Everybody knows somebody with a wisdom tooth removal story: tales of cheek puffiness and recovery room, OMG-she-said-that?! abound. As a nurse, I considered wisdom teeth removal a minor procedure that didn’t count as “real” surgery. But this all changed when I had my own removed at age 28. I told our nanny I would be able to take care of our girls as soon as I returned home. Instead, I tried to eat applesauce, experienced radiating pain and sent my husband off to pick up my pain medications while I went to my room to cry. Our nanny stayed the day.
Experts in This Article
Rachel Uppgaard, DDS, is a clinical associate professor in the Division of Oral and Maxillofacial Surgery at the University of Minnesota.
Thankfully, after getting my pain controlled with ibuprofen, my recovery was mostly smooth sailing, minus the day I decided to eat Nerds, which promptly lodged themselves in the craters where my teeth used to be.
I spoke with Rachel Uppgaard, DDS, clinical associate professor in the Division of Oral and Maxillofacial Surgery at the University of Minnesota, to learn how to prepare for wisdom teeth removal, what recovery looks like, and the things to be aware of both before and after surgery.
When should wisdom teeth be removed?
Between the ages of 17–25, the third molars, aka wisdom teeth, usually surface. Though most people have four or fewer wisdom teeth, some people don’t have any. Wisdom teeth may need to be removed if they don’t grow in properly, or cause problems such as pain, infection, or crowding.
Dr. Uppgaard shared that it is ideal to remove the teeth at a younger age—before they fully develop their roots and bone. Extracting early also makes it easier for the patient to heal because removal in older patients presents a higher risk of healing challenges.
What happens before a wisdom tooth removal?
Some surgeons will remove wisdom teeth on the same day that they meet a patient. Others like to have a pre-surgical consult and then remove the teeth on a different day. Dr. Uppgaard explains that it all depends on the surgeon, if the patient is young and otherwise healthy, and if this is a routine wisdom teeth extraction.
When the procedure is more complex, if the patient has pre-existing conditions, or if the patient/parents have questions, she says it is a good idea to meet with the surgeon prior to the surgical date. Some insurance companies require prior authorization. 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 insurance approval.
Pre-op prep
Each surgeon has different rules, so it’s important to talk to yours about how you should prepare for the surgery. Dr. Uppgaard lists a few of the typical preop rules:
- No eating or drinking eight hours prior to surgery.
- Smoking: She recommends that her patients do what they are already doing prior to sedation as the airway can become more reactive if you quit smoking prior to surgery. (After surgery, she recommends a pause in smoking.)
- If you take medications, herbal supplements, or drugs, 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 modified prior to surgery.
Day of surgery
After you arrive, you will be taken to the surgical room, where the team will double-check that they have the correct patient and are doing the correct procedure. An IV will be started. Once the IV is in, the patient may be given some nitrous oxide (gas) to help relax them, and medications will be administered through the IV to put the patient to sleep.
The procedure length depends on the complexity of the case and the surgeon. Dr. Uppgaard recommends you ask your surgeon about the length of your procedure. You will be unable to drive for 24 hours following anesthesia, so you must bring someone to drive you home.
Why do patients act so weird after?
After I awoke in the recovery room, my mouth full of gauze, I felt great about life.
“I’m hot,” I said to my husband.
“Would you like me to take your blanket off?” he asked.
A creepy smile spread across my puffy face, “No, I’m sexy.”
Youtube is full of videos of people saying hilarious things after wisdom teeth removal. Why is this? Dr. Uppgaard explains that it takes time for the anesthesia medications to wear off. You can expect the medications to wear off after 24 hours.
What OTC medications should you keep 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, though, Dr. Uppgaard says that extra-strength ibuprofen (Advil) and extra-strength acetaminophen (Tylenol) will provide the best pain management post-operatively and have a much lower risk of constipation, nausea, and addiction than opioids. The ibuprofen and acetaminophen can either be taken at the same time, or staggered to provide a more continuous pain management.
Check dosage instructions on the bottle; it’s important not to exceed the maximum dose per day. In the first few days after surgery, it’s helpful to write down the times you take each medication. Dr. Uppgaard recommends keeping a schedule on your phone, making a chart, or putting a little chart on the actual medication bottle that can be checked off when a dose is taken.
Prescription medications
Dr. Uppgaard explains that the medications prescribed after surgery depend on the patient, the difficulty of removal, the surgeon, and if there are any signs of active infection. A patient may be sent home with antibiotics, antimicrobial mouthwash, and steroids. She notes that while many practices are veering away from prescribing opioids, sometimes a patient will be sent home with a limited amount of them—given the opioid epidemic, she stresses the importance of safely disposing of unused doses at your pharmacy.
What can I eat after?
Dr. Uppgaard recommends soft foods for the first few days and advancing the diet as tolerated. Avoid crunchy, granular, or hard food (yes, that means no Nerds), and stay away from acidic and spicy foods. She recommends cold foods on the first day because they cause blood vessels to narrow, helping to slow the bleeding… which I interpret to mean ice cream all day.
Post-op care
Do these things:
- Follow the instructions your surgeon provides about 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. She adds, “This means no 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 dribble out on its own). Some surgeons will send the patient home with a syringe to gently rinse the surgical site. Other surgeons will not, given the concern for dislodging the clot and causing dry socket, a painful condition that can occur after a wisdom tooth removal when the blood clot in the socket where the tooth was extracted fails to properly form or is dislodged, leaving the underlying bone exposed. Talk to your surgeon about how they would like you to do the salt water rinses.
- 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 carbonation for three to four days. Talk to your surgeon about caffeine.
- No smoking.
Complications
Dry socket: This side effect occurs when the clot over the tooth extraction site either doesn’t develop, is dislodged, or dissolves prior to the wound healing. This leaves nerve roots exposed and can cause pain at the surgical site and on the side of the face.
A hole between sinus and mouth: Dr. Uppgaard explains that in five percent of procedures, the removal of a wisdom tooth uncovers a hole between the sinus and the mouth. If this happens, your surgeon will close it up during the procedure and provide care instructions.
Nerve injury: One to five percent of people will have temporary numbness that lasts up to a year, while 0.1-0.3 percent of people will have permanent nerve damage. If you experience numbness that lasts over 24 hours, call your surgeon’s office.
Infection: Up to six percent of patients develop an infection after wisdom teeth removal. This is treated with antibiotics or a minor surgical procedure to drain the infection.
If you are experiencing any of the above or have concerns, Dr. Uppgaard recommends you call your surgeon to set up a post-op visit.
How long does recovery normally take?
Dr. Uppgaard says the majority of people experience the most pain and discomfort for the first three days after wisdom tooth removal and start to feel like themselves around the two-week mark. Each surgeon is different, and each patient has a unique situation. This guide is not specific to you; discuss the specifics of your procedure with your surgeon.
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