Dr. Maneesh RaiBDS 

Smile Designig   Implants   Orthodontia   General Dentistry

Extractions and Impaction Surgeries



One of the main goals of modern dentistry is the prevention of tooth loss. All possible measures should be taken to preserve and maintain your teeth because the loss of a single tooth can have a major impact upon your dental health and appearance. However, it is still sometimes necessary to remove a tooth. Here are some of the reasons a tooth may need to be extracted.

  • Severe Decay
  • Advanced periodontal disease
  • Infection or abscess
  • Orthodontic correction
  • Malpositioned teeth
  • Fractured teeth or roots
  • Impacted teeth

If you've just had a tooth extracted or your dentist has recommended that a tooth be extracted, the following information will help you get through the first few days after your extraction. Should anything occur that seems out of the normal, do not hesitate to call your dentist.




  • DO NOT DISTURB THE WOUND : In doing so you may invite irritation, infection and/or bleeding. Be sure to chew on the opposite side for 24 hours and keep anything sharp from entering the wound (i.e. eating utensils etc. ).
  • DO NOT SMOKE FOR 12 HOURS:: Smoking will promote bleeding and interfere with healing.
  • BRUSHING: Do not brush your teeth for the first 8 hours after surgery. After, you may brush your teeth gently, but avoid the area of surgery.

  • MOUTH WASH: Avoid all rinsing for 24 hours after extraction. This is to insure the formation of a healing blood clot which is essential to proper wound healing. Disturbance of this clot can lead to increased bleeding or the loss of the blood clot. If the clot is lost, a painful condition called dry socket may occur. You may use warm salt water or mild antiseptic rinses after 24 hours only if prescribed.
  • DO NOT SPIT OR SUCK THROUGH A STRAW: This will promote bleeding and may dislodge the blood clot causing a dry socket.
  • BLEEDING: When you leave the office, you will be given verbal instructions regarding the control of postoperative bleeding. A rolled up gauze pad will be placed on the extraction site and you will be asked to change this dressing every 20 minutes or so depending on the amount of bleeding that is occurring. It is normal for some blood to ooze from the area of surgery. We will also give you a package of gauze to take with you to use at home if the bleeding should continue. Should you need to use the gauze at home, remember to roll it into a ball large enough to cover the wound. Hold firmly in place, by biting or with finger pressure, for about 20-30 minutes. If bleeding still continues, you may fold a tea bag in half and bite down on it. Tea contains Tannic Acid , a styptic, which may help to reduce the bleeding. Please be sure to inform us prior to your appointment if you have bleeding problems or are taking blood thinning medications such as Warfare or Aspirin.
  • PAIN :Some discomfort is normal after surgery. Analgesic tablets ( i.e. Aspirin, Tylenol etc. ) may be taken under your dentist's direction. Prescription medication, which may have been given to you, should also be taken as directed. If pain continues, call your dentist.
  • SWELLING : This is normal following surgical procedures in the mouth.  After 2-3 days, the swelling should begin to recede.  If swelling persists or interferes with your ability to eat or talk or swallow, do not hesitate to call our office.To prevent swelling, apply an ice pack or a cold towel to the outside of your face in the area of the extraction during the first 12 hours. Apply alternately, 20 minutes on then 20 minutes off, for an hour or longer if necessary.
  • DIFFICULTY IN OPENING MOUTH: You may have difficulty opening your mouth. This is because the jaw muscles become stiff from holding your mouth open during surgery. It usually lasts 3 to 4 days. Massage the jaw muscles gently. Apply moist heat for 10 minutes, remove for 10 minutes and repeat. Eat soft nutritious food like eggs, milk shakes, juices, soup (warm, not hot),pasta,rice,idlis, bananas. Do not force your mouth open.
  • DIET:As stands to reason, liquid and soft foods are recommended for the first couple days (i.e.- milkshakes, yogurt, soups, mashed potatoes, bananas...)  Also, please take all medications as directed, since they are prescribed to not only control discomfort, but to reduce swelling and infection.  It is a very good idea to begin taking medications prior to the numbness wearing off to allow you a smooth transition and comfort. Eat normal regular meals as soon as you are able after surgery. It is also important to drink plenty of fluids.


  If you have any questions regarding these directions, call your dentist for clarification.

Surgical Extraction of Impacted Wisdom Tooth

What is an Impacted Wisdom Tooth?


Wisdom teeth are the teeth that come into the mouth last, at age 17-25 years.  Most people get four wisdom teeth, one in the back of each of the four quadrants of the mouth. But it is not uncommon for a wisdom tooth to be missing and some people get none.
An "impacted" tooth is one that is stuck in the bone and cannot fit or come into the mouth properly.  Impacted third molars are a frequent occurrence in teens and young adults. Sometimes they start to come into the mouth but the mouth is not big enough to hold another tooth. They do not completely erupt, remain partially under the gum, and are easy targets for infection.  It is not unusual for teens and young adults to appear in the dental office swollen, unable to open, febrile and in pain when this happens.
If wisdom teeth are positioned in such a way that they are positioned impacted under the bone, covered by bone,  and not partially in the mouth at all, often they are better left alone. 


When a Wisdom Tooth Erupts Partially but the Whole Tooth Does Not Fit in the Jaw


When wisdom teeth are partially in the mouth and partially submerged, the gum around them can become infected and inflamed causing swelling in the area around the cheek or down the neck.  This seems to happen more often at exam time or when young patients are under stress.  Under stress, the immune system does not function as well as usual, and in a standoff with bacteria, the bacteria may start to get the upper hand.  That is usually when the patient with an impacted third molar shows up at the dental office with swelling and pain.   This swelling is called pericoronitis, or infection tissue around the crown of the tooth  Frequently there is flabby gum around the back of the tooth and/or a flap of gum (called an operculum) extending over the biting surface of the  tooth.   Debris and bacteria collect and are trapped under this gum tissue and an infection is the result.

If the tooth is properly erupted and oriented, it may be possible to trim away the excess gum flap around the back of the tooth (an Operculectomy). 

If the tooth is hopelessly submerged and there is no room for it to erupt normally,  the tooth should be extracted.

Care of Your Mouth After Surgical Extraction of Wisdom Tooth (Impaction Surgery)


· You will be leaving with gauze to bite on.  Keep this gauze in place for 45 minutes.  After this time gently remove and discard this gauze. 

· Keep PRESSURE on gauze until the bleeding stops. If HEAVY bleeding continues for more than two hours, call us.

· It is useful to apply pressure and a cold pack to reduce swelling. This can be applied to the outside of the mouth but make sure any local anesthetic has worn off or you may get frost bite.  Never use a hot compress as this will increase the swelling.

· It is normal to find a little bleeding, even for a couple days. To help stop oozing, you can take a tea bag, wet it, squeeze all the water out, place it over the extraction area and bite on it for 20 minutes. The tannic acid in the tea constricts tiny blood vessels in the wound and helps to form a clot and stop the bleeding.

· Drink plenty of fluids.

· Try to eat soft, not too hot, non spicy nutritious foods for the next few meals. Ice creams, yogurt, fruit juices (non citrus), semisolid khichri or dalia.

· Reduce strenuous activity for 24 hours.

· Avoid all rinsing for 24 hours after extraction. This is to insure the formation of a healing blood clot which is essential to proper wound healing. Disturbance of this clot can lead to increased bleeding or the loss of the blood clot. If the clot is lost, a painful condition called dry socket may occur. You may use mild antiseptic rinses after 24 hours only if prescribed.

·  If you have received a prescription for pain or an antibiotic, please take the medication as directed.

· If you have been directed to use an ice pack, please follow the instructions.

· Place an old towel on your pillow to prevent any blood spots.

· Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for several days following surgery. This is a normal post-operative event which will resolve in time. Gentle exercise of the jaw by opening wide and stretching the muscles will help to clear up the trismus more quickly.

· 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. Maneesh Rai.

· Sleeping with the head slightly elevated by using an extra pillow during the first three or four nights after surgery will help ease management of oral secretions and minimize swelling.


· Do not smoke, or drink alcohol, for a minimum of 24 hours or better avoid for 48 hours.

· Do not rinse or spit vigorously for one week.

· Do not drink through a straw for one week.

· For the first day after the operation do not rinse, poke or brush the area of surgery.

· Do not suck on candy, mints, etc. for at least one week.

· Avoid strenuous exertion on the day of surgery.

If you have prolonged/severe pain, bleeding, swelling, or fever, please contact us.

No two mouths are alike. Do not accept well intended advice from friends. Dr. Maneesh Rai and his team are readily accessible through the office and available to answer any questions you have regarding your surgery or post-operative experience.