the bleeding persists.
• Once you have an established blood clot, do not disturb or dislodge the clot by rinsing vigorously, sucking on straws, smoking, drinking alcohol, or brushing the teeth next to the extraction site for 72 hours post-surgery.
• Do not participate in vigorous exercise for 24 hours because it may dislodge or dissolve the clot and cause more bleeding.
• Within 48 hours, the pain and swelling of the area should subside. An ice pack or a bag of unopened frozen peas can be applied to the area to minimize swelling. You can also take pain medications as prescribed by the surgeon.
• Call our office if the pain medication is not working.
• If you are prescribed antibiotics, please continue to take every pill until the medication is complete (even if you feel better).
• Drink plenty of water and eat a healthy diet of soft foods on the day of surgery. When your mouth is ready, you can resume eating normal food.
• Resume your normal dental cleaning routine after 24 hours. Brush and floss your teeth at least once a day to speed healing, and keep your mouth feeling fresh and clean.
• If you have heavy bleeding, severe pain, continued inflammation for 2 – 3 days after the extraction, or have an allergic reaction to the medication, please call our office immediately.

There are a few things to keep in mind if you or a loved one is having multiple teeth extracted. You can follow the same instructions as a single extraction, but there are some additional directives.

• A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and bite down to apply pressure for 30 minutes.
• Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt water rinse (½ teaspoon of salt in a glass of lukewarm water) every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. After you have seen your dentist for denture adjustments, take out dentures and rinse 3 – 4 times a day.
• If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately.
• Do not remove dentures unless the bleeding is severe. Expect some oozing around the side of the dentures.
• Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 36 hours only. Apply ice continuously while you are awake.
• For mild discomfort, use aspirin, Tylenol^®, or any similar medication; take two tablets every 3 – 4 hours. With ibuprofen (Advil^®, Motrin^®) 200 mg, take 2 – 3 tablets every 3 – 4 hours. For severe pain, use the prescription given to you. If the pain does not begin to subside within 2 days, or increases after 2 days, please call our office.
• If an antibiotic has been prescribed, finish all of your prescription regardless of your symptoms.
• Drink plenty of fluids. If several teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day.

The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:

• The area operated on will swell, and discoloration around the eye may occur. The application of a moist, warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 36 hours after surgery (remember ice packs are used for the first 36 hours only).
• A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2 – 3 days.
• If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline.
• There may be a slight elevation of temperature for 24 – 48 hours. If temperature continues, notify our office.
• If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24 – 48 hours after surgery, and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.