mverybody knows someone with a wisdom tooth extraction story: stories of cheek swelling and recovery room, OMG-did-she-say-that?! abound. As a nurse, I considered wisdom teeth removal a minor procedure that didn’t count as “real” surgery. But that all changed when I had mine removed at 28. I told our nanny that I will be able to take care of our girls once I get home. Instead, I tried to eat applesauce, felt radiating pain, and sent my husband to get my pain meds while I went to my room to cry. Our nanny stayed the day.
Fortunately, after controlling my pain with ibuprofen, my recovery was mostly smooth, minus the day I decided to eat Nerds, which promptly fell into the craters where my teeth used to be.
Experts in this article
- Rachel Uppgaard, DDSRachel Uppgaard, DDS, is a clinical associate professor in the Department of Oral and Maxillofacial Surgery at the University of Minnesota.
we talked Rachel UppgaardDDS, clinical associate professor in the Department of Oral and Maxillofacial Surgery at the University of Minnesota, to learn how to prepare for wisdom teeth removal, what recovery looks like, and what you need to know both before and after surgery.
When should wisdom teeth be removed?
Between 17-25 years old, the third molars, also known as wisdom teeth, usually surface. Although most people have four or fewer wisdom teeth, some people have none. Guardians may need to be removed if they do not develop properly or cause problems such as pain, infection or crowding.
Dr. Uppgaard shared that it’s ideal to remove teeth at an earlier age — before they’ve fully developed their roots and bones. Early extraction also facilitates the patient’s healing, because removal in elderly patients presents a higher risk of healing challenges.
What happens before a wisdom tooth removal?
Some surgeons will remove wisdom teeth the same day they see a patient. Others like to have a pre-surgical consultation and then have the teeth removed on a different day. Dr. Uppgaard explains that it all depends on the surgeon, whether the patient is young and otherwise healthy, and whether it’s a routine wisdom tooth extraction.
When the procedure is more complicated, if the patient has pre-existing conditions, or if the patient/parents have questions, he says it’s a good idea to meet with the surgeon before the surgery date. Some insurance companies require prior approval. In this case, the surgeon would meet with the patient, submit notes to the insurance company explaining why the procedure is necessary, and wait six to eight weeks to receive the insurance.
Pre-op prep
Every surgeon has different rules, so it’s important to talk to yours about how you should prepare for surgery. Dr. Uppgaard lists some of the typical preop rules:
- Do not eat or drink eight hours before surgery.
- Smoking: She advises her patients to do what they already do before sedation, as the airway can become more reactive if you quit smoking before surgery. (After surgery, he recommends a smoking cessation.)
- If you are taking any medications, herbal supplements or medications, it is important to discuss them with your doctor. Some medications can be taken the morning of surgery with a small sip of water, other medications, such as diabetes medications, may be changed before surgery.
Day of surgery
Once you’ve arrived, you’ll be taken to the operating room, where the team will double-check that they have the right patient and are doing the right procedure. An IV will be started. Once the IV is in, the patient may be given some nitrous oxide (gas) to relax them, and medication will be given through the IV to put the patient to sleep.
The duration of the procedure depends on the complexity of the case and the surgeon. Dr. Uppgaard recommends asking your surgeon about the length of your procedure. You will not be able to drive for 24 hours after the anesthesia, so you must get someone to drive you home.
Why do patients act so weird afterwards?
After waking up in the recovery room, my mouth full of gauze, I felt great about life.
“I’m hot,” I told my husband.
“Do you want me to take off your blanket?” asked.
A creepy smile spread across my swollen face, “No, I’m sexy.”
Youtube is full of videos from people saying hilarious things after wisdom teeth removal. Why is this? Dr. Uppgaard explains that it takes time for anesthetic drugs to wear off. You can expect the drugs to wear off after 24 hours.
What OTC medications should you have on hand?
First and foremost: It’s important to talk to your surgeon about your pain management plan—some patients may have contraindications to certain medications. In general, however, Dr. Uppgaard says extra-strength ibuprofen (Advil) and acetaminophen (Tylenol) will provide the best pain management postoperatively and have a much lower risk of constipation, nausea and addiction than opioids. Ibuprofen and acetaminophen can either be taken at the same time or staggered to provide more continuous pain management.
Check the dosage instructions on the bottle. it is important not to exceed the maximum dose per day. In the first few days after surgery, it is helpful to note the times you take each medication. Dr. Uppgaard recommends keeping a schedule on your phone, making a chart, or putting a small chart on the actual medicine bottle that can be checked when a dose is taken.
Prescription drugs
Dr. Uppgaard explains that medications prescribed after surgery depend on the patient, the difficulty of removal, the surgeon, and whether there are signs of an active infection. A patient may be sent home on antibiotics, antimicrobial mouthwashes, and steroids. He notes that while many practices are moving away from prescribing opioids, sometimes a patient is sent home with a limited amount of them—given the opioid epidemic, he emphasizes the importance of safely disposing of unused doses at your pharmacy.
What can I eat next?
Dr. Uppgaard recommends soft foods for the first few days and advancing the diet as tolerated. Avoid crunchy, grainy or hard foods (yes, that means no Nerds) and stay away from acidic and spicy foods. He recommends cold foods the first day because they constrict the blood vessels, helping to slow the bleeding… which I take to mean ice cream all day.
Postoperative care
Do these things:
- Follow the instructions your surgeon provides regarding the gauze in your mouth. Dr. Uppgaard usually has her patients bite firmly on the gauze for 30 to 40 minutes after the procedure until the bleeding slows. He adds, “That means we’re not talking.” How boring.
- Elevate your head to reduce swelling.
- Rinse your mouth with warm salt water after every meal and snack (but don’t spit the water out, let it drain on its own). Some surgeons will send the patient home with a syringe to gently flush the surgical site. Other surgeons won’t, given the concern about removing the clot and causing dry socket, a painful condition that can occur after wisdom teeth removal when the blood clot in the socket where the tooth was removed doesn’t form properly or dislodges, leaving the exposed underlying bone. Talk to your surgeon about how he or she would like you to do the seawater flushes.
- Ice 20 minutes on/off to reduce swelling and pain.
- It is okay to brush your teeth gently on the day of surgery. It is normal to have blood in your saliva for two days after the procedure.
Don’t do these things!
- Avoid spitting as it can dislodge the clot over the surgical site
- Do not use a straw.
- Avoid alcohol and fizzy drinks for three to four days. Talk to your surgeon about caffeine.
- No smoking.
Complications
Dry reception: This side effect occurs when the clot above the tooth extraction site either does not grow, or is removed or dissolved before the wound heals. This leaves the nerve roots exposed and can cause pain at the surgical site and on the side of the face.
A hole between the vagina and the mouth: Dr. Uppgaard explains that in five percent of procedures, removing a wisdom tooth reveals a hole between the sinus and the mouth. If this happens, your surgeon will close it during the procedure and provide care instructions.
Nerve injury: One to five percent of people will have temporary numbness lasting up to a year, while 0.1-0.3 percent of people will have permanent nerve damage. If you experience numbness that lasts more than 24 hours, call your surgeon’s office.
Contamination: Up to six percent of patients develop an infection after wisdom teeth removal. This is treated with antibiotics or minor surgery to drain the infection.
If you experience any of the above or have concerns, Dr. Uppgaard recommends calling your surgeon to set up a post-op visit.
How long does recovery usually take?
Dr. Uppgaard says the majority of people experience the most pain and discomfort in the first three days after a wisdom tooth is removed, and start to feel like themselves around two weeks. Every surgeon is different and every patient has a unique situation. This guide is not specific to you. discuss the specifics of your procedure with your surgeon.
