After the Removal of Multiple Teeth

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.

The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone may have been shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:

The area operated on will swell reaching a maximum in two days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 36 hours after surgery (remember ice packs are used for the first 36 hours only).
A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline. There may be a slight elevation of temperature for 24-48 hours. If temperature continues, notify our office.
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 with moderate pressure should be kept in place for 30-60 minutes minimum. After this time, the gauze pad should be removed and discarded. Try not to chew on the gauze. Steady pressure gives the best results.
Vigorous mouth rinsing, using staws, 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. You may begin gentle rinsing with salt water or mouthwashes after 48 hours.
Unless you have received different instructions from the doctor, take 2-3 tablets of ibuprofen 200mg (Advil, Motrin IB) every 4-6 hours in between your prescribed medication.
Restrict your activities the first few days after surgery. Avoid lifting, bending and try to keep your head elevated. This will help promote reduction in swelling and quicker recovery.
Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
Do not drive the day of surgery if you had an IV anesthetic. Avoid driving or operating machinery while taking Narcotic medication.
Do not smoke for at least 5 days following surgery. See your doctor about a nicotine patch if needed. Smoking is a primary cause of dry sockets and post-operative healing complications.

Bleeding

A 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.

Swelling

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.

Pain

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.

Diet

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.

Keep the mouth clean

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.

Smoking

Avoid completely for 3-4 days. Smoking increases your chances of a dry socket, infections, and prolonged healing.

Discoloration

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.

Antibiotics

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.

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 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.

Other Complications

Numbness due to the use of local anesthetic is expected. Numbness of the lower lip, chin, or tongue can last up to 10-12 hours, while the upper jaw usually remains numb up to 4 hours after the procedure. As stated before surgery, this is usually temporary in nature. Please use extreme caution while eating if you are still experiencing numbness as you can traumatize other mouth structures. Call Dr. Wees, McDermott, Glow or Shnayder if you have any questions.
Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists for greater than 24 hours, notify the office or doctor on call. 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. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up too quickly. Before standing up, you should sit for one minute then get up.
Occasionally, patients may feel hard projections in the mouth with their tongue. These are not roots, they are the bony walls which supported the tooth prior to extraction. These projections usually smooth out spontaneously over the first few weeks. If not, they can be evaluated and removed by scheduling a follow up appointment with the surgeons - please call our office to schedule a post-op appointment.
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. These muscles can become mildly swollen. The normal act of swallowing can then become painful. This should subside in 2-3 days.
Stiffness (Trimus) 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. Heat and massage to the area will help with this.
Small bone chips or slivers may appear at the extraction socket during the healing process. This may be felt as a sharp area sticking out of the gum line by the extraction site. They usually work themselves out, but you can always call our office if this occurs and we will be happy to remove them for you.

Finally

Sutures (stitches) are commonly placed during surgery to minimize post-operative bleeding and to help with the healing process. They can become dislodged or fall out as soon as 3-4 days after surgery but this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures will otherwise dissolve and fall out on their own within 7-14 days after surgery. Some sutures are non-resorbable and your surgeon will schedule a follow up appointment to have these removed.
The pain and swelling should start subsiding more and more after 3-4 days. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions.
There will be an empty area where the tooth was removed. This opening will gradually fill in over the next 2 months with new tissue. During the healing time, the area should be kept clean especially after meals with rinses or a toothbrush.
Your case is individual and 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: Dr. Wees, McDermott, Glow, Shnayder or your family dentist.
Brushing your teeth is okay after the initial 24 hours - just be gentle at the surgical sites.
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.

Irrigation Syringe Instructions

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.

The Dry Socket

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.