Immediately Following Surgery

• Keep the gauze pad in place over the surgical site with firm biting pressure for 1 hour. After this time, remove and discard the gauze pad. A new moist gauze pad does not need to be placed unless bleeding continues or recurs.
• Avoid vigorous mouth rinsing, sucking on straws, smoking, and touching the surgical sites. 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 2 or 3 pillows or sit in a recliner and take it easy.
• Place an ice pack on the outside of your face over the area where surgery was performed for the first 24–48 hours to help minimize swelling.
• Do not use straws 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 surgery. Slight oozing or blood-tinged saliva is not uncommon for the first 12–24 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.

Sutures are placed to minimize post-operative bleeding and to help healing. The sutures will be removed approximately 1 week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. If 1 or 2 become dislodged early, there is no cause for alarm. Remove the loose suture from your mouth and discard it.

SWELLING

Swelling is normally expected after most surgical procedures and is usually proportional to the extent of surgery performed. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. 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 48–72 hours postoperatively. 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 surgery was performed for the first 24–48 hours. Ice packs should be placed on for 20 minutes, then removed for 20 minutes. 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 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 2–3 days after the procedure and take 1–2 weeks to gradually fade away.

DIET

Continuing to eat a nutritionally balanced diet is essential for feeling better, regaining strength, experiencing less discomfort, and more rapid healing after surgery. Try not to miss a single meal. It’s understandable that your food intake will be limited for the first few days after your procedure. It is best to wait until after the local anesthetic has completely worn off before beginning to eat. Start with plenty of fluids (juice, milk, water) during the first 24 hours. At least 6–8 glasses (2 quarts) of liquid a day will help prevent dehydration. Do not use straws, as this may encourage more bleeding by dislodging a blood clot. Do not drink hot fluids or eat hot food the first day. You may eat anything soft and cool the first day by chewing away from the surgical sites. It’s best to progress to more solid foods and return to your normal diet as soon as possible.

ORAL HYGIENE

No rinsing of any kind should be performed until the day following surgery. Begin gentle, warm saltwater rinses (1/2 teaspoon of salt in a glass of warm water) the morning after your extraction. Rinsing 4–5 times a day for several days, especially after meals, will help to gently flush food particles away. Continue to brush your teeth as best as you can, remembering to stay away from the surgical sites for several days. Furthermore, an irrigating syringe may be provided for use starting a week after the procedure.

There will be a cavity where your tooth was removed. This cavity will gradually close over the next month and fill in with new tissue. Be sure to keep the area clean to promote better healing.

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.

NAUSEA AND VOMITING

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least 30 minutes, including prescribed medicines. Sitting in a darkened environment, limiting movement, and applying a cold compress to your forehead may be helpful. Taking an over-the-counter diphenhydramine (Benadryl^®) may stave off mild nausea. Start again with bland fluids (water, ginger ale, 7Up^®, Sprite), sipping them slowly over a 15-minute period. When nausea subsides, begin taking solid foods and the prescribed medications again. If nausea persists or you have trouble keeping anything down, notify the office, as an anti-nausea medication and/or a change in pain medication may be necessary.

ACTIVITIES

Please keep physical activities to a minimum immediately following surgery. 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 1 minute then get up slowly. Resume normal activities a day or so after surgery.

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 2–3 days following surgery.

The use of tobacco products slows down the healing process and may lead to developing other complications. We strongly recommend avoiding tobacco products for at least 7 days following surgery.

If This Happens…

DRY SOCKET

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 sixth day following your procedure 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.

NUMBNESS

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 the office.

FEVER

A slight elevation of temperature immediately following surgery is not uncommon. If an elevated temperature persists or a fever develops, please notify the office.

DRYNESS

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.

SORE THROAT

A sore throat and pain when swallowing are not uncommon due to swelling and inflammation of the nearby. These issues will subside in 2 or 3 days.

STIFFNESS

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 5–10 days. Chewing gum may help relax muscle tension and bring relief. Taking an anti-inflammatory medication such as ibuprofen (Advil^®/Motrin^®) may also help.

BONY PROJECTIONS

You may feel hard projections in your mouth with your 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, your surgeon will smooth them off for you.

Please notify our office if you have:

• Increased pain after 4 days.
• Increased swelling after the third day.
• An elevated temperature or fever after 2 days.
• Excessive or uncontrollable bleeding.
• A bad reaction to any of your medications.
• Any questions or concerns.