After undergoing wisdom teeth removal, it's natural to be concerned about changes you observe in your mouth and face. One common phenomenon is facial bruising, often appearing as a yellow discoloration around the surgical site. This article aims to provide a comprehensive understanding of why bruising occurs after wisdom teeth removal and how to manage it for a smoother recovery.
Understanding Post-Operative Care
The primary goals of post-operative care following oral surgery are to control bleeding, ensure good nutrition, manage pain effectively, maintain excellent oral hygiene, and care for the wound properly. Good post-operative care is very important for a quick and easy recovery. The effects of oral surgery can be quite variable, so not all instructions will apply in all cases.
Initial Steps to Control Bleeding
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. To control bleeding, apply direct, firm pressure to the surgical site by biting on a moistened gauze pad placed over the surgical area. This should be done for 30-60 minutes, repeating if necessary. Avoid touching the wound area following surgery. Tea contains tannic acid, which is an astringent and can help minimize further bleeding. Try to relax, sit upright, and avoid strenuous exertion to minimize bleeding.
Oral Hygiene After Surgery
If bleeding is well-controlled, you may brush your teeth carefully and rinse gently the night of surgery. The day after surgery, begin brushing your teeth at least twice a day using a soft-bristle toothbrush and toothpaste. Rinse at least 5-6 times a day, especially after eating. An oral rinse, if prescribed, may be started either the night of surgery or the next day.
What Causes Facial Bruising?
In some cases, discoloration (bruising) 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 that may not be apparent until 2-3 days after surgery. Bruising happens when tiny blood vessels under the skin burst during surgery. Initially, the area may appear red, blue, or purple. As the bruising heals, it fades to green or yellow before disappearing altogether.
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Bleeding into the soft tissues after third molar extractions is considered normal. Some of this residual blood can be pushed directly under the skin and cause an extensive “bruising” appearance as this blood is removed by the body as part of the healing process. It is very rare to have bruising going down from the neck down to the chest area (unless you are taking blood thinners or have issues with clotting). As the body initiates a healing response to repair the surgical site, part of this response involves the breakdown of hemoglobin in the blood, which can lead to a yellowish appearance as the bruise heals. This discoloration is a sign that your body is working to heal the area and is a normal post-operative occurrence.
Managing Swelling and Bruising
Immediate application of ice packs to the sides of your face where surgery was performed will help to minimize swelling and bruising. Significant swelling will not necessarily occur in all cases. The amount of swelling, bruising, and jaw stiffness that one experiences is usually proportional to the extent of surgery involved. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon and is the body’s normal reaction to surgery, part of the healing process.
To minimize swelling, two baggies filled with ice or ice packs should be applied to the sides of the face where surgery was performed. The ice bags should be used continuously or as long and often as possible while you are awake. Ice is most helpful during the first 24 hours following surgery. After 72 hours, ice has no beneficial effect. For bruising, moist heat applied to the area may speed up the removal of the discoloration.
The Role of Medications
If you have been placed on antibiotics, take the tablets or liquid as directed to help prevent infection. Discontinue antibiotic use in the event of a rash, hives, wheezing, or other unfavorable reaction and call the office immediately. For slight to moderate pain, one or two 325mg tablets of Tylenol may be taken every four hours. For severe pain, take the prescribed pain medication as directed. Avoid alcoholic beverages while taking pain medication. Pain and discomfort due to surgery should subside a little more every day.
Many post-operative pain medications such as Tylenol #3, Percocet, and Vicodin contain narcotics, which can make you dizzy, sleepy, impair coordination and judgment. If you are taking narcotic pain medication you should remain at home. Caution: If you suddenly sit up or stand from a lying position you may become dizzy, caused by a drop in blood pressure, which can be exacerbated by a sudden change in position. If you are lying down following surgery, make sure you sit for one minute before standing; get up slowly.
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Dietary Recommendations
After oral surgery, liquids should be consumed initially. Do not use straws. Drink from a glass or cup, as the sucking motion required to drink from a straw is often difficult to do after oral surgery, is less efficient than drinking out of a cup, and can cause more bleeding by dislodging the blood clot. Avoid hot beverages and hot foods on the day of surgery, which can unintentionally burn you if the mouth is still numb or prolong bleeding.
Cool or warm soft food such as yogurt, applesauce, juice, ice cream, pudding, Carnation Instant Breakfast, milk shakes, scrambled eggs, mashed potatoes, oatmeal, cream of wheat, cool or warm soup, very soft pasta (the consistency of Spaghetti-Os) are ideal on the day of surgery and during the first few postoperative days. On the first post-operative day, you may eat hot, warm, or cool food. Over the next several days, you may gradually progress to more solid food such as fish, chicken, meatloaf at your own pace. If you experience pain while chewing, go back to softer food for a day or two, then try solid food again. Your body requires nourishment after surgery; high-calorie, high-protein intake is very important. You should prevent dehydration by drinking fluids regularly, at least 6 glasses of liquid daily.
What to Expect During Recovery
Most of the time, 90% of the swelling will go away within the week. The rest will resolve by the next week. After 72 hours, your swelling should slowly start to improve, and you should gradually start to feel better. If you do not feel that you are beginning to improve after 72 hours, please call the office.
Addressing Common Concerns
- Numbness: If numbness of the lip, chin, or tongue occurs, there is no cause for alarm. This is usually temporary. If post-operative numbness persists for more than 24 hours, contact your oral surgeon.
- Temperature: Slight elevation of temperature immediately following surgery is not uncommon. If your temperature is 101 degrees F. or greater at any time, or a low-grade fever persists after the first twenty-four hours, please notify the office immediately.
- Bone Projections: Occasionally, patients may feel hard projections of bone at the surgical site with their tongue. These projections of bone usually smooth out spontaneously; if not, they can be removed by Dr. Turesky.
- Sutures: Suture knots will often feel like hard projections in the mouth. If the sutures become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it.
- Dry Socket: A dry socket occurs occasionally when the blood clot breaks down and becomes dislodged prematurely from the tooth socket. Symptoms of a dry socket typically present three to five days following surgery with sudden severe aching pain at the surgical site often with referred pain to the ear and/or forward into the jaw and teeth. Management includes oral pain medication, Peridex (chlorhexidine) oral rinse, and sometimes an antibiotic is prescribed.
Long-Term Complications
While most patients recover from wisdom tooth extraction without issue, some may experience long-term side effects, although these complications are rare but can have lasting consequences for oral health:
Nerve Damage
One of the most serious long-term effects is nerve damage. The lingual and inferior alveolar nerves are placed near the wisdom teeth, and if these nerves are accidentally injured during surgery, they can cause paraesthesia, characterized by numbness, tingling, or burning in the lips, chin, or tongue.
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Persistent Pain
Chronic pain that follows wisdom tooth extraction is referred to as post-extraction neuralgia. This can happen because of nerve damage, infection, or improper healing and may persist for months or even years after the procedure.
Temporomandibular Joint (TMJ) Disorders
TMJ disorders can worsen after wisdom tooth extraction because the procedure stresses the jaw, particularly if it involves long periods with the mouth open.
Sinus Complications
For upper wisdom teeth, there is a risk of sinus complications due to their proximity to the sinus cavities. After extraction, this can lead to sinus infections or even perforation that causes sinus pain and congestion.
Changes in Teeth Alignment
There is a possibility of changes in the alignment of their remaining teeth after the removal of wisdom teeth because the extraction of the tooth can create extra space in the jaw.
Bone Loss and Jaw Weakness
When a tooth is removed, the bone that supports it may start to resorb. Over time, this can cause problems with neighboring teeth and the overall structure of the jaw.
Preventing Long-Term Risks
Following the dentist’s post-operative care instructions will reduce the possibility of long-term negative effects. This includes stopping smoking, maintaining the extraction site clean, and taking time for all follow-up consultations with the oral surgeon or dentist. Effective strategies to minimize long-term risks:
- Protect the blood clot: After your tooth is removed, a blood clot forms in the socket to aid healing. Avoid rinsing vigorously, spitting, or using straws during the first 24 hours to prevent the clot from dislodging.
- Return to your dental routine: Gently brushing your teeth and rinsing with warm salt water 24 hours after surgery helps keep your mouth clean and promotes healing.
- Reintroduce solid foods gradually: Try reintroducing solid foods as soon as you’re comfortable. Avoid hard, or spicy foods until your mouth feels ready to handle them.
- Stay hydrated: Drinking plenty of water keeps your body hydrated and supports healing.
- Role of Regular Dental Check-ups: Early detection is key to preventing long-term damage. Dentists can monitor the healing process, identify any signs of nerve damage, and provide treatment for issues such as chronic pain or TMJ disorders.
When to Seek Professional Help
While yellow bruising is usually nothing to worry about, it’s essential to know when to seek professional help:
- If bleeding doesn’t subside after several hours of using gauze, contact your oral surgeon immediately.
- If your pain worsens or becomes unmanageable, reach out for help.
- Look for symptoms like pus, a bad taste in your mouth, or fever. These are signs of infection and need immediate attention.
- If you’re unsure about what’s normal or have questions about your healing process, don’t hesitate to call.