After Tooth Extraction
Immediately following surgery
- Bite down firmly on the gauze to slow down the bleeding and leave in place for 30 minutes. After this time the gauze should be discarded. If still bleeding fold up two more gauze and place all the way to the back of the teeth area and bite down again for another 30 mins and repeat if needed. Do not talk as this will not allow biting down on the gauze effeciently.
- As you can swallow a pill take 3 over the counter tablets of ibuprofen if not contraindicated by your physician or package insert. Patients taking blood thinners, severe asthmatics, or those allergic to NSAIDS should avoid ibuprofen. Taking ibuprofen will get some pain medicine in your blood stream prior to the narcotic pain medicine that may have been prescribed. The narcotic medication especially when taken immediately after a sedation may induce nausea and vomiting.
- The local anesthesia or numbing medicine used will begin wear off about a couple of hours or so after the procedure. Take the prescribed medicine as soon as you feel this wearing off and/or discomfort.
- If you feel you need to get something in your stomach so you will not get sick, consume something liquid until the bleeding stops. Preferably not dairy. A smoothie is a great option.
- Avoid vigorous mouth rinsing or touching the wound today as this may dislodge the clot. Gentle warm salt water rinses may be used to clean the mouth of dried blood.
- Place ice packs on the sides of your face where the surgery was performed. Refer to the section on swelling for explanation.
- Restrict your activities the day of surgery and be aware that the sedation and medications we prescribe may make you dizzy. You should have someone with you after surgery to assist you if needed.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.
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 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 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. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. If swelling subsides then increases again this then could be a sign of infection or inflammation. Please call our office for an appointment.
For mild to moderate pain, one or two tablets of over the counter Tylenol or Extra Strength Tylenol may be taken every four to six hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 4-8 hours. A maximum dose of Tylenol is 3000 mg in a 24 hour period and Ibuprofen is 3200 mg in a 24 hour period.
For moderate to severe pain, take the tablets prescribed as directed. Usually, 1/2 of a pain pill (5mg of hydrocodone or oxycondone) and 400mg of Ibuprofen will keep most pain away during the recovery. You can alternate the prescribed pain medication with Ibuprofen taking one or the other every two hours. If you have any questions regarding this regimen please call our office. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Be careful going up or down stairs. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If severe pain persists or worsens after 3 days, it may require attention and you should call the office. This may be a sign of dry socket.
After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws for the first couple of days. Drink from a glass. The sucking motion can cause more bleeding. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment should be taken regularly. 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 5-6 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.
Keep the mouth clean
No vigorous rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. For lower molar teeth, the day after surgery you should begin rinsing at least 3 times a day (after each meal) by placing the curved plastic syringe just into the socket or under the gum and flushing out the food particles as the assistant showed you after surgery. This will create turbulence and wash out any food that is trapped under the gum. Use a mixture of 8 oz of warm clean water and 1/2 teaspoon of salt. Discard this each day and keep the syringe clean and store in a clean place. If you lose it come by the office and pick up another one as soon as possible.
For all other teeth you will be fine by swishing with warm salt water starting on the first night of surgery or the day after.
Note: no matter how difficult it is to open, how uncomfortable it is, or how hard it is to see back there, you must rinse out these sockets in order to help prevent a dry socket.
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 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
Antibiotics are not routinely prescribed for teeth extractions. 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. Most of you will be given an antibiotic rinse called peridex and this should be used twice daily after brushing teeth. Take 15-30 ml and swish and spit after 1 min. Use this for one week unless directed by your doctor. Prolonged use can stain the teeth and tongue brown. This stain if present can be removed with brushing and/or your hygienist.
Nausea and Vomiting
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 can take the prescribed nausea medication if not an oral route. You should then try ice chips first, then sip on sprite with the bubbles stirred out or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.
- 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 Drs. Dupree, Neupert, & Chandler if you have any questions.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
- You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get 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 Drs. Dupree, Chandler, & Kelley.
- If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as vaseline.
- 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 2-3 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 which will resolve in time.
Sutures are placed 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 form your mouth and discard it. The sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.
The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call my office for instructions.
There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, 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: Drs. Dupree, Chandler, & Kelley or your family dentist.
Brushing your teeth is okay – just be gentle at the surgical sites.
A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. Call the office if this occurs.
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.