After the Removal of Multiple Teeth
The removal of many teeth at one time is quite different than the extraction of one or two teeth. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.
If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.
Immediately Following Surgery
- The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
- Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
- Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the effects of the local anesthetic wearing off.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
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. Two baggies filled with ice, or ice packs 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. The application of a moist warm towel will help eliminate the skin bruising and discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 72 hours after surgery. 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.
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.
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.
After surgery liquids should be initially taken until the effects of the oral numbing medication has worn off. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.
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.
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.
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
Nausea and Vomiting
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.
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 infection and dry socket.
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 sites a chance to breath. If you had all of your remaining teeth removed and recieved a complete denture please leave the denture in place for 24 hours following surgery. If you remove the denture prematurely you will not be able to get it back your mouth due to soft tissue swelling. You should see your dentist the day following surgery so he or she can adjust the denture and relieve sore spots on your gum tissue. After the first 24 hours you should remove and clean your denture every night. DO NOT SLEEP WITH YOUR DENTURE IN YOUR MOUTH. This will cause pain and inflamation to your gum tissue.
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.
- If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call Foley and Foley if you have any questions.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
- You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery and you may be dehydrated. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
- Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Foley and Foley.
- If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.
- Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
- Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.
Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures will dissolve on their own and will not require removal..
The pain should subside more and more each day following surgery. If your post-operative pain worsens or unusual symptoms occur call our office for instructions.
There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush.
Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Foley and Foley or your family dentist.
Keeping your mouth clean while you heal from surgery is important to help prevent infections. Begin brushing your remaining teeth the night of surgery- just be gentle when brushing around the surgical sites.
A dry socket occurs when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 3-5 days following surgery. Call the office if this occurs.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.
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.