How long should you ice after wisdom tooth removal

Most problems that patients face after surgery are related to pain and swelling, bleeding or oozing, dietary difficulties, or medication-related side effects. We have attempted to provide some helpful hints that you may use to minimize any post-surgical difficulties and make your experience as pleasant as possible. If you have any questions, please call our office.

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Swelling and Bruising
Medications

Bleeding

Bleeding is common to some degree in the first 24 hours. Your bleeding should stop within 4 hours after surgery. Oozing and episodes of occasional bleeding may occur for up to 1–2 weeks, and you should not be alarmed. Usually, simple pressure with a wet, rolled gauze pad over the extraction site will stop the bleeding when applied for about 45 minutes to 1 hour. Remove the gauze after about 1 hour and replace it if the bleeding persists. A tea bag is often more effective in stopping the bleeding. If bleeding persists, the tea bag may be used like a gauze pad. Take the staple out of the tea bag, dampen it, roll it up, and place it over the extraction site. Bite on the bag for 45 minutes to 1 hour.

Swelling and Bruising

It is common to swell and bruise. Swelling is usually at its worst 48–72 hours after the surgery, and then it begins to improve. Bruising may occur over a few days and resolve within 2 weeks. Ice helps. Apply ice to your face over the surgical areas for about 20 minutes on and 20 minutes off over the first 24 hours.

Pain

Each person experiences pain in a different way, and what may seem like a minor procedure to one person may be very objectionable to another. Although pain may persist for a few days to some degree, it always seems to get better. If your pain does not improve, you may be developing a dry socket. A dry socket is a condition that may develop when the clot in an extraction site breaks down and leaves behind a painful socket that may need to be treated with medicated gauze in the office. Please call us if you are concerned that you may be experiencing unusual discomfort.

Warm saltwater rinses help muscle stiffness and pain. Mix a ½ teaspoon of salt in an 8-ounce glass of warm water (as warm as possible without burning yourself). Swish over the extraction site(s) and spit 3–4 times per day for 1 week starting the morning after your surgery. Avoid smoking! Do not use straws, and do not use a Waterpik®.

Take over-the-counter ibuprofen (200 mg) every 6 hours for 3–4 days or the prescribed anti-inflammatory medication. Call us if you develop any nausea, stomach cramps, upset stomach, or notice blood in your stool.

You have been prescribed narcotic pain medication. Take this medication as prescribed on that bottle if necessary.

Infection

Continue to take any antibiotics as prescribed. Unusual swelling or discharge may mean that you have an infection. Please note that your healing wound will appear whitish-grey. A slight elevation in temperature after surgery is common in the first 24 hours and does not necessarily signify an infection.

Brush your teeth. Your teeth need to be clean to help prevent an infection. Use a toothbrush, softened under warm water, and brush gently around the teeth next to your extraction sites. A little bleeding with brushing is common.

Diet

After your surgery, it will be difficult to eat. Hot, spicy foods and sharp particulate foods are especially difficult to chew and may irritate a wound or tooth socket. Softer, bland foods are the best to eat. Jell-O®, cottage cheese, ice cream, scrambled eggs, mashed potatoes, soft fish, apple sauce, macaroni and cheese, ground beef in small pieces, yogurt, and well-cooked vegetables are some examples.

You may try more substantial foods as the wounds begin to heal a few days after surgery. Be sure to use care when eating while your mouth is numb. You may expect to be numb from 2 to 12 hours depending on the anesthetic used.

Stitches

We may use dissolving or non-dissolving sutures. The sutures may untie, fall out, or dissolve in a few hours, a few days, or a week. Do not be alarmed by this. We usually remove them at your follow-up visit. They usually do not need to be present for more than a few hours.

Medications

Medications and general anesthetic agents may cause nausea and have undesirable effects. Take your medications with food if they upset your stomach, and please call us if you have any questions.

If you were provided an irrigation syringe because you had your lower wisdom teeth removed, please start using it 5–7 days after surgery.

Please review these tips for the safe use and proper disposal of prescription medications.

If you have any questions or concerns, please feel free to call our office at (360) 293-2808. Our after-hours emergency number is (360) 647-4027.

After Your Surgery

Post-Operative Instructions

General Anesthesia Precautions

**If general anesthesia or IV sedation was utilized, do not leave the patient unattended for the first 12 hours.

**Please closely supervise the patient when getting up or going to the bathroom.

Medications

Please refer to your medication information sheets if you were given prescriptions. If you have any reaction to medications prescribed, call the doctor immediately.

Managing Bleeding After Surgery

For the first hour after surgery:

Keep firm pressure on the surgical site with the gauze that was placed in your mouth after surgery. Remove gauze after 1 hour.

If Bleeding Continues

Take 1 piece of gauze and fold it in quarters, creating a firm pad. Place the pad over the surgical site. Use firm biting pressure where possible (extraction site), or direct finger pressure by holding the gauze (biopsy site). You may have to repeat this procedure several times. The bleeding should stop within 2-3 hours, but you can expect to see blood-tinged saliva for up to 24-48 hours following surgery. If bleeding is heavy, or continues after 2 hours, moisten a tea bag, place on surgical site, and apply pressure or bite firmly for 30 minutes. This usually stops the bleeding. Please remember, most bleeding is controlled and stopped with a well-positioned gauze or tea bag with direct pressure. If bleeding is heavy or continues after 24 hours, call the doctor. Do not rinse, spit, or use a straw the day of surgery, as this can cause bleeding to resume.

To Reduce Swelling

Ice for the initial 24 hours. Use ice packs applied to the face for 20-minute intervals (20 minutes on, 20 minutes off). If oral surgery was performed on both the right and left sides, it is recommended to use one ice pack and alternate sides every 20 minutes. This is the most effective way to reduce swelling. Do not exceed 20 minutes in one area as this can cause tissue injury. Swelling usually reaches its maximum 2 days following surgery. To help reduce swelling, sit semi-reclined in a reclining chair; if lying down, keep your head elevated with 2-3 pillows. Icing should be discontinued after 24 hours. While icing your face may feel good, it will act to increase swelling. Again, DO NOT ice beyond 24 hours.

Orthodontic Retainers

If you have orthodontic retainers, please do not use them immediately after surgery. Use of your retainers can resume 1-3 days after the procedure or as comfort allows.

Diet

Resume your diet immediately following surgery. When you get home, start with a milkshake, smoothie, or other thick liquid using a spoon, NOT a straw. Your diet should be limited to cool and soft foods for the first day. Sometimes numbness from local anesthesia may last for hours; therefore, hot foods and liquids should be avoided, as they can cause a burn. A normal diet can be resumed as tolerated. Most foods can be eaten as long as care is taken to avoid the surgical sites. The following are some suggested softer foods: pancakes with syrup, eggs, and pastas like macaroni and cheese or spaghetti.

Oral Hygiene

Rinse with warm salt water or tap water beginning 3 days after surgery. To make a salt water rinse, add 1 teaspoon of salt to 4-5 oz of warm water. Rinse at least 3 times per day: in the morning, after meals, and before bed. Do not gargle. With extractions, you may have been given a plastic irrigating syringe. Begin using this syringe 3 days after your extraction. Using tap water or salt water, gently irrigate only the lower extraction site(s) once a day to remove any food debris that may persist after rinsing. Continue until all debris is removed. Do not use over-the-counter mouthwash, such as Scope® or Listerine®, as these can irritate the surgery site and slow healing. Resume brushing your teeth the day after surgery, being careful to avoid the surgical sites. It is not unusual to see traces of blood on your toothbrush.

Activity and Smoking/Vaping

Physical activity should be limited after oral surgery procedures. Vigorous exercise or organized sports should not be resumed until 3-5 days after surgery or as your condition allows. Please contact our office if a written excuse is needed for organized sports or gym class. The nicotine from smoking and vaping can significantly delay healing and cause an increase in post-operative pain. Therefore, you should refrain from smoking as long as possible.

Stitches

Stitches that have been placed are usually dissolvable and will fall out on their own within the first 4 days, possibly longer. It is not unusual for one or more to loosen and fall out before dissolving, especially in moving areas of your mouth, such as the tongue or cheek areas. If the stitches come out and the wound opens and creates a hole, it is typically not of concern unless there is excessive bleeding. Fortunately, incisions in the mouth do heal very quickly, and any wound that does open will close naturally.

Follow-Up Visits

If a follow-up visit is necessary, an appointment would have been scheduled for you. Post-operative appointments are always available. Please call the office during business hours if you would like to be seen.

When You Get Home

Remove gauze packing.
Drink at least ¼ of your milkshake (or smoothie, or other cool, thick liquid) using a spoon—NOT a straw.
Take pain reliever immediately, as explained in the “Pain Management” instruction sheet, unless you were already given ibuprofen in recovery.
Take the antibiotic (if prescribed) as directed.
Replace the gauze packing, if necessary.
Begin ice packs to the outside of your face, as explained previously, no longer than 20 minutes on one side.
Increase your fluid intake throughout the day.

Typical Recovery

With most oral surgery procedures, post-operative discomfort can actually worsen between the third and sixth days. This discomfort is considered normal and should be managed with your pain medication. If you have significant discomfort, even with pain medication, or you cannot tolerate the pain medication, please call the office.

When to Call the Doctor

If there is a drug reaction, significant swelling, persistent pain or bleeding, or any other unusual reactions, call the office immediately. Additionally, if you have any questions during the post-operative period, do not hesitate to call. There is an answering service to respond to emergencies at all times when the office is closed