FAQ: Extractions

1) How long is a typical surgery for wisdom teeth?

 For a standard surgery for 4 wisdom teeth with general anesthesia, the appointment would be approximately 1 hour (30 minutes for the actual surgery and 30 minutes for the recovery time). It is very dependent on the person and how long they need to be in recovery, and/or how complicated the surgery is itself.

 2) What can I eat after I have extractions done?

It depends on how many teeth are extracted.

If you’re feeling up to it, you can eat right after surgery.

However, we recommend soft, cold foods for the first day. Examples: Jell-O, pudding, applesauce, yogurt, ice cream. The second or third day, you will be able to move to soft, warmer foods such as mashed potatoes, plain pasta, etc. Refrain from eating any foods with seeds.

We also recommend smoothies and milkshakes as a fun meal replacement. The only restriction with these drinks is that you are not to use a straw. Straws can disrupt the clot that forms in the socket where the extraction was performed. This can possibly lead to a dry socket.

With full mouth extractions, we give instructions for a liquid diet only.

3) What are the levels of anesthesia? Which one will I have?

 Depending on the surgery, there are three main options of anaesthesia available at our office.

 The first type is called local anesthesia. Local anesthesia is a method that freezes specific areas. This is typically used for single tooth extractions. Unlike general anesthetics, local anesthetics don’t require any main instruction. However, after an appointment with local anesthetic, we recommend not eating hot, chewy, or crunchy foods until the freezing has worn off. This is in order to avoid biting your lip, cheek, or burning your mouth.

 The second type is called nitrous oxide (“laughing gas”). Nitrous oxide is a form of conscious sedation using nitrous oxide gas through an inhalation technique. A mask that delivers a mixture of nitrous oxide and oxygen is placed over the nose and helps the patient to feel at ease and relaxed. We recommend it to patients who do not want to be fully asleep but would like to take the “edge” off their anxiety. The instructions for nitrous oxide are not to have anything to eat or drink 2 hours prior to the appointment.

 The third and final type of sedation we offer is neurolept analgesia (intravenous sedation). Neurolept analgesia is a non-conscious form of sedation that is administered via an intravenous technique. Firstly, the patient is seated comfortably in the dental chair and given a mask with a flow of nitrous oxide (laughing gas). Then, the intravenous needle is placed to deliver the unconscious sedation. And finally, local anesthetic is delivered to freeze the tissues.

We have qualified nurses that administer the IV for general anesthesia and provide instructions specific to each patient.

Please visit this page for pre-operative and post-operative anesthetic instructions.

After general sedation, you will sit in the recovery room for as long as needed, until you are discharged by a nurse. This is a precaution for all patients to ensure they are steady and not in need of anymore treatment or instruction.

 4) Can I brush my teeth after surgery?

Absolutely! You are encouraged to continue all oral hygiene care. However, we recommend brushing very lightly as not to irritate any areas, and avoid the surgical site. If you have extractions done, it is best to avoid the area (socket) for a couple days in order to let it heal. We say not to swish or rinse with water or mouthwash, as it interferes with the blood clot that forms after extractions. However, you are able to spit toothpaste out.

5) Can I eat after my surgery?

Absolutely! Sometimes we find patients are unsure if they should eat or not. You are absolutely allowed to eat after surgery. As listed above, for surgeries such as wisdom teeth or multiple extractions, you are given instructions on what you can have after (soft, cold foods). We recommend not eating anything chewy/crunchy or hot after, as you might irritate the area or burn your mouth (loss of feeling from anesthesia).

6) When can I take my gauze out?

You may remove and discard the gauze within thirty minutes. Once you arrive at home after your procedure, you may remove the gauze and at the point, you may have something to eat. However, if there is still bleeding after a couple of hours, please call the office for further instruction. It is very normal to bleed after extractions, but should cease shortly after. Please see question #13 for more information.

7) What do I take for pain?

A prescription for high dose ibuprofen (Advil, Motrin) will likely be provided to help manage post-operative pain. One 600 mg tablet may be taken every 6 hours. Additionally, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four to six hours.

 If you receive a prescription for a stronger pain medication, take the tablets prescribed as directed. The prescribed pain medicine may make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

 8) Why does it matter if I’m on blood thinners?

Anticoagulants (blood thinners) lessen the thickness of blood flow through the body so the heart doesn’t have to work as hard to pump the blood through the veins. Anticoagulants are typically prescribed for anyone with a risk of heart attack or stroke, or who have a past of either of these conditions. When someone is on blood thinners, the surgeon must make sure that all levels are where they should be and that everything is stable. If a patient is on blood thinners, they tend to bleed significantly longer because the blood is thinner and doesn’t clot as quickly. Our surgeons need to ensure that blood levels are stable, or they might have the patient go off of the medication for a couple days. This is up to the discretion of the surgeon and might involve the medical doctor/physician as well.

9) Do I always get prescribed antibiotics after surgery?

No, unless you have a recurring or obvious infection, we will not prescribe antibiotics. We do not prescribe antibiotics as a preventative measure, only to clear up an infection.

10) How long should I use ice for?

Ice should definitely be used after surgery. It will initially help with any swelling that may occur. However, after 24 hours ice has no effect.

11) Is it normal to bleed, have swelling, or have bruising?

 A certain amount of bleeding is expected following surgery. Excessive bleeding may be controlled by first wiping any clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting blood vessels. If bleeding continues after trying these methods, please call the office immediately for further instructions.

Swelling is proportional to the surgery involved. Swelling around the mouth and cheeks, under the eyes, and sides of the face is not uncommon. The body is reacting to the surgery and preparing for repair. Swelling may not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. Swelling may be minimized by immediate use of ice packs, however after 24 hours, ice has no beneficial effect. If you find swelling has still not lessened after 3-4 days, please call the office as soon as possible.

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discolouration is due to blood spreading beneath the tissues, which is normal and may occur 2-3 days post-operatively. Moist heat may speed up the removal of discoloured tissue.

 12)  What is “dry socket”? What does it feel like?

 A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. Often, there is a “bad taste” in your mouth. Please call the office as soon as possible if this occurs.

 13)  What other complications can occur?

If numbness of the lip, chin, or tongue occurs, there is no cause for alarm. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. It is also possible that the local anesthesia that originally froze certain areas has not fully come out yet.

Slight elevation of temperature immediately following surgery is not uncommon. If a fever does persist, please call the office as soon as possible. Tylenol or ibuprofen should be taken to reduce the fever.

You should be careful going from the lying down to the standing position. With fasting prior to surgery, and pain medications, you could possibly be dizzy/light-headed. Before standing, sit up for one minute.

Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by one of the doctors.

Sore throats and pain when swallowing are not uncommon. The muscles get swollen and can become slightly painful after surgery. This should subside within 2-3 days.

Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is normal and should resolve in time.