After Tooth Removal

 

A dental extraction is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.

 

Immediately Following Surgery

• The gauze pad placed over the surgical area should be kept in place for 30-45 minutes. 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 cause bleeding by dislodging or disturbing the blood clot that has formed.

• Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually happen as the numbing medicine wears off.

• Restrict your activities the day of surgery and resume normal activity when you feel comfortable which may be few days.

• Place ice packs to the sides of your face where surgery was performed for 20 minutes at a time. Refer to the section on swelling for explanation.

 

Bleeding

Bleeding is to be expected in variable amounts for several hours and oozing may continue throughout the night. This is normal and should not be cause for alarm. Saliva may be pink for 2-3 days.  If the bleeding seems to be excessive, there are several things to do. First, remove any superficial blood by thoroughly rinsing the mouth one time with cold water. Then, place a folded piece of clean moist gauze over the bleeding area, using enough gauze to apply pressure to the tissues when the jaws are closed. Maintain pressure with the gauze pack for a full 30 minutes with the head elevated. If this does not control the bleeding, you can try a moist black tea bag in place of the gauze, place this over the socket and bite firmly.  If there is concern, please call our office.

 

Swelling

Swelling is expected and usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face may not be the same on both sides. 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 2-3 days after surgery. However, the swelling may be minimized by the immediate use of ice packs to the sides of the face where surgery was performed. Use the ice packs for 20 minutes on and 20 minutes off for the first 48 hours after surgery. After 48 hours, you may consider using moist heat to the sides of the face or you can continue with cold compresses. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm as this is a normal reaction to surgery, usually inflammation in your jaw muscle known as the masseter muscle.  You can stretch this muscle by holding your mouth open with support of your fingers against your teeth for 20-30 seconds, followed by massaging the cheeks overlying that same muscle from your cheek bone to the bottom of your lower jaw.  If difficulty with swallowing occurs, please contact our office.

 

Pain

Pain may be expected soon after the surgery and increase over the first three days as swelling increases. It is recommended that you start taking your prescription medicines as written as the numbing medicine begins to wear off.  It is helpful if the patient rests during this period of discomfort. One should not drive while taking narcotic medication for pain. In most cases, prescription medication may only be necessary for 72 hours. After the 3rd post-operative day, as the swelling decreases, over the counter pain medication such as Ibuprofen (Advil) or Tylenol may be used to relieve discomfort. Studies suggest that over the counter Ibuprofen 400mg taken with over the counter Tylenol 500mg every 6 hours have a synergistic effect for pain control (think 1+1=3).  If severe pain persists after the 4th day, it may require attention and you should call our office.

 

Diet

After IV sedation, liquids should be initially taken after bleeding is controlled.  We don’t recommend chewing any food until the numbing medicines have worn off and the patient has feeling in their tongue, cheek, and lips to avoid any possible trauma.  You may eat anything soft.  Acidic or crispy foods may not feel good right after surgery or during initial healing.  Nourishment should be taken 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.  You should prevent dehydration by taking fluids regularly. You will feel better, have more strength, less discomfort and heal faster if you continue to hydrate and nourish.

 

Keep the mouth clean

You can brush your teeth and rinse the day of surgery gently. Be cautious around the surgical sites but do your best to keep your teeth clean.  The day after surgery you should begin rinsing at least 3-4 times a day, especially after eating, with a cup of warm water mixed with a half teaspoon of salt.  We do not recommend using full strength Scope or Listerine, or alcohol based oral rinses as these may be harsh on healing surgical sites.  Warm water and preferably warm salt water will be ideal.  Gravity will drain the extraction sites in the upper jaw but food debris will try to settle into the lower extraction sites so be sure to keep up with the hygiene (brushing and rinsing) after each meal.

 

Discoloration

In few cases, discoloration (bruising) of the skin may appear. This is due to blood spreading beneath the tissues and may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

 

Antibiotics

If you did not receive an antibiotic, that is OK, there was not a medical indication or clinical reason to place you on one.  If you were written for an antibiotic, take them as directed.  Antibiotics will be given to help prevent infection or support your specific medical need. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and contact our office. If you take birth control pills, you should be aware that birth control pills may become ineffective while on antibiotics and you should use alternative means of birth control.

 

Nausea and Vomiting

If nausea is a problem, drink using small sips of clear liquids or decarbonated beverages such as flat ginger ale. Sipping frequently is better than taking large, single gulps. Also, sometimes the prescription pain medication can be the cause, if so try changing to an over-the-counter pill such as Aleve or Tylenol. Dehydration is often a main cause for nausea, so be sure you are well hydrated.

 

Other Complications

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. This is most likely due to the close relationship between your lower teeth and the nerve located below the tooth roots.  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 our office if you are experiencing any altered sensations after the first week of surgery.

• Slight elevation of temperature immediately following surgery is common. If the temperature persists, notify the office. Tylenol or ibuprofen (Advil) will help reduce an elevated temperature.

• Be careful when moving from lying down or seated position to standing. Dehydration as well as pain medications can make you dizzy. You could get light headed when you stand up suddenly.

• Occasionally, patients may feel sharp spots or bumps in the mouth. Often times, they are the bony walls which supported the tooth. These areas usually will smooth out with time. If they persist and troublesome, please contact the office.

• The corners of your mouth may be stretched and may dry out and crack. Keep areas moist with an ointment such as Vaseline or any lip balm.

• Sore throats and pain when swallowing are not uncommon. This usually will subside in 2-3 days as swelling decreases.

• Limited mouth opening from stiffness (trismus) of the jaw muscles may be present for a few days following surgery. This is a normal post-operative event which will resolve in time. Remember to stretch and massage those jaw muscles as described above.

 

Finally

• Sutures may be placed in the area of surgery to support the surrounding gum tissues.   Sometimes they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will dissolve on their own usually between the 3rd and 7th post-operative day.

• The pain and swelling should subside more and more each day following the 3rd day after surgery. If your post-operative pain or swelling worsens or unusual symptoms occur after the 4th day, please call our office.

• There will be a hole where the tooth was removed. The hole will gradually fill in over the next month with new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses and a toothbrush.

• Your case is individual, different from a family member’s or friend’s.  Do not accept well intended advice from friends. Follow these instructions and contact us if you still have questions. 

• A dry socket is when the blood clot gets dislodged early from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 3-10 days following surgery. Call our office if this occurs.

 

 

 

Sinus Precautions (if you were told these were necessary for you to follow, please read)

 

Because of the close relationship between the upper teeth and the sinus, an opening between the sinus and the mouth can sometimes result from surgery. If that complication has occurred, certain precautions will assist healing and promote closure of the opening when followed. It often heals slowly. We ask that you faithfully follow these instructions (usually for 3 weeks):

1. Do not blow your nose under any circumstance for at least three weeks, even though your sinus may feel “stuffy” or there may be nasal drainage. This will re-open the holes.

2. Try not to sneeze. If you must sneeze, keep your mouth open to reduce undesired sinus pressure for three weeks. Sneezing with your mouth closed can create pressure that could reopen the hole.

3. Take prescriptions as directed.

4. Recommended over the counter medications:   Afrin nasal spray and/or Mucinex (or their generic equivalent)

 

Slight bleeding from the nose is not uncommon after surgery.

 

Please keep our office advised of any changes in your condition, especially if drainage or pain increases. It is important that you keep all future appointments with our office until this complication has resolved.  Please remember that occasionally a second procedure may be required if there is a persistent sinus communication.