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After Surgery Instructions Following Removal of Teeth

The discomfort and swelling that may follow your surgery are due to a combination of factors, including the difficulty or duration of surgery and individual patient responses. However, careful surgical technique and your compliance with these instructions will enhance your rapid and uneventful recovery.  Your surgeon can only optimize the environment in which healing must occur.  The supply of fuel for healing (nutrition) and maintenance of the area (oral hygiene) are up to the patient.

Please do not underestimate the importance of your role in a rapid recovery!

DISCOMFORT: in most cases a NSAID (like prescription Flurbiprofen or OTC Ibuprofen or Advil 400 to 600mg every 6 hours) or even Tylenol (if your doctor has advised you to avoid NSAIDs) will relieve a significant amount of your discomfort, if not all of it.  It can be helpful (but not required) to start taking the NSAID (or Tylenol) several hours before your surgery if this is possible.  Then continue to take the NSAID or Tylenol on a schedule for 5 days after the procedure. This is your BASELINE pain-preventive medication. Depending upon your specific procedure, you may also receive a prescription for a narcotic analgesic (like Darvocet or Lorcet); if so, then use thisonly if pain persists in spite of your taking the BASELINE medication.  If your BASELINE medication is Tylenol, then you should stop taking this while you are using the Prescription narcotic medication (as it contains some Tylenol).  If your BASELINE is an NSAID medicine, then continue taking and use the narcotic prescription in addition for break-through discomfort.

DRY SOCKET: You may have heard of something called a dry socket.  This is a wound-healing nuisance (not a serious complication) that occurs in a minority of patients (under 10%) and starts as an aching pain in one or both sides of the jaws (usually lower) or as an earache.  It begins 3 to 7 days after surgery but can be quickly relieved in the office by placement of a medicated dressing.  Do not hesitate to call, anytime (24/7) if your pain is not relieved by the prescribed medications.  Even if weekend or evening, your call will be returned.  Dry sockets only become significant when ignored.

SWELLING & BRUISING: This develops to a variable degree within the first 24 hours, peaks at 48 to 72 hours, rapidly resolves, and is negligible by the 7th day. You may apply an ice pack during the first 36 hours for comfort & to reduce swelling. Try and keep your head elevated for the first 48 to 72 hours.  Discoloration of the face sometimes normally occurs as a result of bleeding into the tissues (bruise or hematoma) and will resolve in 5 to 7 days.  Patients who have had removal of impacted teeth should expect at least 2 to 3 days of significant discomfort, facial swelling & stiffness when opening the mouth.

BLEEDING: Bite firmly on the gauze for at least 60 minutes after surgery, then remove the gauze and throw it away.  The gauze will be colored red-- this is normal). Expect to see persistent oozing from the sockets for the first 24 hours; it will color your saliva pink-red and is normal.  Continuing to change/replace the gauze throughout the day is not necessary but is not harmful either. No spitting or sucking through straws, as this encourages wound oozing/bleeding.  Before taking a nap, consider placing an old towel over a pillow, as dilute, bloody saliva may leak from the mouth.  Any stains may be removed with 3% Hydrogen peroxide solution. 
Directions for replacing gauze (if desired): use ice-cold water to moisten & then twice-fold 1 or 2 of the gauze from your HomeCare Bag into a square & place over the surgical site in your mouth, maintaining constant (not chewing!) pressure for 30 minutes.  If the oozing is bothersome, you may place a dry, caffeinated tea bag (NOT herbal tea) over the wound, then the gauze. Elevate your head (extra pillow) and bite firmly on the bag & gauze for one hour.  In order to be effective, your upper teeth should not be touching your lower teeth while the packs are in place.  If you notice that they are touching, either reposition the packs or replace them with a thicker pack.  In other words, ALL of your jaw pressure should be directed on the gauze!  However, if your mouth fills with large clots of blood in spite of these steps, please call the office promptly.

EATING & NUTRITION:  If you were asleep during surgery, begin with clear liquids like 7-UP to avoid nausea.  Then rapidly advance to milkshakes (use a spoon, not a straw), soups, and then solid food as tolerated.  Be careful not to chew until the numbness has worn off. Let the severity of your discomfort guide you in the selection & placement of food.  Take smaller bites & keep the food in an area remote from the wound(s) if possible.  After 3 or 4 days you should be able to chew a soft or even regular consistency diet, depending on your level of discomfort.  A normal intake of calories is important, as your body now has a higher than usual metabolic requirement in order to heal your wounds.

NAUSEA:  This uncommonly occurs as a side effect of the prescribed narcotic medications or (rarely) from the anesthetic drugs. Try not to take your pills on an empty stomach.  Antacids (Maalox, Pepto-Bismol, etc.) may help to alleviate nausea.  If vomiting occurs and is persistent, call the office.  A prescription will be called in for a suppository medication.

ACTIVITY:  Get plenty of rest & go to bed early!  Following minor surgery like removal of a non-impacted tooth, you may be able to return to normal activity immediately.  Depending upon your occupation, you may return to work within 24 to 48 hours.
However, following removal of impacted teeth, do not participate in any activity that will significantly raise your blood pressure or pulse (like vigorous exercise) for 48 hours after your surgery. Avoid contact sports for 1 to 2 weeks.

WOUND CARE: This will promote rapid healing & will reduce both odor & risk of infection.  Beginning 24 hours after surgery (not before), gently rinse your mouth with warm salt water (a pinch of table salt in a small glass of water) at least four times a day, and continue for seven days.  Resume brushing your teeth on the day after your surgery, but avoid brushing in the area of your wounds for 3 days.  If you were given a curved-tip syringe, begin to use it on the 3rd day after surgery as an aid to removing food from your wounds.

DO NOT SMOKE for at least five days after surgery. Any stitches will spontaneously dissolve within 1 to 2 weeks.

IF QUESTIONS ARISE, PLEASE DO NOT HESITATE TO CALL US AT 770-218-9135