Post-op Instructions – After Single/Multiple teeth Extractions

IMMEDIATELY FOLLOWING SURGERY

• Keep the gauze pad in place over the extraction site with firm biting pressure for one (1) hour. After this time, remove and discard the gauze pad. A new, moist gauze pad does not need to be replaced unless bleeding continues or recurs.
• Avoid vigorous mouth rinsing, sucking on straws, smoking, and touching the extraction site. These may cause continued bleeding by dislodging the blood clot.
• Take the prescribed pain medication before you begin to feel discomfort. This usually coincides with the start of the local anesthetic wearing off.
• Restrict your activities the day of surgery and avoid exercise. Lie down with your head elevated on two or three pillows or sit in a recliner and take it easy.
• Place an ice pack on the outside of your face over the area where your tooth was extracted for the first 24 to 48 hours to help minimize swelling.
• Do not use straws when drinking as this may encourage more bleeding. Do not drink hot fluids or eat hot food the first day. Very soft food for the first several days is recommended as it can be chewed and swallowed easily.

BLEEDING

A certain amount of bleeding is to be expected following the extraction of a tooth. Slight oozing or blood-tinged saliva is not uncommon for the first 12 to 24 hours. Excessive or continued bleeding may be controlled by first rinsing or wiping any old clots from your mouth and then placing a new, moist gauze pad over the area with firm biting pressure for an additional hour and repeating as necessary. If bleeding continues, you may bite on a moistened tea bag in the same manner. Tannic acid in tea helps blood to clot. If bleeding does not subside, please call our office for further instructions.

SWELLING

After a tooth is extracted you may experience some swelling around the mouth, cheeks, eyes and sides of the face. This is the body’s normal and healthy reaction to surgery. Most swelling will not become apparent until the day following surgery and will not reach its maximum until 48 to 72 hours post-operatively. However, swelling and discomfort may be minimized by the immediate use of ice packs. Ice packs should be applied to the outside of the face over the area where the tooth was extracted for the first 24 to 48 hours. Ice packs should be left on for 30 minutes and then left off for 30 minutes while awake. After 48 hours ice has no beneficial effect. Instead, the application of heat may be helpful in reducing the size of swelling more quickly.  On occasion, some residual swelling may last a week or longer.

PAIN

Take the prescribed pain medication before you begin to feel discomfort. This usually coincides with the start of the local anesthetic wearing off. Taking pain medication on an empty stomach may cause nausea, so it is recommended to take the pills with food or drink. Pain medication may make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery while medicated. It is also best to avoid alcoholic beverages. Aspirin or other over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen (Advil/Motrin) may be used when appropriate. Discomfort following surgery may increase on the second or third day following the procedure and then should improve each day thereafter. If pain persists or worsens after four (4) days, please notify our office as it may require attention.

BRUISING

In some cases bruising of the skin may follow swelling. The development of black, blue, green, or yellow discoloration is due to blood oozing and spreading beneath the tissues of the mouth and face. This is a normal post-operative occurrence that may occur two to three days after the procedure and take one to two weeks to gradually fade away.

DIET

It is best to wait until after the local anesthetic has completely worn off before beginning to eat. You may eat anything soft and cool the first day by chewing away form the extraction site. Do not use straws as this may encourage more bleeding by dislodging the blood clot. Do not drink hot fluids or eat hot food the first day. Avoid hard, crunchy foods that may disturb the area. It’s best to progress to more solid foods and return to your normal diet as soon as possible.

ORAL HYGIENE

Begin gentle, warm salt water rinses (1/2 teaspoon of salt in a glass of warm water) the morning after your extraction.  Rinsing four to five times a day for several days, especially after meals, will help to gently flush food particles away. Continue to brush your teeth as best you can – remembering to stay away from the extraction site for several days.  Our doctors may prescribe an antibiotic mouth rise to use in place of salt water.  Furthermore, an irrigating syringe may be provided for use starting a week after the procedure.

ANTIBIOTICS

Antibiotics may be prescribed for certain patients after a surgical procedure to help prevent or cure an infection. If you have been placed on an antibiotic, take the tablets or liquid as directed until gone. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and notify our office immediately.

GOOD THINGS TO KNOW

• There is always the possibility of developing a dry socket when a tooth is removed. Please notify our office if severe pain develops between the fourth and six day following your extraction which is unrelieved by pain medication, radiates to your ear, or wakes you up at night. Dry sockets are easily and effectively treated and should not cause undue alarm.
• If persistent numbness of the lip, chin, or tongue occurs, there is no cause for alarm. As stated during your consultation, this is almost always temporary in nature. It may persist for a few days to several months, but rarely is permanent.  Should any numbness or altered sensation persist after the first 24 hours, please notify our office.
• Keep your lips moist with a lip ointment. Due to stretching of the mouth during surgery, your lips may dry out and crack – especially at the corners.
• Stiffness of the jaw muscles (trismus) may occur and cause difficulty when opening your mouth and during chewing for several days following surgery. This is a normal post-operative event that resolves on its own in five to ten days.  Chewing gum may help relax muscle tension and bring relief.  Taking an anti-inflammatory medication such as ibuprofen (Advil/Motrin) may also help.
• You may have sutures in your mouth to minimize post-operative bleeding and to help healing. If one or two becomes dislodged early, there is no cause for alarm. Just remove the loose suture from your mouth and discard it. Dr. Jong or our Certified Oral & Maxillofacial Surgery Assistants will tell you if your sutures are dissolvable or if you will need a return visit to have them removed.
• There will be a cavity (looks like a hole) where your tooth was removed. This cavity will gradually close over the next month fill in with new tissue. Be sure to keep the area clean to promote better healing.
• It is best to avoid strenuous activity for a day or two following your extraction as this may cause the extraction site to start bleeding again. After a few days you should feel fine to resume your normal routine.
• If an immediate denture was inserted after the extractions, sore spots may develop along the gum tissue. In most cases, your dentist will plan on seeing you within 24 to 48 hours after surgery to make any necessary adjustments to relieve these areas. Failure to do so may result in severe and painful denture sores that may prolong the healing process.
• A slight elevation of temperature immediately following surgery is not uncommon. If an elevated temperature persists or a fever develops, please notify our office.
• Be careful going suddenly from a lying down position to a standing, upright position. You may get light-headed standing up suddenly. Before standing up, you should sit for one minute then get up slowly.
• A sore throat and pain when swallowing are not uncommon due to swelling and inflammation of the nearby muscles or some of the medications used for I.V. anesthesia. These issues will subside in two or three days.
• You may feel hard projections in your mouth with you tongue near the surgical sites. These projections are not forgotten tooth roots but the bony walls of the empty tooth sockets. These projections usually smooth themselves out as the tooth sockets heal. If not,  you might need additional treatment and Dr. Jong can re-evaluate area.
• If you regularly exercise please be aware that your normal caloric intake may be reduced and you may be dehydrated after surgery. Exercise may further weaken you. It is best to avoid strenuous activity for two to three days following surgery.