The after-effects of oral surgery are quite variable, so not all of these instructions may apply. At a minimum, you must control bleeding, provide for good nutrition, maintain adequate pain control, and provide proper oral hygiene/wound care. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office any time for clarification.
Instructions for the day of Surgery:
The day of your procedure should be committed to actions that will promote proper, complication free healing.
Some bleeding and oozing is expected. The gauze pack which was placed over the surgery site can be removed 30 minutes after surgery. If there is continued bleeding, lie down with your head elevated, place a new gauze or moistened tea bag over the area and bite down firmly for 45 minutes without changing the gauze, talking or releasing of pressure. Repeat if necessary. Slight oozing is anticipated for several days after surgery.
Care of the Mouth:
For the first 24 hours, do not rinse your mouth, brush your teeth, spit, smoke, or use a straw when drinking. This may dislodge the blood clot and interrupt the normal course of healing. After the first 24 hours, resume brushing and rinsing gently with warm salt water (1/2 teaspoon of salt in an 8 oz. glass of water). Rinse the mouth 6 to 8 times a day, especially after meals until the area has healed (usually 1 week).
Control of Bleeding:
Bleeding after surgery may continue for several hours. Bite down firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not being controlled. If active bleeding persists after one hour, place enough new gauze to obtain pressure over the surgical site for another 30-60 minutes. The gauze may be changed as necessary and may be dampened and/or fluffed for more comfortable positioning.
Intermittent bleeding or oozing is normal. It is typical for bleeding to continue for a few hours after simple extractions and for several (6-10) hours after more complex surgery such as removal of impacted teeth. Placing fresh gauze over the surgical areas and biting down firmly for 30-60 minutes may control it.
Maintaining the head in an elevated position (use of a recliner or several pillows) will also help to reduce bleeding and swelling.
Do not disturb the surgical area today. DO NOT RINSE vigorously or probe the area with any objects or your fingers. You may brush your teeth gently. DO NOT SMOKE for at least 48 hours, since it is very detrimental to healing.
Bleeding should never be severe. If it is, it usually means that the packs are being clenched between your teeth rather than exerting pressure on the surgical areas. Try repositioning fresh packs. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in hot water, squeezed damp dry and wrapped in a moist gauze) for 20 or 30 minutes. If bleeding remains uncontrolled, please call our office.
Often there is some swelling associated with oral surgery that will reach its peak in around 48 hours and can take 7-10 days to resolve. You can minimize this by using a cold pack or ice bag wrapped in a towel and applied firmly to face or cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 12 to 24 hours after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed.
A slight fever is not uncommon the first few days after surgery (temperature to 100.5F) If you have a high fever or fever persists, please call our office.
Operating a Motor Vehicle:
Please do not operate any machinery or a motor vehicle for 24 hours after sedation or general anesthesia, or if you are taking any prescribed narcotic pain medicine (Percocet, Endocet, Roxicet, Oxycodone, Vicodin, Hydrocodone, Tylenol with Codiene).
Smoking and Drinking:
You should not smoke following surgery for at least 48 hours. This may disrupt the healing process. Do not consume any alcohol for 24 hours after intravenous sedation, general anesthesia or while taking any prescription pain medications.
Unfortunately, most oral surgery is accompanied by some degree of discomfort. If you have no history of allergy to non-steroidal anti-inflammatory medications like Ibuprofen (Motrin, Advil) or ketorolac (Toradol), we recommend taking this prior to the local anesthetic wearing off. If pain is more severe, a narcotic pain medicine may be needed. There is no interaction between the prescribed narcotic pain medicine and ibuprofen or ketorolac (Toradol). Be aware that narcotic pain medicine may cause upset stomach, which may include nausea, vomiting or constipation. Also, these should not be taken if you must operate any machinery or a motor vehicle. Effects of pain medicines vary widely among individuals. Remember that the most severe discomfort is usually within the first six hours after the anesthetic wears off, after that your need for medicine should lessen.
Nausea is not an uncommon event after surgery, and it is sometimes caused by stronger pain medicines or certain anesthetic agents. Preceding each pill with a small amount of soft food, then taking the pill with a large volume of water may reduce nausea caused by pain medications. Try to keep taking clear fluids and minimize the pain medication, but call us if you do not feel better or if repeated vomiting is a problem. Cola drinks that have less carbonation may help with nausea.
On the day of surgery, we ask that you avoid hot foods that will prolong bleeding. Cold soft foods (such as ice cream, milk shakes, Instant Breakfast, puddings and yogurt) are ideal. Over the next several days you can progress to solid foods at your own pace. It is important not to skip meals! If you take nourishment regularly, you will feel better, gain strength, have less discomfort and heal faster. Avoid foods like nuts, sunflower seeds, popcorn, etc., which may get lodged in the socket areas. If you are diabetic, maintain your normal eating habits as much as possible and follow our instructions or those from your physician regarding your insulin schedule.
Sutures (or “stitches”) may be placed to reapproximate tissue and help control bleeding. These sutures are usually dissolvable and do not need to be removed.
Instructions for the second and third days:
Keeping your mouth clean after surgery is essential. Use one-quarter teaspoon of salt dissolved in an 8-ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily and always after eating for the next five days. We may prescribe an antibiotic rinse (chlorhexedine, Periogard, Peridex) for certain procedures. This rinse should be used in the morning and at bedtime after routine mouth care. Do not eat or drink or rinse your mouth after using the medicated rinse.
Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.
Normal healing after tooth extraction should be as follows: The first day of surgery is usually the most uncomfortable and there is some degree of swelling and stiffness. The second day you will usually be far more comfortable and, although still swollen, you can usually begin a more substantial diet. From the third day on, GRADUAL, STEADY IMPROVEMENT should mark the remainder of your post-operative course. If a DRY SOCKET occurs (loss of blood clot from socket, usually on the 3rd to 5th day), there is a noticeable, distinct, persistent throbbing pain in the jaw, often radiating toward the ear and forward along the jaw to cause other teeth to ache. If you do not see steady improvement during the first few days after surgery, don't suffer needlessly. Call the office and report symptoms so you can be seen as soon as possible.
Sockets from tooth extractions may remain open for several weeks after surgery. Rinsing after any food intake is very important, and you may be given a small irrigating syringe to help keep food out. This can be used with plain warm water.
If you feel sharp edges in the surgical areas with your tongue it is probably the bony walls that originally supported the teeth. Occasionally small slivers of bone may work themselves out during the first week or two after surgery. They are not pieces of tooth and, if necessary, we will remove them. Please call the office if you are concerned.
Some procedures in the back part of the upper jaw may involve entry into the sinus cavity. If you are advised of this, please follow these precautions for 10 days after the surgery. Do not blow your nose vigorously or sneeze holding your nose. Scuba diving and flying in pressurized aircraft may also increase sinus pressure and should be avoided. Decongestants such as Drixoral, Dimetapp, or Pseudofed will help reduce pressure in the sinuses. You may also be given a prescription for antibiotics. Please take these as directed.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office where you had your surgery. Please try to call during office hours, however a 24-hour answering service is available for after hours contact with a doctor. Calling during office hours will afford a faster response.