After Tooth Extraction

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 a half hour. 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 initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take the prescribed pain medications as soon as you get home before the local anesthetic wears off.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.

 

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon (for up to 24 hours after surgery). Excessive bleeding may be controlled by placing a gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, sit upright, and avoid exercise. If bleeding does not subside after 24 hours, call for further instructions.

 

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. 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 three to four days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Ice packs should be applied to the sides of the face where surgery was performed in cycles of 20minutes on, followed by 20 minutes off. The ice packs should be used as much as possible for the first 24 hours after surgery. After 24 hours, ice has little beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. 24 hours following surgery, apply heat to the sides of the face to relive any muscle stiffness.

 

Diet

It is important to replenish fluids directly after surgery. Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least five to six glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.

 

CAUTION: If you suddenly sit up or stand from a lying position, you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing

 

 

Pain

 

Dr. Cline highly recommends Ibuprofen (generic Advil) in doses of 600 mg every six hours (three “over the counter” tablets) the first three days after surgery regardless if there is pain or not.  Ibuprofen suppresses the production of prostaglandins (a natural substance your body releases after tissue injury that increases swelling and painful nerve transmission).  

         
THOSE ALLERGIC TO IBUPROFEN SHOULD NOT FOLLOW THIS PROTOCOL!

 

1) 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.  Ideally, you should pick this medication up before the day of your surgery so it is available for you to take as soon as you return home after surgery while your mouth is still numb.  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.

 

2) 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)

 

Keep the Mouth Clean

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the morning after surgery. The day after surgery you should begin rinsing after every meal or snack with a cup of warm water mixed with a teaspoon of salt.

 

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

 

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions

 

Nausea & Vomiting

A small amount of carbonated beverage every 5 to 6 hours can reduce the occurrence of post operative nausea.  Some patients just have very sensitive systems and experience nausea or vomiting with almost any kind of pain reliever (Dr. Cline has this problem).  Please inform us in advance if you know this to be your case.  There are several new medications that are very effective at preventing nausea and terminating vomiting.  Dr. Cline would be happy to provide you with a post operative prescription.

 

1.) Please avoid foods high in acid (i.e. orange juice, grapefruit juice, cranberry juice, lemon juice, etc.) as they contribute to nausea (apple and white grape are good examples of fruit juices with lower citric acid content).

2.)Dehydration is another source of post operative nausea.  Even if you don’t feel hungry or thirsty, please be sure to drink the equivalent of half a cup (4 oz.) of fluid an hour.  The pre-operative fasting state of many patients, in combination with reduced post operative oral intake can increase the risk of dehydration, especially for small children, petite patients and the elderly.

 
The tendency for nausea or vomiting after surgery is variable for everyone.  If you experience nausea 36 hours or later after your surgery the most common cause is the post operative medication (pain relievers are the number one causes, followed by antibiotics).  If you have late onset post operative nausea and/or vomiting:

 

 ·         Rinse your mouth and use gauze to stop any residual bleeding you may experience

·        
Sip a small amount of  soda (non-diet) very slowly over a 15 minute period

o   When nausea subsides you may resume eating solid foods

·         If your nausea and/or vomiting is persistent please call the office for instructions


Other Complications:

 

 

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. 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 Dr. Cline-Fortunato if you have any questions.
  • A slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. 350mg of Tylenol taken every 4 hours can be used to “break” the fever.
  • You should be careful going from the lying down position to standing. Taking pain medications can make you dizzy. You could get light headed when you suddenly stand up.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls, which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Cline-Fortunato.
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with a non-petroleum based lip moisturizer.
  • Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in two to three days.
  • Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event that will resolve in time.

 

Finally

 

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged.  This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will be removed approximately one week after surgery if they are still present.

 

If your post-operative pain or swelling worsens or unusual symptoms occur, call the office for instructions.

 

There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean especially after meals with salt-water rinses or a toothbrush.

 

Your case is individual.  No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Cline-Fortunato or your family dentist.

 

Brushing your teeth is okay – just be gentle at the surgical sites.

 

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.