Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place for at least one hour after surgery. If the extraction site still appears to be oozing, place enough new gauze to obtain pressure over the surgical site for another 60 minutes. The gauze may be changed as necessary and may be dampened and/or fluffed for more comfortable positioning.
Do NOT disturb the surgical area today. Do NOT rinse vigorously or probe the area with any objects or your fingers. Do NOT brush your teeth the day of the surgery – you may begin gently brushing the next day. Do NOT smoke for at least 72 hours (three days), since it is very detrimental to healing. NO spitting or rinsing for two days. NO carbonated sodas, acidic acid (orange & grapefruit juice), or drinking through a straw for at least four days. You may drink using a cup, can, or bottle. NO straws!
Refrain from strenuous exercise for a minimum of five days to include weightlifting, running, hiking, swimming, Yoga, Pilates, etc., anything that significantly increases the heart rate and blood pressure.
Rest means minimal activity. Read a book, watch TV, play video games, etc. Avoid unnecessary conversation – the activity of speaking aggravates the muscles near the surgery site. Consider giving your cell phone a rest too! Rest with your head elevated – during the day rest in a recliner or on the couch. In bed, use an extra pillow to keep your head above your heart. This will minimize bleeding and swelling. The more active you are and the more you speak or chew, the more swelling you will have.
Intermittent bleeding or oozing is normal. Placing fresh moist gauze over the surgical areas and biting down firmly for 60 minutes may control it. Expect a slight bit of oozing at night. You may want to place a towel over your pillow before going to sleep.
Bleeding should never be severe. If it is, it usually means that the packs are being clenched between your teeth rather than exerting pressure on the surgical areas. DO NOT spit in the sink to see how much bleeding there is. Instead, inspect the gauze. If it is completely saturated with bright red blood, try repositioning with fresh gauze packs. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in moist gauze) for 20-30 minutes. If bleeding remains uncontrolled, please call our office.
Often there is some swelling associated with oral surgery. You can minimize this by using a cold pack or ice bag wrapped in a thin towel or T-shirt and applied firmly to the face or cheek adjacent to the surgical area. Small bags of frozen peas work very well as cold packs. If you get four bags, they can be rotated between the freezer and your face (two in the freezer and two on your face – one for each cheek). Cold packs should be applied for 20 minutes on and 20 minutes off during the first 48 hours (two days) after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed. After 72 hours (three days), it is usually best to switch from ice to moist heat to the same areas.
Unfortunately, most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication, and if you take the first pill (ibuprofen) before the anesthetic has worn off, you will be able to manage any discomfort better. Effects of pain medicine vary widely among individuals. Most of our patients are prescribed two types of oral pain medication – 1) ibuprofen (Motrin, Advil) and 2) a narcotic such as oxycodone (Percocet) or hydrocodone (Vicodin) mixed with acetaminophen (Tylenol). We suggest using ibuprofen as your primary pain medication, and add one tablet of oxycodone or hydrocodone as needed, preferably at bedtime. It is important to remember that you should not drive a vehicle or drink alcohol while taking a narcotic. Narcotics will make you sleepy and can increase the risk of upset stomach, especially if taken on an empty stomach. All pain medication is better tolerated with food, in this case soft food. Remember that oral pain medication will not make you numb again like the local anesthetic, it will only “turn the volume down” on the post-operative pain. The most severe discomfort is usually within the first six to twelve hours after the anesthetic wears off, after that your need for pain medication should gradually decrease.
Nausea is not an uncommon event after surgery and it is sometimes caused by stronger pain medications. Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with at least eight ounces (one cup) of water. Keep movement to a minimum. Increased activity is usually associated with increased chance of nausea. Try to keep taking clear fluids and minimize the pain medication, but call us if you do not feel better or if repeated vomiting is a problem.
EAT SOMETHING SOFT ABOUT AN HOUR AFTER YOU GET HOME WHEN YOU REMOVE YOUR GAUZE (if the bleeding is controlled). Soft food that is usually well tolerated may include: soup, Jell-O, pudding, yogurt, cottage cheese, scrambled eggs, mashed potatoes, noodles, ice cream shakes. CONTINUE TO EAT SOFT FOOD FOR THE FIRST TWO – FOUR DAYS. It is very important to increase fluid intake for a couple of days after surgery, this aids healing and makes you feel subjectively better. Avoid dehydration. After that, eat any nourishing food that can be taken with comfort. Luke warm is OK but avoid extremely hot foods or fluids. Avoid spicy food. Avoid foods like nuts, sunflower seeds, popcorn, rice, peanuts, potato chips, etc. that may get lodged in the socket areas. Over the next several days you can progress to solid foods at your own pace. It is important not to skip meals! If you eat regularly, you will feel better, gain strength, have less discomfort and heal faster. If you are diabetic, maintain your normal eating habits as much as possible and follow instructions from your physician regarding your insulin schedule.
If you feel sharp edges in the surgical area with your tongue it is probably the bony walls which originally supported the teeth. These will usually not be noticeable after the socket heals. Occasionally small slivers of bone may work themselves out during the first week or two after surgery. They are not pieces of tooth and, if necessary, we will remove them. Please call the office if you have questions.
Keeping your mouth clean after surgery is essential. You may have a prescription for Peridex or Perioguard. If so, use as directed. If not, use one teaspoon of salt dissolved in an eight (8) ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as possible, but at least three times daily for the next five days, especially after meals. Avoid using over the counter mouthwash (Listerine, Scope, etc.) for one week.
Begin your normal hygiene routine the day after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.
Normal healing after tooth extraction should be as follows. The first day of surgery is usually the most uncomfortable and there is some degree of swelling and stiffness. The second day you will usually be far more comfortable and, although still swollen, you can usually begin a more substantial soft diet. From the third day on, GRADUAL, STEADY IMPROVEMENT should mark the remainder of your post-operative course. If a DRY SOCKET occurs (loss of blood clot from socket, usually on the third to fifth day), there is a noticeable, distinct, persistent throbbing pain in the jaw, often radiating toward the ear and forward along the jaw after surgery. Don’t suffer needlessly. Call the office and report symptoms so you can be seen as soon as possible. To avoid dry sockets – no rinsing or spitting the first day, no carbonated beverages (soda, beer) for four days, and do not drink through a straw or smoke cigarettes for at least four days after surgery. All of these activities tend to dislodge the clot before it gets a chance to turn into a rubbery plug, which is necessary to help protect the healing socket and prevent food from collecting in the extraction site while it is healing. No exercise (running, weightlifting, Pilates, Yoga, cardio) for four days as this raises your blood pressure, increases the risk of new bleeding, which pushes out the old clot but does not create a new one and can lead to the development of a dry socket.
It is our desire that your recovery be as smooth and as pleasant as possible. Following these instructions will assist you in that.
Lake Norman Dentistry 704-895-3858
Dr. Daniel Miller 703-963-5570
Dr. Scott Guice 704-507-5876