The post-wisdom tooth removal “weirdness”—slurred speech, emotional release, and general grogginess—is a temporary and expected side effect of the drugs administered during the procedure. This distinct behavior is not caused by the surgery itself but by the pharmacological agents used for sedation and pain control. The immediate effects stem from the intravenous medications used to ensure comfort and lack of memory during the extraction process. Understanding the specific drugs responsible clarifies why this temporary state of confusion occurs and how quickly it resolves.
The Immediate Impact of IV Sedation
The most pronounced instances of strange behavior are directly attributable to the intravenous (IV) sedation cocktail used by the oral surgeon. Medications like midazolam, propofol, and fentanyl are central nervous system (CNS) depressants that temporarily alter brain function to achieve an anesthetic state. These drugs are responsible for the immediate lack of coordination and emotional swings seen immediately after waking.
Midazolam, a benzodiazepine, is known for inducing anterograde amnesia, meaning the patient will not form new memories of the procedure or the first few minutes of recovery. This temporary disruption of memory formation contributes to the patient’s confused state upon waking. Propofol and fentanyl depress awareness and provide pain relief, slowing down overall cognitive processing and motor skills.
These depressant effects on the CNS cause the characteristic slurred speech and slow reaction times. The lack of inhibition and impaired judgment can lead to emotional disinhibition, resulting in unexpected crying or laughing fits. This acute impairment is intentional and keeps the patient calm and comfortable during the surgical procedure.
Residual Effects of Post-Operative Pain Management
After the acute effects of the IV drugs wear off, a secondary, more prolonged mental dullness can be caused by prescribed take-home pain medications. Opioid-based pain relievers, such as hydrocodone or oxycodone, are commonly prescribed for the initial days of recovery. These medications act on opioid receptors in the brain, contributing to generalized drowsiness and a lingering mental fog.
The cognitive effects of oral opioids differ from immediate sedation but involve a slowing of thought processes, attention, and concentration. This residual effect is primarily responsible for the feeling of being sluggish in the 12 to 24 hours following the surgery. Many dental surgeons now recommend alternating over-the-counter pain relievers like ibuprofen and acetaminophen, which do not carry the same degree of sedating side effects.
This extended grogginess is exacerbated by the body’s natural response to the surgery, including inflammation and the stress of recovery. While prescribed pain medication provides comfort, it also contributes to the feeling of being mentally slow and unable to focus. This dullness should be distinguished from the acute effects of the initial IV sedation.
How Long the Confusion Lasts
The acute “weirdness” caused by the IV sedation is short-lived, with the most effects resolving within two to four hours after the procedure ends. This timeline corresponds to the body rapidly metabolizing and clearing the short-acting intravenous medications. However, the residual grogginess and slow processing from both the residual IV drugs and the prescribed oral pain medication can persist longer.
Patients should anticipate feeling drowsy and cognitively impaired for the remainder of the day of surgery, and potentially into the following morning. A responsible adult caregiver must be present for at least the first 12 hours after the procedure. During this period, the patient must not drive, operate heavy machinery, or make important personal or financial decisions, as judgment remains temporarily compromised. The full clearance of all sedative effects, including the mild mental fog from oral pain relievers, is complete within 24 hours.