Every year teens and adult alike troop to their oral surgeon for an evaluation and removal of third molars. With them come the twice told tales of how badly someone else had it. In truth, many patients have minimal difficulty and those who do can be straightened out with minimal additional treatment.
While every case is different, the symptoms and treatments remain the same with very little variations. Prior to having the procedure done, talk with your specialist about if your wisdom teeth are impacted or not. This will give you a better idea of what your recovery period is going to be like.
Fully erupted: This simply means that the wisdom teeth are entirely visible in the mouth. The teeth can be easily extracted using an upper or lower third molar forceps. Swelling is unlikely with this type of extraction; however each case is different and the patient may experience minor swelling and discomfort.
Partially erupted: These teeth are almost through the gum tissue. Teeth may require several small incisions to remove the tissue to expose the tooth. In some cases drilling may also be needed. Some swelling is to be expected.
Soft tissue impacted: The tooth is hardly visible (or invisible) above the gum line. This procedure will require the use of a scalpel to remove the gum tissue and sometimes drilling to remove any bone surrounding the tooth. Expect sutures to close any incisions
Fully impacted (with complications): These teeth are still encased in bone and in some cases may be pushing against the roots of second molars. Expect incisions, the use of the drill, and a lot of suturing. A patient will experience more swelling with this type of extraction because of what is involved in removing the teeth.
*Note- complications can arise with any extraction if the roots are deep, wrapped around or embedded in the jaw bone. Red heads and fair skinned people are also most likely to have more swelling than the average person.
Knowing what type of extractions you will have will enable the specialist and their staff to better help you. Before the procedure there are several things you can pick up in order to minimize swelling. Reusable ice packs or frozen peas can be picked up; preferably the frozen peas as they conform to the face better. Extra gauze may be needed to bite down on to help slow any bleeding and promote clotting. Also ask your dental office if you can get your prescriptions fill prior to the procedure. This alone can greatly affect the amount of discomfort you may experience.
After the procedure is complete and a thorough assessment made of your procedure, your treatment team will go over post operatory instructions with you. Many of the instructions are very basic and do not vary no matter what type of extraction you have had. Under no circumstance are you to drink through a straw, smoke or do any excessive chewing. This may cause the clot to become dislodged and cause dry socket. Your mouth is to be rinsed eight to ten times a day with salt water. Gentle rinsing will help keep food particles from being trapped in the open sockets. Keep head slightly elevated while laying down or sleeping. Apply the ice packs or frozen peas (wrapped in a towel) to the face ten minutes on, ten minutes off. Do not brush teeth for at least two to three days. The reason being is that when people brush their teeth they tend to spit out the toothpaste. The act of spitting causes a sucking motion(kind of like a straw) and could dislodge the clot. It is also suggested that patients minimize physical activity. This will help keep bleeding from reoccuring and reduce the chances of severe swelling.
While the above are the simple instructions that apply to every case, other instructions may apply; especially if the teeth were impacted. As stated above there will be swelling on impacted extractions, there is no getting around that. It becomes more important to follow instructions to minimize swelling. However, excessive swelling, pain or the appearance of bruising can be signs of infection.
When impacted teeth are removed, it may become necessary to place a medicated packing strip into the socket. This will help with discomfort and discourages infection. If this applies to you, be careful of the packed site. The packing is generally sutured in, and will be removed in about one week. Until then be very careful when brushing your teeth and when chewing do so on the other side of the mouth.
Regardless of what type of extraction was performed if swelling is going to occur, it will show up in about 24-48 hours. It will take about a week for the swelling to go down; until then simply follow the instructions given by your dental team. Very little interferes with the swelling process; however as stated above if it is accompanied by excessive pain or bruising call your dental office. If the swelling has not begun to go down a week after the extraction, you may be advised to take over-the-counter Tylenol with your prescribed pain medication.
The best thing patients can do to minimize swelling after extractions is to follow the post operatory instructions and keep the dental team in the loop. Those two things will go a long way to ensuring a happy and successful recovery.