After Exposure Of An Impacted Tooth 

Bleeding

 

It is normal to have some post operative bleeding for about twenty four hours after surgery.  However, after the first two to three hours, this bleeding should be mainly light “oozing”.  It is NOT NORMAL to have bleeding for 24 hours as if you have been cut.  If you’re bleeding continues at the same rate as it was directly after surgery and you have followed the instructions below YOU SHOULD CONTACT DR. CLINE.

 

1. Place the gauze directly over the surgical sites as demonstrated in the office and gently close your teeth together maintaining light, but continuous pressure on the gauze.  It is suggested you do this using a mirror or with the help of someone while numb to ensure the gauze is in the correct position AND that you do not bite yourself.


2. When the gauze over your surgical site becomes saturated (soggy) it is time to change it.  This may take only 10-15 minutes with the first piece of gauze you use.  As the bleeding slows, you will notice that it will take longer periods of time for the gauze to become saturated with blood.  After about two hours, you will find that the gauze will be saturated mainly by saliva with an area or “spot” more lightly saturated by blood.


3. Keep your head elevated above your heart with pillows while in bed, or use a reclining chair the first twenty four hours after surgery.

 

Swelling

 

To minimize swelling, apply an ice bag or a plastic bag or towel filled with ice cubes on the outside of the face at the surgery area. Apply the ice continuously as much as possible for the first 24 hours.


1. The application of cold/ice packs to the outside of your face to the area corresponding to the surgical site the first twenty four hours after surgery is the best way to reduce post operative swelling and the resulting discomfort.  Most swelling peaks about the third/fourth day after surgery.  The more cold you apply directly after surgery (the first twenty four hours) the smaller the peak of swelling will be on the third/ fourth post-operative days. 


2. Cold/ice packs should be applied in cycles of 20 minutes on the face/20 minutes off the face for the first twenty four hours after surgery.

 

Oral Hygiene

 

The morning after surgery you may resume brushing your teeth. Brush all of your teeth, but carefully avoid the surgical sites.

Beginning the day after surgery, you should begin rinsing your mouth with warm salt water (8 oz warm water + 1 tsp salt) after all oral intake.  You should continue rinsing in this fashion until your post operative evaluation.

 

Activity

 

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising.   Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you    get light headed, stop exercising.

 

 

Diet

 

A soft, cold diet is recommended the day of surgery.  Keep your diet room temperature or colder the first twenty four hours after surgery, as hot foods can increase your bleeding.  Be sure to get adequate hydration as this helps decrease the incidence of post operative nausea.


1.  DO NOT USE A STRAW for a couple of days (at least 3 days) after surgery as this can contribute to blood clot displacement and prolong your bleeding or develop a “dry socket” at any extraction sites.


2. NO nuts, seeds, chips or popcorn until after your post operative evaluation (in about seven days).

 

 

Pain

 

1. Dr. Cline recommends Ibuprofen (generic Advil) in doses of 600 mg every four hours (three “over the counter” tablets) the first three days after surgery regardless if there is pain or not.  THOSE ALLERGIC TO IBUPROFEN SHOULD NOT FOLLOW THIS PROTOCOL!

 

2. You may have been provided with a prescription strength pain reliever in the event you need more relief than the Ibuprofen provides.  Take it as directed.  As soon as you get home you should:

           a) Remove your gauze and eat something soft and cold (see dietary instructions) and then….

           b) Wait about fifteen minutes after eating and then take the first dose of your pain reliever while your mouth is still numb so it will be working in your system by the time the numbness wears off. This assists you in “staying ahead” of the pain cycle and results in the use of less post operative medication to remain comfortable.  If you wait until you feel discomfort before taking your first dose of your pain reliever, you may have to wait 30 to 45 minutes before you start to get relief.


3. If you develop a rash, hives, itching, nausea or vomiting discontinue all medication and contact the office immediately.  Most patients experience the most intense discomfort the third to fourth day after surgery.  This is mainly the result of two simultaneously occurring events:

            a) Peak prostaglandin production (which can be reduced by the use of Ibuprofen as previously described)

            b) Peak post operative swelling (which can be reduced by the use of cold/ice packs the first twenty four hours after surgery as described in the next section of these instructions)

The more you exert yourself the first two days after surgery, the more discomfort you will experience the third and fourth days after surgery.

 

Expose & Bond

 

If you have had a tooth exposed and a bracket placed on it for your orthodontist (called an expose and bond), you should see you orthodontist within the week of your surgical appointment.  A small black suture will be tied to your arch bar from the brackets chain so that it is not loose in your mouth. Should your bracket become dislodged, call the office as soon as possible as it may need to be replaced.