After Tooth Extraction

Home Instructions After Tooth Extraction

 

The removal of teeth is a significant procedure and post-operative care is very important. Unnecessary pain and complications 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 thirty (30) minutes
  • 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 Ibuprofen 600mg and or Tylenol 325mg (if those medications are not contraindicated for you) before the numbness wears off. This will allow the medication to work more effectively.
  • Restrict your activities the day of surgery and resume normal activity when you feel
  • Place ice packs to the side of your face where surgery was Refer to the Swelling

section for an explanation.

  • DO NOT SMOKE for at least 5 days, since it is very detrimental to healing and can contribute to the development of a “dry socket”.

Bleeding

A certain amount of bleeding is to be expected for a day or 2 following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for 30 to 60 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 to 60 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding avoid exercise. If bleeding does not subside, call our office 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 may not become apparent until the day following surgery and will not reach its maximum until 2 to 3 days after surgery. However, the swelling may be minimized by the immediate use of ice packs and keeping your head elevated above your heart.

A plastic bag filled with ice then wrapped with a towel, or an ice pack should be applied to the side(s) of the face where surgery was performed. For the first 24-48 hours, ice packs should be utilized every 20 minutes (20 minutes on, 20 minutes off) while you are awake. After 48 hours, ice has no 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. The application of moist heat to the sides of the face is beneficial in reducing the size of the swelling 48 hours following surgery. Taking two (2) to three (3) 200mg tablets of Ibuprofen every four (4) hours may also help reduce the swelling in the first 2 to 3 days.

Diet

Good nutrition is extremely important for healing. Start off with cool, soft foods after general anesthesia or IV sedation. Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. Once you are able, you may eat anything soft by chewing away from the surgical

site(s). You may want to confine the first day’s intake to bland liquids or pureed foods (soups, puddings, yogurt, milk shakes, etc.). Avoid foods like nuts, sunflower seeds, popcorn, etc, which may become lodged in the socket(s) or surgical site(s).

Pain

Unfortunately, most oral surgery is accompanied by some degree of discomfort. You will usually be prescribed with Ibuprofen 600 mg for mild to moderate discomfort (unless you have heart disease, bleeding disorder, are on a blood thinner/anticoagulation medication, or have stomach ulcers). Please take the first dose before the anesthesia wears off for better pain management. You may supplement this with two regular-strength or one extra-strength Tylenol, every four to six hours. An effective pain regimen is to alternate Ibuprofen and Tylenol every 3 hours, thereby taking Ibuprofen every 6 hours and Tylenol every 6 hours. For example, take Ibuprofen at 12:00 pm, Tylenol at 03:00pm, Ibuprofen at 06:00 pm, Tylenol at 09:00 pm, and so on and so forth.

For severe pain, you may be prescribed a narcotic pain medication. If you take this, it will make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Alternating between Ibuprofen 600mg (unless contraindicated, as above) and the narcotic pain medication will help achieve adequate relief. Do not take Tylenol if you are requiring the narcotic, which usually has Tylenol (acetaminophen) in it. A common side effect is constipation and nausea, so please stay well hydrated. Typically, the more severe discomfort is usually experienced within the first 3 days after the surgery. This will usually subside more and more each day after that, and your need for medicine should lessen as well. Sometimes, the pain increases as the swelling increases over the next 2 to 3 days. If significant pain persists for more than 5 days, it may require attention and you should call the office. Do not take any of the above medications if you are allergic, or have been instructed by your doctor not to take it.

Oral Hygiene

Mouth cleanliness is essential to good healing. No vigorous rinsing should be performed the day of surgery. You may brush your teeth the night of surgery, but rinse gently. Avoid brushing the gums in the area of surgery for one (1) week. The day after the surgery, you should begin gently rinsing after meals and additionally with an 8oz glass of warm water mixed with one-half teaspoon of salt. Continue this procedure until the gums fill in over the surgical site(s).

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 post-operative occurrence, which may occur two (2) to three (3) days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

Antibiotics may be given to help prevent or treat an infection. If you have been placed on antibiotics, take the tablets or liquid as directed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction.

Antibiotics make birth control pills ineffective. Women who take birth control pills should use another form of contraception for one complete cycle after the course of antibiotics has been used.

Nausea & Vomiting

Nausea may occur after surgery, and is sometimes caused by stronger pain medications. Nausea may be reduced by preceding each tablet with a small amount of food, then taking the tablet with a large volume of water. In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour, including the prescribed medicine. You should then sip on tea or ginger ale (after stirring out carbonation). You should sip slowly over a 15-minute period. If you are not also on Coumadin/warfarin, you may also try Alka-Seltzer or Pepto Bismol. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. If nausea persists for more than four (4) hours, call the office.

Sutures

Sutures may be placed in the area of surgery. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. In most cases, sutures will dissolve unnoticed within a week.

Activity

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

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, it is important to be especially careful when eating because you could bite your lip or tongue and not feel the sensation. Call the office if you have any questions, or if the numbness persists for more than a
  • A slight elevation of temperature immediately following surgery is not uncommon. Tylenol may be taken to reduce the fever. If a temperature of 101°F persists for longer than a day after surgery, notify the office.
  • You should be careful going from the lying-down position to Since you may not have

been able to eat or drink prior to surgery, and it may be difficult to take fluids after surgery, your body may be low on fluid. Because of this, you could get light-headed if you stand up suddenly. Taking pain medications can also make you dizzy. Before standing up, you should sit for one minute and then get up slowly.

  • Occasionally, patients may feel hard projections or sharp edges in their mouth with their tongue. They are most likely the boney walls that supported the tooth, and not roots. These projections usually smooth out spontaneously in a few weeks. If not, they can be removed in our office.
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with lip balm or Vaseline.
  • A sore throat and discomfort when swallowing are not uncommon. The muscles of the throat may become swollen, so the normal act of swallowing can become This should subside in three

(3) to four (4) days.

  • Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for several days following surgery. This is a normal post-operative event that will resolve in Eating soft foods and applying moist heat to the side of the face will also help relieve stiffness.

Finally

The discomfort and swelling should subside more and more after the third day following surgery. If your post-operative discomfort or swelling worsens or unusual symptoms occur, call the office for instructions. There will be a hole or socket where the tooth was removed. The hole or socket will gradually fill in with new tissue over the next two (2) to three (3) months. In the meantime, the area should be kept clean, especially after meals, with saltwater rinses or a toothbrush.

Occasionally, small slivers of bone may work themselves to the surface of the gums during the first week or two (2) after surgery, or even up to three (3) months afterward. They are not pieces of tooth, and they usually work themselves out. Gently massaging the gums in the area can help with this process. If the pieces do not come out on their own after a week, or if you experience significant discomfort in the area, please call during office hours for assistance. Brushing your teeth is okay – just be gentle near the surgical site(s).

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, call the office. Please try to call during office hours in order to obtain a quicker result. After hours, we can be reached by calling our main phone number (found at the top of this page) and following the prompts to be directed to your doctor. Please note that you may have to leave a message if the doctor is in surgery or temporarily unavailable, but your doctor will return your call personally as soon as possible.