Wisdom teeth removal is a routine surgical procedure, but recovery requires diligent support from a caregiver to ensure proper healing. The patient will likely feel groggy, uncomfortable, and unable to manage post-operative instructions independently. Your role is to monitor the surgical sites and strictly manage the initial protocols that establish a healthy foundation for recovery. Providing consistent care during the first few days significantly reduces the risk of complications and promotes a smoother return to comfort.
Immediate Care in the First 24 Hours
The primary goal during the first 24 hours following surgery is allowing a stable blood clot to form within the extraction sites, acting as a protective bandage. The oral surgeon places gauze pads over the wounds before the patient leaves the office. Ensure the patient maintains firm, consistent biting pressure on these pads for at least 30 minutes to an hour upon returning home.
Replace the gauze with fresh, slightly dampened pads every 30 to 45 minutes until the bleeding slows to a light pink tinge or mere oozing. Constant changing is counterproductive, as pressure encourages clotting. Once the pads show little to no active blood, they can be removed entirely, as continued use can pull the clot out.
It is absolutely necessary to prevent any action that creates suction or pressure in the mouth, which could dislodge the newly formed clot and lead to a painful complication called dry socket. Strictly prohibit the patient from spitting, forcefully rinsing, or using a straw for drinking during this first day.
The patient should rest with their head elevated using two or three pillows or a recliner to minimize bleeding and swelling. Lying flat increases blood flow to the head and jaw area, which can prolong or worsen bleeding.
Managing Pain and Reducing Swelling
Controlling swelling and pain immediately is paramount to the patient’s comfort and recovery. Swelling is a natural inflammatory response to the surgery, managed most effectively with cold therapy during the first 24 to 48 hours. Apply ice packs to the outside of the cheeks, following a schedule of 20 minutes on and 20 minutes off.
This cyclical application helps constrict blood vessels to minimize inflammation without causing ice burn or nerve damage.
Pain management relies on strict adherence to the prescribed medication schedule, especially for opioid or prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs). Administer the first dose of pain medication before the local anesthesia fully wears off to prevent a sudden spike in pain intensity. Ensure the patient takes all pain medication with a small amount of soft food to prevent stomach irritation and nausea.
Swelling typically peaks around the second or third day post-surgery before it begins to resolve naturally. After the 48-hour window, ice packs are no longer effective, and you should transition to using gentle, moist heat. A warm, damp washcloth applied to the jaw can help soothe muscle stiffness and resolve residual swelling, but this must only be done after the initial two days of cold therapy.
Navigating Diet and Hydration
Maintaining hydration is a primary concern, as adequate fluid intake supports healing and prevents complications like dizziness or faintness. Encourage the patient to drink plenty of fluids, such as water, apple juice, or broth, directly from a glass or cup. The suction created by using a straw can easily pull the protective blood clot from the surgical site, leading to painful exposure of bone and nerves.
The diet must consist exclusively of soft or liquid foods that require minimal to no chewing for the first several days. Acceptable items include yogurt, smooth soup, mashed potatoes, applesauce, and protein shakes.
All food and beverages should be served cool or lukewarm, as excessive heat can increase swelling, promote bleeding, and potentially damage the surgical area.
Avoid any foods that are crunchy, sharp, or contain small particles, such as nuts, seeds, rice, or chips. These items can easily become lodged in the empty socket, introducing bacteria and potentially causing an infection. Gradually introduce more solid foods only as the patient’s comfort level improves and the oral surgeon permits it, typically after the first week.
Recognizing and Responding to Potential Complications
Closely monitor the patient for signs that recovery is not progressing normally, as early detection of complications is important. One of the most common issues is dry socket, or alveolar osteitis, which occurs when the blood clot is lost, exposing the underlying bone. The hallmark symptom is intense, throbbing pain that begins three to five days after surgery and is not relieved by prescribed pain medication.
Signs of infection, which typically present a few days after the procedure, include:
- A persistent fever above 100.4°F.
- A foul taste or odor coming from the mouth.
- The presence of yellow or white pus at the surgical site.
A worsening of swelling after the third day, especially when accompanied by increasing pain, also indicates infection may be present. While minor oozing is expected, excessive bleeding is defined as soaking a fresh gauze pad completely within 30 minutes.
If you observe excessive bleeding that does not stop after applying firm pressure with a fresh gauze or a moistened black tea bag for 30 minutes, contact the oral surgeon immediately. Severe medication reactions, such as hives, difficulty breathing, or sudden severe nausea, require immediate communication with the surgical office or a trip to an emergency room. When in doubt about any symptom, it is always safer to call the provider for professional advice rather than waiting for symptoms to resolve on their own.