Post-Operative Instructions 2016-02-29T16:58:45+00:00

What to do after Extractions/Surgery

The Day of Surgery

  • 1) There will be some degree of discomfort, and pain arises as the numbness subsides. At the first sign of pain or discomfort, take (3-4) tablets of 200mg Motrin/Ibuprofen/Advil. If you cannot take NSAIDS products, then take (2) 365mg Tylenol/Acetaminophen. Repeat every 6–8 hours as necessary. If the pain is not relieved, then you may take the prescribed pain medication, but only in small doses, and only after eating some food. All pain medications have the ability to cause severe nausea, and vomiting. It is very important that you have some food in your stomach before you take them. To repeat: take (3–4) tablets of 200mg Motrin/Ibuprofen/Advil as the numbness wears off. Do not take the prescribed narcotic pain medicine unless absolutely necessary.
  • 2) Do not disturb the area of surgery. The first stages of healing are aided by placing tissues at rest. Avoid vigorous chewing, excessive spitting, or rinsing for the first 24 hours as initial healing may be delayed, active bleeding restarted, or infection introduced.
  • 3) Expect minor bleeding or oozing from the operative site. This bleeding may continue throughout the first day. For the first hour, keep firm pressure on the area of surgery by biting on the gauze sponge placed in your mouth at the office. If bleeding persists continue constant pressure on a fresh piece of gauze sponge for an additional 30-60 minutes. It is acceptable to leave the gauze in for longer periods of time (even if soaked) if it is maintaining pressure on the surgical site. Tea has an ingredient called tannin that promotes blood clotting.
  • 4) Limit physical activity during the first 24–48 hours after surgery. Over exertion may lead to post-operative bleeding, and discomfort. When you lie down, keep your head elevated at least 45 degrees on a pillow.
  • 5) Pain following oral and facial surgery will be most severe within the first 6–8 hours after the operation. To limit the amount of pain, you should take Motrin/Ibuprofen/Advil (3–4) tablets of 200mg or (2 tabs) of 365mg Tylenol/Acetaminophen before the numbness wears off. If you have to take the prescribed medication, remember to have some food intake prior to ingesting, and to start slowly. Please do not drink alcoholic beverages while taking pain medication. Do not wait for the pain to become unbearable before using some form of pain medication, as then it will be more difficult to control. Moderate to sever pain usually does not last longer than 24–72 hours, sometimes peaking on the third post-operative day. Relief should begin on the fourth post-operative day. Persistent or increasing pain 3–5 days following oral surgery may be caused by early loss of the blood clot (dry socket) or infection. If you feel that this may be happening to you, please contact us so the surgical site may be re-evaluated.
  • 6) Swelling related to the surgical procedure usually develops during the first 12–24 hours following surgery, often peaking on the third post-operative day. It should begin to subside by the fourth day after your surgery. Swelling can be minimized a great deal by putting a ice pack on the side of your face for 30–45 minutes every hour while you are awake during the first 24 hours following the surgery, unless you receive special instructions. Anti-inflammatory medications, suchas Motrin/Ibuprofen/Advil and Steroids (if prescribed), also may help decrease swelling.
  • 7) Fluid intake and nutrition is very important. I suggest you start with clear carbonated beverages such as Ginger Ale, Seven-Up, or Sprite. Once your stomach is settled you can advance to other fluids such as water, teas, soda, broth, soups, or juices as tolerated. Please avoid hot liquids until the numbness has worn off, and the bleeding has stopped. You should try to maintain a normal fluid balance to assist in the healing process. Please contact us if you have any questions regarding your post-operative diet.
  • 8) Avoid using a straw to ingest milk shakes or thick beverages, as it may cause the blood clot to dislodge and delay healing. Try to avoid generating excessive negative pressure.
  • 9) Food selection is largely a matter of your choice. Soft, cool foods that require little or no chewing are most easily tolerated initially. A nutritious diet throughout your healing process is very important to your comfort and to assist your immune system. Since you will be taking medication it is important to remember that eating can prevent nausea sometimes associated with certain medications. If vomiting occurs please do not ingest water after you vomit. Use an acidic beverage to return your stomach to an acidic level. Water will only encourage further vomiting, ginger ale or sprite are recommended. Please contact the office if excessive nausea and vomiting continues. Once your stomach is settled, soup, broiled fish, stewed chicken, mashed potatoes, macaroni and cheese, and cooked vegetables can be added to your diet as your comfort indicates. Ensure, Carnation Instant Breakfast and yogurt supply excellent added nutrition. You are strongly encouraged to add a Multivitamin to your post-operative regimen.
  • 10) Take any special medication such as antibiotics we have prescribed on the specified dosing schedule. Yogurt with active cultures or acidophilus should be taken while on antibiotics to prevent diarrhea. It is important to take the antibiotics to completion (as directed). If you are given antibiotics and take birth control pills, you should be aware that the birth control pill may become ineffective, therefore please consider alternative contraception measures.
  • 11) Take any regularly scheduled medication (for diabetes, high blood pressure, etc.) on your regular schedule unless advised to do otherwise.
  • 12) Try to avoid smoking completely, as it tends to slow the healing process, and may also contribute to development of a dry socket, infection, or increased, and prolonged discomfort.
  • 13) Do not drive an automobile for 24 hours following your surgery if you have had general anesthesia, or if you are taking a narcotic pain medication.

Day Following Surgery and Thereafter

  • 1) On the morning of the day following surgery, rinse your mouth carefully with the solution made by adding 1/2 teaspoon of salt to a large glass of warm water. Repeat three times a day for 1 week post-operatively. Resume brushing any remaining teeth, and your oral hygiene as soon as possible.Do not avoid brushing area as this will cause more inflammation in the area. Please do not use a syringe or a water pic to aggressively rinse during the first week. This can dislodge the blood clot.
  • 2) Do not worry about the stitches. Stitches (also known as sutures) are usually placed to control bleeding, aid healing, and prevent for from collecting in the surgical site especially for lower teeth. The sutures we use dissolve in 5–7 days, typically do not require removal.
  • 3) Any swelling, soreness, or stiffness in the jaw muscles can be relieved by applying a warm moist towel to the affected side of the face several times a day. Moist heat should be used after the first 24 hours. If swelling, tenderness, or pain should increase after the first three days post-operatively, please contact the office.
  • 4) Sometimes a soft diet may be necessary for the first few days following surgery. Most patients are able to resume regular food intake within a short time.
  • 5) Bruising marks may appear on the skin of the face during the first few days after surgery. Moist heat application will help relieve this condition.
  • 6) A slight elevation in temperature or fever is normal in the first 24–48 hours.
  • 7) Sensitivity may develop in the adjacent areas to the surgical site, especially if a tooth or teeth were surgically removed. Adjacent teeth may become sensitive, this will resolve in approximately 2 weeks.
  • 8) An ear ache may develop, this is referred pain, and can be felt anywhere in the facial region after surgery. It is normal, and will resolve shortly.
  • 9) A sore throat may develop.
  • 10) If the corners of the mouth were stretched during surgery, they may become dry, and crack. Keep your lips moist during the post-operative period to prevent this.

Faithful compliance with these instructions will add to your comfort and hasten your recovery. Be sure to follow these instructions carefully. Only in this way will you avoid the complications which lead to unnecessary discomfort, and delayed recovery. Should any undue reaction or complications arise, notify the office immediately.

Special Considerations

  • Sinus Precautions: Due to the proximity of the extraction site to the sinuses the following should be observed: First, avoid nose blowing for 4–6 weeks. Second, do not create negative pressure in the mouth (i.e. No sucking on a straw). Lastly, if you need to sneeze do not suppress it (i.e. Open your mouth while sneezing).
  • IV Site Discomfort: Sometimes the IV site, which is found in the arm or hand, may have redness, bruising, or may be uncomfortable after general anesthesia. Use warm, moist compresses and elevate the site. Taking aspirin will also help with the discomfort.
  • Implant Surgery: In addition to the above instructions, you should avoid biting on the implant for at least six weeks. Also, you can brush the implant very gently, with a regular toothbrush, so as to keep it clean.

Oral Hygiene

Brush all of your teeth, except the surgical area the night of surgery. The next day brush all of your teeth, brushing gently over the surgical area. Gently rinse your mouth with warm salt water 3 times per day, especially after meals. You may have small openings in the tissue in and around the surgical site for up to six weeks. Rinsing after every meal until you do not see an opening in the tissue will help you to keep food out of the site and to keep your mouth clean. Do not use a Water Pik or water syringe to assist in removing food from the surgical area until about 5 days after surgery. All of these hygiene methods will help the surgical site to heal faster.

Sutures

Light colored sutures may become loose and dissolve within 2–7 days. Black sutures do not dissolve and must be removed.

Swelling & Brushing

Maximum swelling normally occurs within 72 hours after surgery. Use ice packs during the first 48 hours after the surgery to reduce swelling. Use warm moist towels or a heating pad to help resolve the swelling after the first 48 hours has passed. The swelling and bruising may occur and persist for 5–7 days.

  • Ice: Place an ice bag firmly to your cheek, half-hour on, half-hour off, for the first 24–48 hours.
  • Heat: On day 3 (72 hours after surgery) apply moist, warm compresses over swollen area or a heating pad low setting.

Activity

Rest following any surgery. By sitting up or elevating your head on 2–3 pillows when lying down, you will have less oozing and swelling. Avoid physical activities for 2–3 days following surgery or if the bleeding is present. Avoid driving or operating hazardous equipment the day of the surgery if a general anesthetic has been administered.

Diet

You can have liquids immediately after your surgery (i.e. juice or milk shake). Once the numbness starts to wear off you can start having soft diet such as soup, mashed potatoes, ice cream, jello, pudding… etc. Advance your diet as tolerated the next day. Avoid rough foods and popcorn for several weeks.

Nausea

Do not use your medications on an empty stomach. An adequate oral intake will help prevent nausea and dehydration. Nausea can generally be prevented by taking tea with toast, broth with crackers, 7-Up, Ginger Ale, etc. If vomiting persists the day after surgery please notify us.

Discomfort

Take Ibuprofen, Tylenol or the pain medication prescribed for you as directed before the numbness wears off (within 2–6 hours). In general, after oral surgery you should be feeling better by the third day. If you are not feeling better or pain is worsening, please notify us.

Bleeding

Some oozing of blood is expected following any surgical procedure, especially within the first 24 hours. If bleeding is present, bite firmly on a gauze pad or moistened tea bag placed directly over the surgical site for 30-60 minutes. It is acceptable to leave the gauze in for longer periods of time (even if soaked) if it is maintaining pressure on the surgical site. Repeat as necessary, with fresh gauze. Often, you will only need to replace the gauze 2–3 times in the first 24 hours and will not need to use it the day following your procedure. It is normal to have a small amount of blood present in your saliva for a few days and it is not necessary to place gauze in at this time. Avoid spitting, laying flat, physical activity, smoking, hot liquids, or sucking through a straw, all of which will increase bleeding. By doing these things you can help to avoid what is commonly known as dry socket.

Numbness

After surgery, it is normal to be numb anywhere from 4–6 hours because of the local anesthesia that is given. Numbness or tingling of the lip or tongue may sometimes persist on the operated side. This is almost always a temporary condition; one which can last for a few days due to swelling. In rare cases, numbness can last several months.

Other

The use of antibiotics may decrease the effectiveness of oral birth control pills and the uses of alternative birth control methods are recommended. Avoid smoking and alcoholic beverages for at least 72 hours. Small, sharp bone fragments may work their way to the surface of the surgical site during the healing period. Should this occur it is advisable to return back to the office for an evaluation.