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Dr. George McKee
Dr. George McKee, Dentist
Category: Dental
Satisfied Customers: 1396
Experience:  Licensed dentist with 30 years clinical experience in general practice and cosmetic reconstruction.
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severe swelling after wisdom tooth removal

Resolved Question:

I am pregnant and I had my wisdom tooth removed 2 days ago. The tooth was a boney impaction and only local anesthetics could be used. It was easily the most horrific experience of my life. I now have an incredible amount of swelling to my lower jaw. I did ice as directed for 24 hours and am now applying heat. What else can I do for this?
Submitted: 6 years ago.
Category: Dental
Expert:  Dr. George McKee replied 6 years ago.

Dear ,

Thank you for your question and welcome to Just Answer.

I am so sorry to hear of your ordeal. Going through a bony impaction with just a local anesthetic is not pleasant at all. Post operative swelling from a wisdom tooth extraction is directly proportional to the amount of bone removed. The more bone removed, the worse the swelling will be. This is to be expected and is at its worst about two days after the surgery, exactly where you are now.

You are doing exactly what you should be doing but I would also take some anti-inflammatory medication such as Advil or Motrin to help with both the swelling and pain. You can overlap two differing medications in order to not take more then the daily recommended amounts of each and still be taking medication frequently.

You can switch between taking 400 milligrams of ibuprofen (e.g., 2 tablets of Advil), and 1000 milligrams of acetaminophen (e.g., 2 tablets of extra-strength Tylenol) every 3 hours. Be careful not to use these medications if you have had previous adverse reactions to either, or if you have had gastritis or peptic ulcer disease in the past, or if you have liver disease.

Because of your pregnancy, this is about all you can do at this time. You will start getting better soon as you are at the worst stage right now.

I will include for you the instructions we give all out patients for the aftercare from an extraction. These instructions are for someone who had a general anesthetic and can take a narcotic pain medication, so please ignore those parts. I'm sure you will find that you are doing everything correctly. HEre are the instructions:

 

Post-Op Instructions for Wisdom Tooth Removal

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.

Immediately Following Surgery:

  • The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take the prescribed pain medications as soon as you begin to feel discomfort this will usually coincide with the local anesthetic becoming diminished.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body's normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours.

For severe pain take the tablets prescribed for pain as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

Diet

After general anesthetic or I.V. sedation, liquids should be taken at first. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. Therefore, immediately following surgery, if you are laying down, make sure you sit for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be done until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.

Other Complications

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb you could bite it and not feel it so be careful. Call our office if you have any questions about this.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
  • You should be careful going from the lying down position to standing. As you were not able to eat or drink prior to surgery, and it is difficult to take fluids, and taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by us.
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as vaseline.
  • Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
  • Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is normal post-operative event which will resolve in time.

Finally

Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it's really nothing to worry about.

  • The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call my office for instructions.
  • There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush.
  • Your case is individual, no two mouths are alike. Do not take seriously well intended advice from friends. Discuss your problem with the persons best able to effectively help you: your family dentist.
  • Brushing your teeth is okay just be gentle at the surgical sites.
  • A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. Call the office if this occurs.
  • If you are involved in regular exercise be aware that your normal nourishment intake is reduced exercise may weaken you. If you get light headed stop exercising.

 

I hope this answers your question. If you would like to discuss this further or have any additional questions, please reply to my answer and I will get right back to you.

Sincerely, XXXXX XXXXX DDS

 

Customer: replied 6 years ago.
The motrin would be ok even though I'm pregnant? I thought this was the forbidden drug for pregnant woman.
Customer: replied 6 years ago.
ok thanks.
Expert:  Dr. George McKee replied 6 years ago.

Dear ,

Thanks for waiting. I use a great website to check all drug interactions and contraindications. It's http://www.rxlist.com/.

You are correct. Motrin can have problems for women in late pregnancy. See the following link towards the bottom pf the page:

http://www.rxlist.com/cgi/generic/ibup_wcp.htm

I knew that Naprosyn was a problem but after checking all the NSAIDS, they all have the same contraindication; Motrin, Advil, Alleve, Naprosyn, Ibuprofen.

The literature for Tylenol and Bayer Aspirin state no direct problems but advise that you ask your doctor before using them. Aspirin does thin the blood.

I'm afraid you are probably limited to just these two medications but you can still overlap these as they work in different ways in the body to relieve pain and swelling.

I hope this helps and I apologise for the incorrect information.

Sincerely, XXXXX XXXXX DDS

Customer: replied 6 years ago.
I am only 7 1/2 weeks pregnant. Very far away from my delivery date of 2/09. My swelling is severe. Do you feel that the moist heating pad and tylenol should be sufficient? I'm inclined to call me OB/GYN but it's the weekend. I know that Motrin would help alot, but I'm a little scared of the "what if" involved in taking it. One more opinion please for a desperate prego?:)
Expert:  Dr. George McKee replied 6 years ago.

Dear ,

Thanks for the additional information. I would not hesitate to call your OB/GYN on a Saturday. These doctors get called on the weekend all the time for various questions and concerns. He/she should have an emergency number mentioned on the answering machine. Call that number and tell the operator that this is an emergency question and you should get a return call. Your pain is stressing your body and the sooner you can get relief the better. Go by the advice of your OB/GYN. Ask him about Aspirin as well.

The moist heat increases the blood flow to the swollen area which in turn brings the body's natural defenses and wound healing agents to the site quicker. The moist heat merely speeds up the rate of healing. So it does help and keep applying it.

Tylenol isn't the strongest medication out there but it does help and I would keep taking it as well.

Again, you are at the worst stage and in a day or two will notice a relief from all the pain and swelling. Your pregnancy just limits (for good reason) all the other medications and surgical options that you would normally had taken advantage of.

Please let me know if you have any further questions and I will be happy to get right back to you.

SIncerely, XXXXX XXXXX DDS

Dr. George McKee, Dentist
Category: Dental
Satisfied Customers: 1396
Experience: Licensed dentist with 30 years clinical experience in general practice and cosmetic reconstruction.
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