Expert: Joel S. Teig, DMD, Diplomate ABOMS, retired - 8/9/2006

Question
Dear Dr. Teig:

My 19 yr old daughter had her 4 wisdom teeth extracted w/i.v. anesthesia yesterday-about 36 hrs. ago.  She has been very nausious and threw up last night and tonight after the 2nd prescription pill.  I had her first one changed, thinking she was sensitive to codiene. She had the same response to the darvocet-N and her face is so swollen she can barely talk.  She has been using ice 20 min. on and 20 min. off all waking hrs. Is this a normal after surgery situation? Also, is it safe to mix plain tylenol in between pain medication if she is so nausious.  She has been on soft foods and lots of water.

Answer
S.A. -  The causes of the nausea after wisdom tooth extraction under IV Anesthesia can be quite varied.  Yes it can be the codeine, yes it can be the anesthesia, but the most common cause is the seepage of blood that she swallows. For some reason many patients who undergo oral surgeries develop the nausea from blood swallowing.

From what you describe when you wrote me it was 36 hours postsurgery.  The use of ice at this time is best stopped.  Yes it numbs the outside, but allows the body to contain the internally released fluids into the face.  My suggestions to all my patients is to start warm salt water rinses 24 hours after surgery.  No active swishing with force but just a gentle swish.  It removes blood, it reduces bacteria and it allows the body to drain itself of trapped fluids.

As far as helping the nausea again, if she is in that much pain a medication like Vicodin can relieve the pain and very rarely causes nausea (it contains tylenol in it plus a narcotic).

I hope your daughter quickly recovers with minimal discomfort and swelling.  If you have any further questions feel free to contact me again.