Surgical Instructions

• Before Anesthesia
• Dental Implants
• Wisdom Teeth
• Exposure of Impacted Tooth
• Extractions
• Multiple Extractions

After the Removal of Multiple Teeth

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Persistent bleeding may be controlled by gentle rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for 45 minutes. Remember, it is the pressure over the surgical site, not the absorbency of the gauze that results in clot formation! Change the gauze packs every 45 minutes four or five times over three to four hours. If bleeding continues, make sure that the gauze packs are positioned directly over the extraction sites, and the patient is biting on the gauze with good firm pressure.

Elevating the head with 2-3 pillows or sitting up in a recliner will also help stop the bleeding by decreasing the blood pressure in the mouth.

If bleeding persists, bite on a moistened tea bag over the extraction site 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.

Pain

For severe pain, take the pain medication as prescribed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, or increases after 36 hours, it may require attention and you should call the office.

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four hours or Ibuprofen, (Motrin or Advil) two to three 200 mg tablets may be taken every six hours.

Some patients find that Ibuprofen works well in conjunction with their prescribed narcotic pain medication. If the narcotics are not effective, try three Ibuprofen tablets along with the narcotics for additional relief.

Nausea and Vomiting

Nausea can be caused by the anesthesia, the blood in your mouth and stomach from the surgery, or the prescribed pain medication. In the event of nausea and/or vomiting following surgery, stop taking anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods. Before trying the prescribed medicine, try taking Ibuprofen or Tylenol for pain. There is less chance of nausea with these medications, and you may find that they are completely effective at managing your discomfort.

If nausea and vomiting continue, please call the office for 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 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.

It is normal to have generalized swelling for the better part of the week following wisdom teeth extractions. Should you have an increase in swelling after 36 hours please give us a call for instructions?

Bruising and 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 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration

Diet

Initially, after general anesthetic or I.V. sedation, liquids should be taken. Do not use straws. Drink from a glass. The sucking action can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. 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.

Keep the mouth clean

No vigorous rinsing should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.

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.

Dry Sockets

A dry socket is a condition that occurs when the blood clot gets dislodged prematurely from the extraction socket. It results in increased symptoms of pain at the surgical site radiating into the ear. It typically occurs 2-3 days following surgery. They are not dangerous but can be very painful requiring attention. If you experience increased symptoms like these, call the office as soon as you can if these symptoms occur as it can be treated more easily if caught early.

Infection

Infection following wisdom teeth extraction is rare, but can occur. Typically this will occur two to 2-3days following surgery. Signs and symptoms include increased swelling after two days, or failure of the swelling to subside after four days, and increased pain. Infection is typically managed by antibiotics, but can require drainage. Should you experience these, 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. If the numbness continues after 72 hours, please call the office for instructions.
• Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists after 48 hours, notify the office. Meanwhile, 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 either the bony walls, which supported the tooth or the stitches. These projections usually smooth out spontaneously. If not, they can be removed by the doctor.
  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 over one week.

Finally

Dissolvable sutures are typically placed the area of surgery to minimize post-operative bleeding and to help healing. Eventually, they become dislodged, this is no cause for alarm; just remove the suture form your mouth and discard it. In spite of the use of stitches, there will be a hole from where the tooth was removed. The hole will gradually heal over the next month and 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.

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.