Wisdom teeth removal requires specific aftercare steps to ensure proper healing. The immediate post-operative period is particularly important for wound closure and recovery. Understanding the correct protocol for managing extraction sites helps prevent complications. The initial focus immediately following surgery is controlling bleeding, which centers on the proper application of gauze.
Gauze Application and Bleeding Control
The primary question of whether to wet the gauze is typically answered with a preference for dry or slightly damp material. A dry gauze pad applies the necessary pressure to the surgical site, helping blood vessels constrict and begin the clotting process. While slightly dampening the gauze with sterile water may prevent sticking, soaking wet gauze is advised against. Excessive moisture can dilute the blood and interfere with clotting factors.
Proper application of the gauze pad is necessary for achieving hemostasis, or the cessation of bleeding. The gauze should be folded into a thick pad and placed directly over the extraction socket, not simply stuffed into the cheek. Firm, steady pressure is applied by biting down for the recommended duration, typically 30 to 45 minutes, without chewing or talking.
If the initial gauze becomes saturated, remove it and replace it with a fresh, clean pad. Reapply pressure for another 30 to 45 minutes. While replacing saturated gauze maintains consistent pressure, frequent changing should be minimized once bleeding slows. Continually disturbing the site by changing the gauze too often can disrupt clot formation and prolong the bleeding.
Protecting the Blood Clot
The main purpose of using gauze and applying pressure is to facilitate the formation and protection of a stable blood clot, also known as the coagulum. This clot is a dense, jelly-like matrix of blood cells and proteins that acts as a natural biological bandage, sealing the open wound. The presence of this clot is necessary because it protects the underlying bone and nerve endings from the oral environment.
If this protective clot is dislodged or dissolves prematurely, it can lead to alveolar osteitis, commonly called a dry socket. This exposure of the bone results in significant pain that typically begins a few days after the procedure. Patients must avoid activities that create negative pressure in the mouth, which could suction the clot out of the socket.
Actions like spitting, sucking through a straw, or smoking are major threats to the stability of the clot and should be avoided for the first several days. Vigorous rinsing or probing the wound area with the tongue or fingers also risks dislodging the coagulum. Once active bleeding has stopped, the gauze should be removed so that natural healing can proceed without interruption.
First 24 Hours of Recovery
Beyond managing initial bleeding with gauze, the first 24 hours of recovery focus on controlling discomfort and minimizing swelling. Swelling is a normal inflammatory response to the surgery, and its severity can be reduced by applying ice packs to the outside of the face. Apply ice in intervals, such as 20 minutes on and 20 minutes off, during the first day.
Pain management involves taking prescribed or over-the-counter medication as directed by the surgeon. Medication should often begin before the local anesthesia fully wears off to maintain comfort. Restrict physical activity significantly on the day of surgery, avoiding strenuous exercise that could increase blood pressure and restart bleeding.
Diet
Dietary intake must be limited to soft foods and cool liquids, avoiding anything hot, crunchy, or requiring heavy chewing.
Oral Hygiene
While gentle oral hygiene is eventually necessary, the surgical site should not be rinsed, brushed, or disturbed on the day of the surgery. Beginning the day after the procedure, patients can start gentle warm salt water rinses. Use a solution of a half-teaspoon of salt dissolved in a cup of warm water to keep the area clean.
Signs of Concern
Light oozing and a small amount of blood mixed with saliva are expected for up to 24 hours. However, certain signs indicate the need to contact the oral surgeon immediately. Heavy and persistent bleeding, soaking through a fresh gauze pad every 10 to 15 minutes for several hours, suggests clotting efforts are failing. The surgeon may advise trying a moistened black tea bag, which contains tannic acid that aids in blood vessel constriction.
Severe pain unresponsive to prescribed medication is another important symptom requiring professional attention. While some discomfort is normal, pain that intensifies significantly after the first few days, especially if accompanied by a foul taste or odor, may suggest a dry socket or infection. Other signs that prompt an immediate call to the surgical office include:
- Fever
- Swelling that continues to increase after the third day
- Signs of an allergic reaction to medication