I talked about this a little back in March, when I wrote about the COST of having wisdom teeth removed, which varies widely. That was a post where the comments were too different to be helpful: they ranged so VIGOROUSLY. “Absolutely under no circumstances should you get general anesthesia!”/”Absolutely under no circumstances should you skip general anesthesia!” “DEFINITELY go to an oral surgeon!”/”DEFINITELY don’t go to an oral surgeon!” “It was EASY!!”/”It was HELLISH!!”
There was some hand-wringing, and then I decided to stay the course: we were going to go with an oral surgeon because that’s what our dentist said to do (he didn’t give us the option of having it done in the dentist’s office, so maybe he’s not that kind of dentist or maybe these wisdom teeth were in a position where only an oral surgeon could handle them), and we were going to go with the general anesthesia because that’s what the oral surgeon recommended for children and it’s what Rob preferred (and it was $400, which seemed reasonable). If any of those were the wrong decision, I took heart in knowing there was no way to predict what the right decision WAS, considering the unusually oppositional opinions on the subject.
The widely-varying opinions is one way to know you’re in a situation where EXPERIENCES vary widely. So I am going to tell Rob’s experience, Rob being a 16-year-old having four wisdom teeth removed (two sideways/impacted, two normal/emerging), by an oral surgeon (rather than a dentist), at an office visit (rather than a hospital), and using general anesthesia (rather than only novocaine and/or laughing gas)—but it’s to add to the assortment of stories, not to try to predict how anyone else’s experience will go.
Rob was scheduled for 10:30, so they asked us to arrive at 10:10. Rob was supposed to eat/drink nothing after bedtime the night before, and they told him to wear comfortable pajama-like clothing and secure shoes (i.e. no flip-flops or sandals). We paid in full when we checked in at the desk. At about 10:20, an assistant called him in and gave him four pills to swallow. Rob said she told him what they were, but he didn’t remember. “Antibiotic?,” I asked, when he returned to the waiting room. “Sedative? Painkiller?” “Those sound like the sort of thing,” he said, unhelpfully. Later the discharge nurse mentioned that he was given an antibiotic among those pills, so we have confirmation on that at least.
After maybe ten more minutes in the waiting room, they had us both come in. I re-initialed some papers I’d signed before, because it had been awhile since I signed them the first time. They had Rob sit in the chair, and an assistant walked me back to the waiting room. They said they’d call me in when he was in Recovery.
I’d brought a bucket with me, because my OWN wisdom teeth experience was general anesthesia, followed by feeling horrible and having a hard time waking up and spending a couple of hours in the hospital before I could stand up, followed by barfing. But the oral surgeon said, “We use very different drugs now than we did back then,” so I had high hopes. (These were justified.) (And explained why so many staff members gently teased me about the bucket.)
About 45 minutes later (the surgery itself was estimated to take 30, but they still needed to place the IV, and also they let him wake up a bit before calling me in), they came to get me. Rob was sitting upright in a comfy chair, looking very intently at the wall. His mouth was stuffed with gauze. I was glad I’d remembered to warn him about that: when I woke up after having my wisdom teeth out, I didn’t realize I had gauze in my mouth and thought that WAS the inside of my mouth. Gross.
The discharge nurse told me everything had gone well, and then started going over the instructions that were on a printout. She also gave us a prescription for acetaminophen/hydrocodone. She showed me how to change the gauze. Periodically Rob would lean forward to look more closely at the wall, and the nurse would say, “Just sit back and relax,” and he would obey for a few minutes. Rob, peering at the wall even more intently: “Are there TWO machines on that wall? or one?” (It was one.) Or, patting at the IV on the back of his hand and fluffing the tubing: “What…IS…this?” He was a little loopy.
The nurse told me to go bring the car around to the front, and she would meet me there with Rob. I drove it around, then waited long enough that I went mentally through half a dozen scenarios where I would be the idiot for waiting there. (“Er, no…I meant, come back inside after you moved the car.” “Er, that is not the front entrance.” “Er, you still have to sign him out.”) Rob told me afterward that the nurse used a wheelchair with him right to the door of the building, and then he stood up and walked. “Were you…supposed to?,” I asked. He didn’t know; he said he just HAD. When I saw the two of them, she was walking alongside him and didn’t look alarmed, so that was probably how it was supposed to go.
I drove him home, and he gradually became more and more with-it. “I’m feeling clearer now,” he’d say, or “I’m not seeing double anymore.” By the time we got home (about a half-hour drive), he was pretty normal, though he was a little shaky/weavy walking into the house. I settled him onto the couch and read the print-out, which I hadn’t really processed when the nurse was telling it to me.
The first thing to do was the gauze. I was supposed to take it out as soon as we got home, and determine if it was red or pink. If pink, he could be done with gauze. If red, put more gauze in. Repeat every 30 minutes. I think I did three or four gauze changes—so by the time we’d been home an hour and a half or two hours, he was done with gauze. I’d thought “Huh. This is going to be kind of INVOLVED,” but then it wasn’t so bad.
He was also supposed to put ice packs on his cheeks for 20 minutes out of each hour, so we were doing that at the same time. Right after changing the gauze, I went to a nearby pharmacy and got the prescription filled, then hurried back home just in time for the next gauze change.
The nurse told us he should take 800 mg of ibuprofen (i.e., four regular 200 mg tablets), with food, as soon as we got home, during a gauze change. But his mouth was so numb, he couldn’t manage it: he couldn’t eat or drink or tell if the pill was in his mouth. After a couple of hours, with him still feeling totally numb and me getting increasingly concerned that we weren’t following the instructions, I had him drink an Ensure and take the pills ANYWAY, just holding a washcloth under his chin to catch any Ensure that dribbled out (not as much as we’d both feared). If I’d realized it would still be this way 2 hours later, I would have had him do it right away instead.
The oral surgeon’s assistant called to check on us around this time, so I asked her if it was normal for him to still be so numb; the paperwork hadn’t said anything about it. “Oh, YES,” she said. “It should be wearing off on the top half of his jaw by now, but he won’t start to feel anything on the bottom for at LEAST a couple more hours. It could easily still be numb until after dinner.” Well. Good. I’d been fretting that he had permanent nerve damage.
Two hours after the ibuprofen, he was supposed to take his first acetaminophen/hydrocodone, so he had it with a little bowl of pudding and some sips of water. I was hoping it wouldn’t make him queasy, and it didn’t. I’d been hoping it would make him amusingly loopy, but it didn’t.
We continued the ice packs. I kept setting my phone alarm for 20 minutes (on) and 40 minutes (off). The nurse told us that the swelling would likely be worst on Day 3, but if we were diligent about the ice packs it wouldn’t be nearly as bad. I went back to thinking “This is KIND OF INVOLVED.”
For dinner I made him mashed potatoes and some applesauce. He was feeling pretty good: up and around as normal, except for toting around the ice packs. I think he was only on the couch for the first 2-3 hours we were home.
He had another dose of acetaminophen/hydrocodone (every-4-hours dosing) and another dose of ibuprofen (every-8-hours dosing) during the evening; I had him stay up a bit later than usual so he could have a last dose before going to bed. And that was the end of Day 1: The Day of Surgery.
In the morning of Day 2 I was inclined to wake him so he could get right back to painkillers/anti-inflammatories and ice packs, but he wanted to sleep so I let him. He got up around 10:00 and we started right back in on the routine. First some food (the nurse said not to take any painkillers on an empty stomach). Then the ibuprofen. Then the ice. Then two hours after the ibuprofen, the acetaminophen/hydrocodone. He said he wasn’t having hardly any pain at all, so we considered skipping the acetaminophen/hydrocodone, since that one was “as needed”; the ibuprofen is anti-inflammatory as well as painkilling, so the nurse said to continue giving it to him for three days whether he had pain or not. We decided to give him one more dose of the acetaminophen/hydrocodone just in case, then do REALLY “as needed” from then on.
For lunch he had soup, the Lipton chicken noodle kind you don’t even have to chew. For dinner I made pasta, and he also had some applesauce and some ice cream. He continued to do the ice packs for 20 minutes out of every 60. He continued not to have much pain or swelling, so we didn’t do any more acetaminophen/hydrocodone. Another dose of ibuprofen, and that was it for Day 2.
Day 3 was even better. He did take a dose of the acetaminophen/hydrocodone early on, because he was having some more pain when he woke up, but not a second dose, and I get the feeling he didn’t really need it but just enjoyed the drama of taking it. He continued to take the ibuprofen: the nurse said he should continue to take it for inflammation even if he didn’t need it for pain. I made pasta for dinner again. He was getting tired of pasta and yogurt and Ensure and applesauce.
The paperwork said he should start rinsing with salt water after eating and before bed. He DID do it a couple of times, but I don’t think he did it as much as he was supposed to. I reminded him that he was supposed to brush, but not too far back in his mouth. (You’re supposed to avoid disturbing the…sorry, I’m just going to use the word they used: …clots.)
At the 48-hours-past-surgery point, we were suppose to stop using ice (to prevent swelling) and start using heat (to reduce swelling). I had a plug-in heating pad, so we used that. He looked quite silly holding it to his face. The paperwork said that the swelling would peak on Day 3, but there was only a faint swelling on one side. I wouldn’t have noticed it if I hadn’t known to look for it.
Day 3 was the first time he asked me if he was supposed to be wearing his nighttime retainers, and I didn’t know. I said, “Er…try it, and if they don’t hurt, wear them.” He said they didn’t hurt, so he wore them.
Day 4 was basically normal. He kept taking ibuprofen as instructed, no more acetaminophen/hydrocodone. We had tacos for dinner, and I told him he had to have soft shells, no chips or crunchy shells, because the paperwork warned against that kind of thing. He protested a little but not much. He rinsed a couple of times.
Day 5 was even more normal. He went down to a normal dose of ibuprofen at normal intervals (i.e., 2 tablets every 4-6 hours). He had nachos. He rinsed, maybe, I don’t know, probably not. I pretty much stopped thinking of it, except that I had to write something for this post.