Post- Surgery Instructions

Patient Comfort

The effect of the local anesthesia administered in the office generally lasts about 2 hours after you leave the office. When the anesthesia wears off, pain can be intense for several hours. It is important that you take the prescribed medication before the "numbness" wears away. Pain medication will help. It will not entirely eliminate the discomfort. Take the prescription medication as directed. If you can take ibuprofen, it can be taken in between doses of the prescribed medication for an additional level of pain relief. Taken in 400mg or 600mg dosages, it is a very good pain medication and you may find it can be used alone, instead of the prescribed medication. Pain should gradually improve over the first four days. If, by the fourth day after surgery, you are still having a lot of discomfort and feel like you continue to need pain medication, please contact the office.

Bleeding

Before you leave the office we will make sure any bleeding is under control. There will be some minor seepage from the sockets for the first 24 hours. Your saliva may be pink colored for the first day or two. You will leave the office with gauze packs in your mouth. Change them every 30 minutes for the first 2-3 hours. Usually by that time you do not require further gauze packing. Even though the gauze may still have some blood on it, it gets to the point where it is just leeching it out of the clot or socket. You should not be able to look in your mouth and watch blood well up from the extraction sites. If you can watch it bleed or if the gauze becomes totally saturated within a few minutes, there is too much bleeding. Continue with the gauze packs over the sockets and use firm biting pressure on them. A moistened tea bag in place of the gauze pack may help. If you are unable to control it over 30-60 minutes call the office. Do not rinse or brush your teeth the day of surgery. Proper healing depends on a blood clot forming in the socket and staying there. Vigorous rinsing the first day can dislodge the clot and lead to renewed bleeding or delayed healing. The day after surgery you may rinse gently and brush gently.

Swelling

Facial swelling can be significant for the first few days after surgery. It usually increases over the first 36-48 hours and resolves slowly over the next 4-5 days. Different people swell different amounts so you cannot really compare your swelling to someone else you might have known that had oral surgery. Ice packs to the face will help with swelling. Apply them to the cheek and jaw areas on 30 minutes-off 30 minutes over the first day. You can make your own ice packs with crushed ice and a plastic bag. Another thing that works well is small bags of frozen peas or frozen corn. They mold well to the shape of your face and can be refrozen and reused over the first day.

Patients occasionally develop discoloration or bruising on the cheeks, neck,or beneath the eyes. Other than the appearance, this is not a problem.

Diet

It is important to take fluids and soft food as soon as you feel able after surgery. It is usually difficult to manage anything until the numbness wears away. Once it does, liquids, soft food (the consistency of applesauce, mashed potatoes, etc), lukewarm soup, ice cream and milkshakes are all appropriate. Advance your diet back to normal consistency as you feel able. It may be 10-14 days before you feel like you can chew anything and everything. If you have had surgery on just one side of the mouth, obviously chew on the other side during the healing phase.

When drinking liquids, do not use a straw. The sucking action on the straw puts negative pressure in your mouth and may dislodge the blood clot or aggravate bleeding.

Oral Hygiene

Do not rinse your mouth or brush your teeth after surgery the day of your surgery. The next day you may rinse gently and brush gently. Warm salt water is appropriate to rinse with. Use one-half teaspoon of salt in a glass of lukewarm water and rinse three or four times each day for five days. Minor bleeding may occur when you brush or rinse during the first week. Do not be alarmed by this. Alcohol based mouth rinses can be a little hard on the healing tissue and blood clot the first few days. Rather than use them, you may find a sugarless breath mint helps your mouth feel fresher.

Upset Stomach

The percentage of patients having an upset stomach, nausea, or vomiting is fairly small. However it does occasionally occur. Some patients experience nausea while in the office as they emerge from the effects of the intravenous anesthesia. In some cases medication will be administered in the office to help relieve this problem. Other patients experience nausea associated with the pain medication. If, after taking the pain medication, you have nausea or vomiting it is best to discontinue it and try ibuprofen (Advil) or acetaminophen (Tylenol). If nausea and vomiting persists beyond 6-8 hours, call the office. We can sometimes call in some medication that will help.

Dry Socket

Many patients have heard about and ask about "dry socket." The technical term is alveolar osteitis. In normal healing, a blood clot fills the socket and matures and acts as a template for new, healing tissue. In the case of dry socket, the blood clot breaks down before it should and the socket is empty or "dry." This leaves the bone surfaces of the socket exposed. The exposed bone is very sensitive and the source of significant discomfort often described as a throbbing pain radiating to the ear. The area of the socket often has a bad odor and the patient complains of a bad taste.

Dry sockets are not dangerous and they are not infections. They are simply uncomfortable. Treatment consists of gently irrigating the socket to cleanse it and the placement of a small piece of gauze with medication on it into the socket. This relieves most of the discomfort until the healing process progresses. It is usually necessary to irrigate and place the dressing every 24-48 hours for 4-7 days.

Dry sockets are more common when lower teeth are extracted than when upper teeth are removed. They occur more often with wisdom teeth (3rd molars) removal than with other teeth, the rate being approximately 15-20%. Patients who smoke and women who take oral contraceptives have a much higher incidence of dry socket. In these patients the risk approaches 50%.

How do you know if you have a dry socket? In typical extraction healing, discomfort is less each day and by the 3rd or 4th day after surgery you should be reasonably comfortable. The area may still be a little tender but you should not have distracting discomfort by the 4th day. If you do, notify the office to make arrangements for us to treat the discomfort.