Post Operative Instructions for Tooth Extractions and Oral Surgery

It is our goal at MYDENTAL that your recovery be as smooth and comfortable as possible. By carefully following these instructions you will minimize any pain and swelling and lessen the chance for infection and complications. If after reading these directions you have any questions, call the office and we will be happy to speak with you. Calling during office hours will result in a faster response to your concern.

Normal healing after tooth extraction/ oral surgery should be as follows: The first 3 days after surgery are generally the most uncomfortable and there is usually some swelling. On the 4th day you should be more comfortable and, although still swollen, can usually begin a more normal diet. The remainder of the post-operative course should be a gradual, steady improvement. If you do not see continued improvement, please call our office. Unless otherwise instructed, continue taking any medications prescribed by your physician.

NUMBNESS: The local anesthetic will cause your mouth to be numb for a few hours. Be very careful not to bite, chew, pinch, scratch or otherwise injure the numb area. Sometimes the extraction causes residual numbness or tingling for several weeks or longer.

DO NOT DISTURB THE AREA: For the next several days, and especially the first 24 hours, it is very important to allow your body to form a good clot and start the natural healing process. Do NOT rinse vigorously, drink with a straw, probe the area with fingers or other objects, and stretch the lips or cheeks to look at the area. Passively empty your mouth when needed. Keep anything sharp from entering the wound (crunchy food, toothpicks, eating utensils). Be sure to chew on the opposite side for 24 hours or longer.

AVOID SMOKING: Smoking should be stopped following surgery!!! Use Nicotine Patch if necessary. The chemicals in cigarettes are caustic and will significantly delay healing, increase post-operative pain, swelling, risk of infection, and dry socket.

ORAL HYGIENE: Keeping your mouth clean after surgery is essential. If you have been prescribed an antibiotic mouthwash, you may use it gently at bedtime the night of your surgery. Otherwise begin rinsing with warm salt water after the first 24 hours following surgery. Use 1/4 teaspoon of salt dissolved in an 8 oz. glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat after every meal, but at least twice a day. This can continue for 1-2 weeks. Avoid commercial mouthwashes; the alcohol they contain may irritate the surgical site. Brush gently, avoiding the surgical sites for at least 2 weeks. However, we do encourage you to brush and floss all other areas.

MANAGING POST-OPERATIVE PAIN: Unfortunately, most oral surgery is accompanied by some degree of pain and/or discomfort that slowly improves in 1-5 days. You may be directed to use an over the counter pain medication or given a prescription, either will help with pain and swelling. To best manage your discomfort, you should take the first pill immediately and before the local anesthesia has worn off.

• Most of cases are well managed with over-the-counter non-aspirin pain reliever: 2 tablets every 4-6 hours continuously for the first two days alternating NSAIDs such as Ibuprofen [Motrin, Advil] up to 3200 mg daily and Acetaminophen [Tylenol] up to 3000 mg daily.
• If prescription pain medication such as short-term opioids is given, take it as instructed. Do NOT exceed the dose on the label. Taking with food or milk will help reduce upset stomach. The prescription pain medication may cause drowsiness, decreased reaction time, blurred vision and change in mental status. Do not drive, operate dangerous machinery, make important decisions, perform strenuous exercises or drink alcohol while taking these medications. Failure to follow these instructions increases your risk of causing injury to yourself and others. We recommend that you limit opioid use to instances when you feel severe pain (7/10 or more) despite scheduled doses of NSAIDs and Tylenol. Use of opioids (even short term use) may lead to physical dependence and addiction. To dispose of used opioids, return to opioid take back clinics or pharmacies. Do not flush opioids down the drain.
• If you find you are taking large amounts of pain medicine at frequent intervals, please call our office.
• PLEASE NOTE: renewing of narcotic (pain killer) prescriptions must be made during regular weekday office hours, if you anticipate needing more pain medication for the weekend, as pharmacies do not accept over-the-phone narcotic refills.

MANAGING POST-OPERATIVE BLEEDING: Minor bleeding and “oozing” is completely normal and may take 24 hours to fully stop. PRESSURE is the key. Bite down firmly on the gauze that has been placed over the surgical areas. Do not change for the first 30 minutes unless the bleeding is heavy. After that, you may take the gauze out and observe the extraction area. If it is bleeding like a fresh wound (bright red, dripping blood), place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 20 to 30 minutes) until the area is slight oozing and blood is dark & clotting. Remember a little blood and a lot of saliva will look like a lot of blood; usually it is just a lot of saliva. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in very hot water, squeezed damp-dry and wrapped in a moist gauze) for 20 or 30 minutes. The tea contains a beneficial chemical that locally constricts blood vessels. If bleeding remains uncontrolled after a full hour of using the tea bags, call our office. Remove the gauze while you eat and sleep. Place an old towel over your pillow. Discontinue gauze once the bleeding has stopped.

MANAGING POST-OPERATIVE SWELLING: Slight swelling, inflammation and/or bruising may occur for the next two days. It can be minimized by applying ice packs or a bag of frozen peas firmly to the cheek nearest to the surgical area for the first 24 hours while awake (10 minutes on then 10 minutes off). If swelling persists after 24 hours, warm/moist compresses (10 minutes on then 10 minutes off) may help. If you have been prescribed medicine to minimize swelling such as Medrol Dose Pak, be sure to take it as directed. You should take the first group of pills at bedtime tonight. If swelling occurs after 48 hours, call our office.

NAUSEA: Most often caused by taking pain medications on an empty stomach, as well as anesthesia or surgery. It generally improves within 4-6 hours. Nausea following anesthesia is best managed by avoiding all foods until you are feeling hungry. Try sipping small amounts of clear liquids to prevent dehydration. If the pain medication is the cause, reduce it by preceding each pain pill with soft food, and taking the pill with a large glass of water. Try to keep taking clear fluids and minimize dosing of pain medications, but call us if you do not feel better.

ANTIBIOTICS: Take as directed until all pills are gone, even if symptoms dissipate. Women: some antibiotics can interfere with the effectiveness of birth control pills or other medications. Use alternative birth control methods for 2 months.

PROBIOTICS may prevent and relieve some of the common side effects of antibiotics such as nausea, stomach upset, and diarrhea. Probiotics are considered safe and are naturally contained in products such as yogurt. We recommend taking probiotics while you are taking antibiotics we prescribe for you.

MOUTH OPENING EXERCISES: Tightness and stiffness to the jaw and joint areas are common following oral surgery that can be reduced by stretching your mouth open with two fingers each hour.

DIET: After all bleeding has stopped you may drink cool non-carbonated liquids but should NOT use a straw. Encourage fluids to help avoid dehydration. Avoid alcohol for 48 hours. Your 1st day will consist of soft, cool foods such as: Jell-O, pudding, yogurt, milkshakes, applesauce, mashed potatoes, cottage cheese, fish, pasta and ice cream. Soup is fine as long as it is room temperature only. By the 2nd day, consistency of foods can progress as tolerated. Maintain a balanced diet. Return to normal regular meals as soon as you are able after the first 2 days. Until healing is more established, avoid foods such as nuts, sunflower seeds, and popcorn that may get lodged in the surgical areas. No spicy food is recommended. It is normal to have a little tenderness while chewing and difficulty opening wide. Around day 3-4 you may resume regular diet as tolerated, but should your jaw start to ache, resume soft diet for a couple more days to rest the jaw muscle.

ACTIVITY: Rest and avoid strenuous activities for the remainder for the day. Keep blood pressure low to reduce bleeding and aid healing.

SINUS: Because of the close distance between your upper jaw and maxillary sinuses, the removal of upper teeth, infection, implant placement, etc. can result in an opening between sinus and mouth. To allow the closure and healing of sinuses:

• Avoid forcefully spiting, drinking through a straw, smoking, blowing your nose, playing a wind musical instrument and sneezing for the first week (if you must sneeze, do so with your mouth open to prevent sinus damage).
• Take over-the-counter Afrin or Neosynephyrine nose drops as directed for no more than 7 days.
• Take over-the-counter Sudafed tablets for 5 days if directed.
• Rinse the affected sinus with saline solution such as NeilMed Sinus Rinse
• Take all prescription medications as directed (e.g. complete the antibiotics).
• Eat only soft foods on the opposite side of your mouth until your surgeon has told you it is OK to resume a normal diet.

DRY SOCKET: Painful condition that results from premature loss of the blood clot. Risk factors for developing a dry socket are extracting painful or infected teeth, wisdom tooth surgery, females, smokers, and oral contraceptives. Symptoms typically occur on the 3rd or 4th post-operative day. The usual complaints are severe throbbing pain, not responsive to pain medications and bad breathe. This condition requires an office visit where your surgeon will place a medicated dressing into the socket. A few visits may be necessary in some cases.

SHARP EDGES: If you feel something hard or sharp edges around the surgical areas, it is likely you are feeling the bony walls, which once supported the extracted teeth or the ends of the sutures. Occasionally small slivers of bone may work themselves out during the following weeks. This is normal but if they cause concern or discomfort, please call the office.

STITCHES: If sutures (stitches) were placed to help control bleeding and promote healing, avoid playing with them. They will either dissolve as you heal and do not need to be removed OR will be removed at your follow-up visit. If the stitches come out during the first 48 hours, call our office. Avoid chewing gum.

FOLLOW-UP APPOINTMENTS: You will be given an appointment to return to the clinic for a post-operative check to have sutures removed, or just for brief follow-up healing check. This will usually be about 1-2 weeks after surgery. This appointment was included in your original fee, and is no charge. Write down and bring any questions you have to this appointment. If you are unable to keep the appointment, please be sure to call and reschedule.

WATCH FOR: Please contact the office immediately

• If you have severe or increased pain not relieved by medication.
• If you have any side effects to medications such as, rash, nausea, headache, vomiting, irritability, constipation or difficulty breathing.
• If you have a marked fever (oral temperature over 100.5 degrees). Check to make sure you are getting enough liquids. Dehydration can cause the body temperature to rise.