Dental health and wisdom teeth

What happens during wisdom teeth removal?

Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anaesthetic which is the same injection with the same medication you would receive to numb a tooth prior to having a cavity filled. In addition to the local anaesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control any anxiety. Sedating medications that could be selected include: nitrous oxide (otherwise known as "laughing gas"), an oral sedative, or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment.

What does recovery involve after wisdom teeth are pulled?

After having your wisdom teeth removed, the speed of your recovery depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone). In general, here's what to expect.

During the first 24 hours

• Bleeding may occur for several hours after tooth extraction. To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acid in tea helps blood clots to form (blood clots function similarly to a scab over an open wound). Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid "sucking" actions (for example, don't drink through straws or smoke) and avoid hot liquids such as coffee or tea. These activities can dislodge the clot, causing a dry socket to develop (see below).
• Facial swelling in the area where the tooth was extracted typically occurs. To minimise swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a rotation of 10 minutes on, followed by 20 minutes off. Repeat as necessary during this first 24-hour period.
• Pain medications, such as paracetamol or ibuprofen can be taken for minor pain. Your dentist or oral surgeon may prescribe more potent pain relievers, such as opioid medication, if necessary.
• Antibiotics that may have been prescribed prior to tooth extraction and are being used to treat any active infection around the wisdom tooth to be extracted should continue to be taken until the full course is finished.
• Foods should be restricted to a liquid diet until all the numbness from the anaesthetic has worn off. Eat soft foods for a few days. Also avoid alcohol if you're taking opioid medication.
• Continue to brush your teeth, but avoid the teeth directly neighbouring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of all your teeth. Do not use commercial mouth rinses as these can irritate the extraction site.

After 24 hours

• Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. Apply a moist warm flannel to the area on a 20 minute on, 20 minute off rotation. Repeat as necessary.
• Rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses.
• Stitches, if used and if not of the self-dissolving type, need to be removed by your dentist or oral surgeon in about 1 week. If you do require stitches, ask what type you have been given.
• Watch for signs of dry socket (described below). This condition requires treatment by your dentist.
• Complete healing doesn't occur for a few weeks to a few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction. Your dentist will explain what to expect in your specific case.