Post Op Instructions: Oral Surgery and Tooth Extraction

THE DAY OF SURGERY

1. Some degree of discomfort and pain arises as numbness subsides. At the first sign of pain or discomfort, take the pain medication prescribed. Please make sure you read the directions carefully before taking the medication. Any pain medication can cause nausea and vomiting. It is very important that you have some food in your stomach before you take them.
2. DO NOT DISTURB THE AREA OF SURGERY. The first stages of healing are aided by placing tissues at rest. Avoid vigorous chewing, excessive spitting, or rinsing as initial healing may be delayed, active bleeding restarted, or infection introduced.
3. Expect minor bleeding or oozing from the operative site. This bleeding may continue throughout the first day. For the first hour, keep firm pressure on the area of surgery by biting on the gauze sponge placed in your mouth at the office. If bleeding persists, continue pressure on a fresh sponge for an additional 30 minutes to an hour. Biting on a moist tea bag wrapped in gauze may help control persistent oozing from the surgical site. Tea has an ingredient that promotes blood clotting.

If active bleeding should recur at any time, carefully rinse your mouth with cold water and apply a fresh gauze sponge to the bleeding site. Firm pressure for 15-30 minutes usually controls the problem. Should active bleeding persist, please call the office.

4. LIMIT PHYSICAL ACTIVITY during the first 24-48 hours after surgery. Overexertion may lead to postoperative bleeding and discomfort. When you lie down, keep your head elevated on a pillow.
5. PAIN FOLLOWING ORAL SURGERY will be most severe within the first 6-8 hours after the operation. If you have to take the prescribed severe pain medication, remember to have some food intake prior to that and to start slowly. Please do not drink alcoholic beverages while taking prescription pain medication. Do not wait for the pain to become unbearable before using some form of pain medication, as then it will be more difficult to control. Moderate to severe pain usually does not last longer than 24-48 hours, and there should be no more than the slight pain or discomfort after the third day. Persistent or increasing pain 3-4 days following oral surgery may be caused by early loss of the blood clot (dry socket) or infection. If you feel that this may be happening to you, please contact us so that we can help make you more comfortable.
6. SWELLING RELATED TO THE SURGICAL PROCEDURE usually develops during the first 12-24 hours following surgery, often increasing on the second day. It should begin to subside by the third day. Swelling can be minimized a great deal by wearing an ice pack on the side of your face for 15-30 minutes every hour while you are awake during the first 24 hours following the surgery, unless you receive special instructions. Anti-inflammatory medications, such as Motrin or Advil, also help decrease swelling.
7. FLUID INTAKE IS IMPORTANT. We suggest you start with clear beverages. Once your stomach has settled, you can advance to other fluids such as soda, broth, soups, or juices. We suggest avoiding dairy products initially, such as milk, milk shakes, and eggnogs. Also avoid hot liquids until the numbness has worn off, and the bleeding has stopped. It is important to drink plenty of fluids.
8. AVOID USING A STRAW FOR SEVERAL DAYS as it may cause the blood clot to dislodge and delay healing.
9. FOOD SELECTION is largely a matter of your choice. Soft, cool foods that require little or no chewing are most easily tolerated at this time. A nutritious diet throughout your healing process is most important to your comfort and temperament. Hungry people become irritable and less able to deal with discomfort which can follow surgery. Since you will be taking medication, it is important to remember that eating can prevent nausea sometimes associated with certain medications. Once your stomach is settled, soups, broiled fish, stewed chicken, mashed potatoes, macaroni and cheese, and cooked vegetables can be added to your diet as your comfort indicates. Ensure, Carnation Instant Breakfast and/or yogurt supply excellent added nutrition.
10. Take any special medication such as ANTIBIOTICS we have prescribed on the specified dosing schedule. Yogurt with active cultures or acidophilus should be taken while on antibiotics to prevent diarrhea. It is important to take the antibiotics to completion. If you are given antibiotics and take birth control pills, you should be aware that the birth control pill may become ineffective, therefore take appropriate precautions.11. Take any regularly scheduled medication (for diabetes, high blood pressure, etc.) on your regular schedule unless advised to do otherwise.
11. AVOID SMOKING COMPLETELY, as it tends to slow the healing process and may also contribute to development of a dry socket.
12. DO NOT DRIVE AN AUTOMOBILE for 24 hours following surgery if you have had intravenous sedation, or if you are taking prescription pain medication.
13. IF YOU WERE INFORMED THAT A SINUS COMMUNICATION OCCURRED DURING SURGERY, as a result of the close relationship between the roots of your upper teeth and your sinuses, or if you have had some surgery that involved work near your sinuses or in your sinuses, please follow these instructions:
    DO NOT blow your nose.
    DO NOT sneeze through your nose. If the urge to sneeze arises, sneeze with your mouth open.
    DO NOT smoke or use a straw.
    AVOID swimming and strenuous exercise for at least one week.
    It is not uncommon to have a slight amount of bleeding from the nose for several days.
    Please remember that occasionally a second procedure may be required if there is a persistent sinus communication.

THE DAY FOLLOWING SURGERY AND THEREAFTER

1. On the morning of the day following surgery, rinse your mouth carefully with the solution made by adding 1/2 teaspoon of salt to a large glass of warm water. Repeat three times a day until remaining soreness subsides. Resume brushing any remaining teeth and your regular oral hygiene as soon as possible. Do not avoid brushing the area as this will cause more inflammation in the area. Please do not use a syringe or Water Pik® to aggressively rinse during the first week. This can dislodge the blood clot.
2. DO NOT WORRY ABOUT STITCHES. Stitches (also known as sutures) are usually placed to control bleeding, aid healing and help prevent food from collecting in the surgical site – – especially for lower teeth. The sutures we use dissolve on its own and DO NOT HAVE TO BE REMOVED.
3. ANY SWELLING, SORENESS, OR STIFFNESS IN THE JAW MUSCLES can be relieved by applying a warm moist towel to the affected side of the face several times a day. Moist heat should be used after the first 24 hours. If swelling, tenderness, or pain should increase after the first few days, call the office.
4. Sometimes a soft diet may be necessary for the first few days following surgery. Most patients are able to resume regular food intake within a short time.
5. Bruising marks may appear on the skin of the face during the first few days after surgery. Moist heat application will help relieve this condition.

WHAT ARE DRY SOCKETS? Dry sockets continue to be the most common problem people experience following dental surgery. They arise due to premature loss of a blood clot in the empty tooth socket and affect approximately one out of five patients. This seems to occur with greater frequency in people who smoke or are taking birth control pills. While both jaws can be affected, they usually occur in the lower jaw on the third to fifth day. They cause a deep, dull, continuous aching on the affected side(s). Patients may first notice the pain starting in the ear radiating down towards the chin. It frequently begins in the middle of the night, and the Motrin medication usually doesn’t help. Treatment involves placing a medicated dressing in the “empty” tooth socket. This will help decrease the pain and protect the socket from food particles. The effectiveness in alleviating the pain lasts for 24-48 hours and usually will require dressing changes every day or two for five to seven days. Dressings usually are removed when you have been pain free for 2-3 days. The dressing doesn’t aid in healing. The only reason to place a dressing is for pain control. If Motrin is controlling the pain, the socket will heal without a dressing. An irrigation device will be given to you to help keep food particles from lodging in the extraction site following removal of the dressing.

Faithful compliance with these instructions will add to your comfort and hasten your recovery. Be sure to follow these instructions carefully. Only in this way will you avoid the complications which lead to unnecessary discomfort and delayed recovery. Should any undue reaction or complications arise, notify the office immediately.

If you need to contact us after office hours, please call the office .  We make every attempt to answer the emergency pager as promptly as possible. Occasionally, your messages do not reach our pagers. If you do not hear from the doctor on call within one hour, please call back and ask them to page the doctor again. If for some reason, we still do not respond and you think this is an emergency situation, please contact your local emergency room.