When should you rinse with salt water after wisdom teeth

The following will cover important information regarding proper post-surgical care for wisdom teeth extraction. If you have been scheduled to have your wisdom teeth removed, it will be important to follow these instructions exactly as we present them.

Discomfort after oral surgery is normal. To best manage your discomfort, please take the prescribed pain medications on schedule per the directions provided. Staying on top of a regular schedule will best minimize discomfort after oral surgery. If you are still experiencing significant discomfort despite the medications, please contact our office.

Gauze pad(s) should be placed directly over the extraction site(s) and held in place with firm biting pressure; proper placement will help you not swallow blood, which can make you nauseated. Replace the gauze pad(s) every 30–45 minutes. When the gauze pads have little or no blood on them, they are no longer necessary. The amount of bleeding will vary from person to person. Most of your bleeding will slow within 4–6 hours, but a small amount of bleeding is common for up to 24 hours.

Do not rinse on the day of surgery; it may prolong your bleeding. Begin gentle saltwater rinses the day after surgery and continue for 1 week. Rinse with warm saltwater 2–3 times each day and gently spit. To make the saltwater solution, dissolve a 1 teaspoon of salt in an 8-ounce glass of warm tap water. If prescribed Peridex®, please use 48 hours after surgery by gently rinsing in the morning and at night every day for 1 week. Please follow the instructions on the label.

If you have been given an irrigating syringe, start irrigation on the fifth day following surgery. Fill the syringe with warm salt water, and gently place the tip of the syringe into the extraction site to clean. Do this 3 times a day after meals until surgery sites are fully closed, which may take up to 4-6 weeks.

Swelling is normal after surgery and is a major cause of post-extraction discomfort. Swelling typically peaks by the third day and then starts to resolve; it can be reduced by the use of an ice pack. Apply the ice pack to one side of your face for 20 minutes; transfer it to the opposite side for another 20 minutes. Continue icing the face for the first 24-36 hours. Do not freeze the skin, do not sleep with the ice packs on overnight. Ice packs are useful for the first 24 hours only. Also, keep your head elevated on 2 pillows for 3–4 days. These measures will not eliminate swelling, but they will help to reduce its severity.

For the first 24 hours start with clear liquids, such as apple juice, tea, or broth. Gradually ramp up your diet as tolerated. Always cool down any hot foods or liquids during the first 24 hours. You should eat only soft foods for the first week (for example, soups, eggs, mashed potatoes, and meatloaf). If you were sedated for surgery, do not eat fatty, creamy, or oily foods; these foods may cause nausea. To help prevent dry socket, do not use a straw for the first 3 days after surgery.

Begin brushing your teeth the day after surgery. It is important to brush all of your teeth, even if the teeth and gums are sensitive. Bacterial plaque and food accumulation near the extraction site(s) will delay healing.

Do not smoke for at least 1 week. Smoking will increase your bleeding; the nicotine and tar in tobacco impair healing and may cause a dry socket.

Unless told otherwise, do not engage in vigorous physical activity for 3 days following your surgery. Physical activity increases your blood pressure, which will cause an increase in your swelling, pain, and bleeding. You may gradually increase your activity, such as jogging or tennis, 5–7 days after your surgery.

It is our desire that your recovery is as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call our office.

After Your Surgery

Post-Operative Instructions

General Anesthesia Precautions

**If general anesthesia or IV sedation was utilized, do not leave the patient unattended for the first 12 hours.

**Please closely supervise the patient when getting up or going to the bathroom.

Medications

Please refer to your medication information sheets if you were given prescriptions. If you have any reaction to medications prescribed, call the doctor immediately.

Managing Bleeding After Surgery

For the first hour after surgery:

Keep firm pressure on the surgical site with the gauze that was placed in your mouth after surgery. Remove gauze after 1 hour.

If Bleeding Continues

Take 1 piece of gauze and fold it in quarters, creating a firm pad. Place the pad over the surgical site. Use firm biting pressure where possible (extraction site), or direct finger pressure by holding the gauze (biopsy site). You may have to repeat this procedure several times. The bleeding should stop within 2-3 hours, but you can expect to see blood-tinged saliva for up to 24-48 hours following surgery. If bleeding is heavy, or continues after 2 hours, moisten a tea bag, place on surgical site, and apply pressure or bite firmly for 30 minutes. This usually stops the bleeding. Please remember, most bleeding is controlled and stopped with a well-positioned gauze or tea bag with direct pressure. If bleeding is heavy or continues after 24 hours, call the doctor. Do not rinse, spit, or use a straw the day of surgery, as this can cause bleeding to resume.

To Reduce Swelling

Ice for the initial 24 hours. Use ice packs applied to the face for 20-minute intervals (20 minutes on, 20 minutes off). If oral surgery was performed on both the right and left sides, it is recommended to use one ice pack and alternate sides every 20 minutes. This is the most effective way to reduce swelling. Do not exceed 20 minutes in one area as this can cause tissue injury. Swelling usually reaches its maximum 2 days following surgery. To help reduce swelling, sit semi-reclined in a reclining chair; if lying down, keep your head elevated with 2-3 pillows. Icing should be discontinued after 24 hours. While icing your face may feel good, it will act to increase swelling. Again, DO NOT ice beyond 24 hours.

Orthodontic Retainers

If you have orthodontic retainers, please do not use them immediately after surgery. Use of your retainers can resume 1-3 days after the procedure or as comfort allows.

Diet

Resume your diet immediately following surgery. When you get home, start with a milkshake, smoothie, or other thick liquid using a spoon, NOT a straw. Your diet should be limited to cool and soft foods for the first day. Sometimes numbness from local anesthesia may last for hours; therefore, hot foods and liquids should be avoided, as they can cause a burn. A normal diet can be resumed as tolerated. Most foods can be eaten as long as care is taken to avoid the surgical sites. The following are some suggested softer foods: pancakes with syrup, eggs, and pastas like macaroni and cheese or spaghetti.

Oral Hygiene

Rinse with warm salt water or tap water beginning 3 days after surgery. To make a salt water rinse, add 1 teaspoon of salt to 4-5 oz of warm water. Rinse at least 3 times per day: in the morning, after meals, and before bed. Do not gargle. With extractions, you may have been given a plastic irrigating syringe. Begin using this syringe 3 days after your extraction. Using tap water or salt water, gently irrigate only the lower extraction site(s) once a day to remove any food debris that may persist after rinsing. Continue until all debris is removed. Do not use over-the-counter mouthwash, such as Scope® or Listerine®, as these can irritate the surgery site and slow healing. Resume brushing your teeth the day after surgery, being careful to avoid the surgical sites. It is not unusual to see traces of blood on your toothbrush.

Activity and Smoking/Vaping

Physical activity should be limited after oral surgery procedures. Vigorous exercise or organized sports should not be resumed until 3-5 days after surgery or as your condition allows. Please contact our office if a written excuse is needed for organized sports or gym class. The nicotine from smoking and vaping can significantly delay healing and cause an increase in post-operative pain. Therefore, you should refrain from smoking as long as possible.

Stitches

Stitches that have been placed are usually dissolvable and will fall out on their own within the first 4 days, possibly longer. It is not unusual for one or more to loosen and fall out before dissolving, especially in moving areas of your mouth, such as the tongue or cheek areas. If the stitches come out and the wound opens and creates a hole, it is typically not of concern unless there is excessive bleeding. Fortunately, incisions in the mouth do heal very quickly, and any wound that does open will close naturally.

Follow-Up Visits

If a follow-up visit is necessary, an appointment would have been scheduled for you. Post-operative appointments are always available. Please call the office during business hours if you would like to be seen.

When You Get Home

1. Remove gauze packing.
2. Drink at least ¼ of your milkshake (or smoothie, or other cool, thick liquid) using a spoon—NOT a straw.
3. Take pain reliever immediately, as explained in the “Pain Management” instruction sheet, unless you were already given ibuprofen in recovery.
4. Take the antibiotic (if prescribed) as directed.
5. Replace the gauze packing, if necessary.
6. Begin ice packs to the outside of your face, as explained previously, no longer than 20 minutes on one side.
7. Increase your fluid intake throughout the day.

Typical Recovery

With most oral surgery procedures, post-operative discomfort can actually worsen between the third and sixth days. This discomfort is considered normal and should be managed with your pain medication. If you have significant discomfort, even with pain medication, or you cannot tolerate the pain medication, please call the office.

When to Call the Doctor

If there is a drug reaction, significant swelling, persistent pain or bleeding, or any other unusual reactions, call the office immediately. Additionally, if you have any questions during the post-operative period, do not hesitate to call. There is an answering service to respond to emergencies at all times when the office is closed

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