After Tooth Extraction
Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a moistened gauze pad placed directly on the bleeding wound for 30-45 minutes. This may be repeated as needed. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. If bleeding continues after 3-4 gauze changes please call for further instructions. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. Do not disturb the wound. After the blood clot forms, it is important not to dislodge the clot as it aids healing. Do not spit, rinse vigorously, suck on straws, smoke or drink alcohol for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process and will promote bleeding.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until the third post-operative day. However, the swelling may be minimized by the immediate use of ice packs and sleeping with the head in an elevated position. Baggies filled with ice, ice packs, or an unopened bag of frozen peas or corn should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 72 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Seventy-two hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. If possible sleep with your head elevated at a 30 degree angle for the first three days following surgery. In general, patients who use ice and sleep with their heads elevated experience less swelling, have less post-operative pain and recover more quickly from surgery.
Take only fluids until your feeling has completely returned. Drink plenty of fluids and eat nutritious soft food the day of surgery. Avoid hot liquids or food. Return to a normal diet as soon as possible unless otherwise directed. Do not chew solid foods in the surgical area until you return for the first follow-up visit.
Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. To optimize your comfort you should take the first pain pill before the numbing medication has worn off. Remember that the most severe pain is usually within six hours after the local anesthetic wears off; after that your need for medicine should lessen. For moderate pain, take a dose (400-600mg) of Ibuprofen (Advil or Motrin) every 4-6 hours as needed for pain. Do not exceed the maximum daily dosage suggested on the bottle. Do not take Ibuprofen if you are intolerant of this medication or have a history of stomach ulcers or kidney disease. For severe pain, the prescribed medication should be taken as directed. It is best to take pain medication with a small snack or following a meal to avoid stomach upset. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not operate a motor vehicle or machinery (lawn mower, etc.) while taking the pain medication. Do not drink alcoholic beverages. Notify the clinic if you are experiencing pain that is not improving 3-5 days after surgery. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.
We recommend the following protocol for optimum pain management: Take each medication with a small snack and full glass of liquid.
Immediately Following Surgery: 1 Prescription Pain Pill
3 Hours Later: Ibuprofen dosage
3 Hours Later: 1 Prescription Pain Pill
3 Hours Later: Ibuprofen dosage
NOTE: The dosage of the prescription pain medication can be increased to 1 1/2 to 2 pills if needed for pain management.
Nausea and Vomiting
Nausea is not uncommon after surgery. Sometimes pain medications are the cause. Nausea can be reduced by preceding each pain pill with a small amount of soft food, and taking the pill with a large volume of water. In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. To help avoid nausea and vomiting do not take pain medication on an empty stomach.
Keeping your mouth as clean as possible following surgery is essential to good healing and one of the best ways to avoid infection. Begin brushing your remaining teeth the night of surgery, avoiding the surgery site. You can mix 50% hydrogen peroxide and 50% water, dip a Q-tip in the solution and wipe gently over the surgery site to keep plaque from accumulating on the sutures or teeth surrounding the area. Be gentle initially when cleaning the surgical areas. No rinsing of any kind should be performed until the day following surgery. The day after surgery you should begin rinsing at least 5-6 times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt. Try to avoid over the counter mouth rinses that contain alcohol.
Normal healing after tooth extraction should be as follows: The first two days after surgery are generally the most uncomfortable and there is usually some swelling. On the third day you should be more comfortable and, although still swollen, can usually begin a more substantial diet. The remainder of the post-operative course should be gradual, steady improvement. If you don’t see continued improvement, please call our office. If you are given a plastic irrigating syringe, DO NOT use it for the first five days. Then use it daily according to the instructions until you are certain the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket.
You may notice some stitches in your mouth. These may require removal at your first follow-up visit. Do not be concerned if you lose a stitch prior to your first appointment.
If you had an infection or bone graft placed in the tooth extraction site you may have been prescribed an antibiotic. Be sure to take the prescribed antibiotics as directed to help prevent further spread of the infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and notify our office. Otherwise, please finish your entire course of antibiotic. Antibiotics can sometimes cause an upset stomach. If this is the case, it is advisable to take acidophilus or pro-biotic tablets along with your antibiotic. Call our office if you have any questions.
Women taking oral contraceptives: Antibiotics that you have received for your surgery may make your oral contraceptive less effective. You should use an alternate form of birth control until your normal menstrual cycle.
DO NOT SMOKE for a minimum of 4 weeks following surgery. The heat and toxic chemicals in cigarette smoke are harmful to the healing of wounds and increases the likelihood of dry socket and infection.
Because of the close relationship between upper back teeth and the sinus, a communication between the sinus and mouth sometimes results from surgery. If we informed you at the conclusion of you procedure that this complication occurred please read the following instructions. Do not blow your nose for at least 14 days after surgery, even though your sinus may feel “stuffy” or there may be some nasal drainage. Slight bleeding from the nose is not uncommon for several days after surgery. When sneezing during the first two weeks, sneeze with the mouth open to avoid applying pressure to the sinuses. Please take all medications as prescribed. Do not smoke for two weeks. Eat only soft foods for several days, always trying to chew on the opposite side of your mouth. Please keep our office advised of any changes in your condition, especially if drainage or pain increases. Sinus exposures often heal slowly and with difficulty, therefore, it is important that you keep all future appointments until this complication has resolved.
Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.
Wearing your Prosthesis
Partial dentures or flippers should be worn only in social settings. When at home, remove your proestesis to allow the healing extraction site a chance to breath.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have any questions or concerns about your progress please call the office Boulder Office Phone Number 303-444-2255. We are available 24 hours a day.
Thank you for trusting us with your oral and maxillofacial surgery needs.