After Extraction of Wisdom Teeth

The removal of wisdom teeth is performed under intravenous anesthesia with the use of local anesthesia as well.  If you were sedated for the procedure you will be discharged to the care of your escort only after you meet strict discharge criteria.  Although you may be able to be safely discharged, the effects of the medication may linger and you may be forgetful.  For this reason it is extremely important that you choose an escort who is trustworthy and responsible.  Your escort will have your postoperative kit will include postoperative instructions, prescriptions for all medications, and gauze.  They will be responsible to help you get your medications and get started on them.  They are to make sure you are following your instructions and visually monitor you for 24 hours for your safety.  If you can not find an escort you can trust it is highly recommended that you reschedule your appointment until you can as your escort is 100% responsible for your safety once you are discharged from the care of the office.  If you have any questions, please do not hesitate to call us at Big Island Oral Surgery Office Phone Number 808-649-5099.

Our services are provided in an environment of optimum safety. We utilize modern monitoring equipment and our staff are experienced in anesthesia techniques.

Do You Want Your Wisdom Teeth Removed?

If your wisdom teeth are causing you pain or you want to avoid future problems, contact our office to schedule an appointment.

What will I feel like after wisdom teeth removal surgery?

On the first day after wisdom teeth removal surgery, you may experience some minor bleeding and pain. You should not sleep with gauze in your mouth as it may pose a choking risk.  You should cover your pillowcase with something so that you don’t get any blood on it and sleep with your head elevated above your chest with a towel positioned to catch secretions from the mouth. Each individual’s reaction to surgery varies, and the sensation of pain can range from mild discomfort to severe pain. A variable amount of swelling can be expected following the surgery. This swelling usually peaks on the second day to third day and should begin resolving towards the end of the first week. You can limit the amount of swelling you will have by using ice for the entire first day. The more ice you use the first day, the less swelling you are likely to have on the second day.  Avoiding sleeping lying horizontal will help minimize swelling.  Please remember to put ice on the first day even if it is somewhat uncomfortable to have the cold next to your skin, and always use a towel around a cold pack to prevent thermal injury. On the third day, you will notice that your jaw muscles are stiff, and it is difficult to open your mouth normally. You can apply moist heat to your face on the second and third day allowing your muscles to relax more and open wider. Most of the time you will want to limit your activities for a few days. We ask that you follow your post-operative instructions closely as they will be more comprehensive than the information found here.  Thoroughly adhering to your instructions will make you as comfortable as possible during the first few days following your procedure. Please allow time for your body to begin healing before resuming an active social, academic, or athletic schedule. Most patients feel like they are over the hump and on their way to recovery in 3 to 5 days.

Are there any problems after the extraction of wisdom teeth?

As with any medical procedure, there can be complications or situations that cause prolonged pain, or the need for a subsequent intervention. Some complications that patients undergoing wisdom tooth extraction may experience include:

It is imperative that your escort review all post-operative instructions while they are waiting for you to be done with your procedure. We ask that you follow these instructions closely, as they will make you most comfortable following your procedure. If you were sedated, you will be comfortable and drowsy when you leave the office. It is best to get you medications and the go home and rest with no other physical or scholastic activities planned for a few days.

A representation of numbness caused by damage to a sensory nerve

Damage to Sensory Nerve:

A primary concern is a nerve within the lower jaw bone that supplies feeling to the lower lip, chin, and tongue. This nerve is frequently very close to the roots of the lower wisdom teeth. Having these teeth out between the ages of 12 and 18 usually provides shorter roots so that the nerve is not so close to the roots of these teeth. Occasionally, when the teeth are removed, and especially in older patients, the nerve can become injured. When local anesthesia wears off, you may experience a tingling or numbing sensation in the lower lip, chin, or tongue. Should this occur, it is usually temporary and will resolve gradually over a period of weeks or months.  Although Dr. Rotwein may have to purposely leave a small portion of tooth root to decrease the chance of this occurring, unfortunately risk can never be completely eliminated.  On rare occasions it can result in a permanent alteration of sensation similar to having local anesthesia and this may require consult with a neurosurgical specialist.  Dr. Rotwein will have a thorough discussion of the likelihood of this risk and discuss the best options to mitigate their risk given the specifics of their case presentation.

A diagram showing the opening that can occur between your mouth and sinuses

Sinus Communication:

The upper wisdom teeth are situated close to your sinuses, and their removal can result in an opening between your mouth and the sinus. Once again, if the teeth are removed at an early age, the root formation is minimal, and this complication is very unlikely. However, if it does occur, it will usually close spontaneously.  You will be given special instructions to follow to ensure healing.  Not every sinus communication can be visualized during surgery.  Symptoms are very distinct and if you sense this condition occurring after the surgery, please contact the office. An additional procedure may RARELY be necessary to close the opening.

A visual of dry socket that developed after the removal of wisdom teeth

Dry Sockets:

Dry sockets continue to be the most common problem people experience following dental surgery. They arise due to premature loss of a blood clot in the empty tooth socket. This seems to occur with greater frequency in people who smoke or are taking birth control pills. While both jaws can be affected, they usually occur in the lower jaw on the third to seventh day. They cause a deep, dull, continuous aching on the affected side(s). Patients may first notice the pain starting in the ear radiating down towards the chin.

The symptoms frequently begin in the middle of the night, and your pain medication regimen may not help. Treatment involves an office visit so that the site can be rinsed with an antibiotic solution.  Dr. Rotwein will place a medicated dressing in the empty tooth socket. This will help decrease the pain and protect the socket from food particles. The effectiveness in alleviating the pain lasts for 24-48 hours and may require dressing changes every day or two, for five to seven days. Dressings usually are removed when you have been pain free for 2 to 3 days.

The dressing doesn’t aid in healing. The only reason to place a dressing is for pain control. If medication is controlling the pain, the socket will heal without a dressing. Following removal of the dressing, an irrigation device may be provided to help you to keep food particles from lodging in the extraction site.

A diagram depicting an infection that occurs after wisdom teeth removal


Occasionally, postoperative infections occur even in the face of a course of postoperative antibiotics. This usually requires an office visit and clinical examination. Many times, just placing you on another antibiotic for one week will take care of the infection. If it persists, the area will have to be drained and cleaned.  Infections have been known to cause a decrease in the range of jaw motion and cause trouble swallowing.  In some cases they may occur weeks after surgery.  It is extremely important that if you call and make an appointment for a visit if you have any questionable symptoms, especially if it seemed like you were getting better but now feeling worse.

Do You Want Your Wisdom Teeth Removed?

If your wisdom teeth are causing you pain or you want to avoid future problems, contact our office to schedule an appointment.