The removal of teeth is a surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if proper care is followed.
Immediately Following Surgery:
BleedingA certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon for the first 24-36 hours. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad folded in a square over the area and biting firmly for 30 - 60 minutes . Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, try not to become agitated, sit upright, and avoid exercise. If bleeding does not subside despite the above instructions, notify the office or our answering service after hours. It is normal to have blood tinged (red) saliva (spit) for a few days after your extractions.
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 3-4 days post-operatively. Expect the swelling to last 5 or 6 days. Swelling may be minimized by the immediate use of ice packs during the first 24 hours. Fill 2 zip lock baggies with ice, or store bought ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on the face in 20 minute on/off increments while you are awake. After 36 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. 36 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. Swelling that reoccurs after the initial swelling goes down (>6 days) could be a sign of an infection. If this occurs, call our office.
If you find that ibuprofen is not controlling your pain well enough, you may take the prescription pain medication in addition to ibuprofen, but not in place of ibuprofen. Think of the narcotic prescription medication as an ‘as needed’ medication. The prescribed pain medicine could make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery while taking the prescription narcotics. Avoid alcoholic beverages.
Make sure that you take your ibuprofen medication regularly for the first few days to stay ahead of the pain. If your pain increases after the first 4 or 5 days, then please contact our office as this may be a sign of a 'dry socket' or 'infection'. Contact our office during normal business hours for prescription refills. Narcotic prescriptions will not be refilled after office hours or on weekends.
After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws for 3-4 days. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot leading to what is known as the ‘dry socket’. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of this writing. Nourishment and Fluids should be taken regularly as to prevent dehydration and malnourishment. Your regular 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 / high protein shakes should be taken daily. Try not to miss any meals. 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. Avoid crunch foods (peanuts, popcorn, chips) for 2 weeks. Do not drink alcoholic beverages while taking prescription pain medication or antibiotics as this may cause an adverse reaction.
No rinsing of any kind should be performed until 2 days following surgery. You can brush your teeth gently the day after surgery. Begin 3 times a day gentle rinsing 48 hours after the surgery. Salt water or mouth rinses (commercial or prescribed) are suitable. If the mouthwash was prescribed, please use at least twice per day in addition to the regular routine for 10 days.
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 resolution of the discoloration.
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection if needed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.
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 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. Nausea is often the result of low blood pressure, low blood sugar, narcotic use, and sometimes swallowing some blood from the surgery. Nausea that persists longer than 24 hour usually requires treatment, and you should contact our office should this occur.
If an irrigation syringe was given to you, follow these instructions:
The syringe was supplied to you to keep food and debris out of your lower extraction sockets (sites). Do not use the syringe until the third day after surgery. After eating, fill the syringe with warm water, insert tip into sockets (make sure that it goes under the gum tissue) and flush with gentle but firm pressure. It is important to insert the tip of syringe into sockets to efficiently flush out the food particles. Continue irrigating sockets after each meal until the extraction sites are clean (no food or debris present). You may notice some bleeding after irrigation which is normal. Syringe use may be required for 2-3 weeks or until the extraction site completely heals.
And finally, a dry socket is when the blood clot gets dislodged prematurely or dissolves from the lower extraction sites. Food and debris could then get into the socket. Symptoms of throbbing pain at the surgical site and even radiating pain to the ear may occur over the next 2 to 3 days. It is also common for there to be a foul odor, or bad taste associated with the pain. A dry socket is not an infection, but usually requires a return visit to our office for treatment with medicated paste. Dry sockets occur most often in the lower jaw and are usually associated with removal of the molar teeth. Stitches, which are usually placed after the removal of an impacted tooth, do not prevent dry sockets. Women taking birth control pills and smokers are more prone to dry sockets. Call the office if you believe you are developing a dry socket.
Common sense is probably the single most important element in successful healing. Please call our office and speak to our triage coordinators for post-operative care. You aren’t expected to know everything about having teeth removed and we are always here to help you.