PLEASE READ THESE INSTRUCTIONS COMPLETELY AND CAREFULLY. Sometimes the after-effects of oral surgery are quite minimal, so not all of these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office any time for clarification.
DAY OF SURGERY
FIRST HOUR: Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not being controlled. If active bleeding persists after one hour, place enough new gauze to obtain pressure over the surgical site for another 30-60 minutes. The gauze may be changed as necessary and may be dampened and/or folded for more comfortable positioning.
EXERCISE CARE: Do not disturb the surgical area today. Do NOT rinse vigorously or probe the area with any objects or your fingers. You may brush your teeth gently. DO NOT SMOKE for at least 48 hours, since it is very detrimental to healing.
OOZING: Intermittent bleeding or oozing is normal. It may be controlled by placing fresh gauze over the surgical areas and biting down firmly for 30-60 minutes.
STEADY BLEEDING: 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. Try repositioning fresh 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 or 30 minutes. If bleeding remains uncontrolled, please call our office.
SWELLING: Often there is some swelling associated with oral surgery. You can minimize this by using a cold pack or ice bag wrapped in a towel and applied firmly to face or cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 12 to 24 hours after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed. After 24 hours, it is usually best to switch from ice to moist heat to the same areas.
PAIN: Unfortunately most oral surgery is accompanied by some degree of discomfort. You may have a prescription for pain medication, and if you take the first pill before the anesthetic has worn off, you will be able to manage any discomfort better. Effects of pain medicines vary widely among individuals. Remember that the most severe discomfort is usually within the first six hours after the anesthetic wears off; after that your need for medicine should lessen.
NAUSEA: Nausea is not an uncommon event after surgery, and it is sometimes caused by stronger pain medicines. Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with a large volume of water. 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.
DIET: Eat any nourishing food that can be taken with comfort. Temperature of the food doesn’t matter, but avoid extremely hot foods. It is sometimes advisable, but not required, to restrict the first day’s intake to bland liquids or pureed foods (creamed soups, puddings, yogurt, milk shakes, etc.). Avoid foods like nuts, sunflower seeds, popcorn, 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 take nourishment 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 us or your physician regarding your insulin schedule.
SHARP EDGES: If you feel sharp edges in the surgical areas with your tongue it is probably the bony walls which originally supported the teeth. Occasionally small slivers of bone may work themselves out during the first week or two after the surgery. They are not pieces of tooth and, if necessary, we will remove them.
Please call our office if you are concerned.
INSTRUCTIONS FOR SECOND AND THIRD DAYS
MOUTH RINSES: Keeping your mouth clean after surgery is essential. Use ¼ tsp. of salt dissolved in an 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 you like, but at least two or three times daily for the next five days.
BRUSHING: Begin your normal oral hygiene routine as soon as possible 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.
HOT APPLICATIONS: Apply warm compresses to the skin overlying areas of swelling (hot water bottle, moist hot towels, heating pad) for 20 minutes on and 20 minutes off to help soothe those tender areas. This will also help decrease swelling and stiffness.
SYRINGE: If you were given an irrigating syringe at your first office visit, start using it the third day after surgery to keep sockets clean. Fill it with warm water and irrigate any open sockets gently, especially after eating.
ONE WEEK POST-OP
PAIN: Most significant pain should be resolved, although local discomfort may persist for 2-3 weeks. Pain which increases or fails to resolve may be due to dry socket, infection, or other problems.
SWELLING: Swelling should resolve 7-10 days after surgery. Facial bruising may persist for up to 10-14 days. Local heat, a heating pad set on “low”, or hot water bottle will help things return to normal more quickly. Swelling which appears or increases after the first 3-4 days may indicate infection.
JAW STIFFNESS: This is normal and should be expected following surgery. You must make a conscious effort several times a day to stretch your jaws open wide. Chewing gum offers good exercise for the jaw muscles. Local heat and ibuprofen can help the associated discomfort and inflammation.
ORAL HYGIENE: By a week after surgery, you should be back to brushing your teeth as normal, hopefully several times per day. Thorough rinsing with tap water or salt water helps maintain cleanliness at the surgical sites. There is no need for excessive use of mouthwashes; in fact it may be harmful. Extra attention at the extraction sites may be necessary for up to 3-4 weeks after teeth are removed until tissue healing has filled the defect.
DIET: Approximately 1 week after surgery your diet should be returning to normal. You may require an additional week to be able to consume hot, spicy, or tough types of foods without difficulty.
ACTIVITY: By approximately 1 week after surgery, most routine activities may be resumed. It is usually advisable to avoid swimming or diving for 10-14 days. Routine dental work is best postponed for 2-3 weeks.
MEDICATION: Any antibiotics (penicillin, erythromycin, etc.) should be taken until gone. Pain medication should only be taken as prescribed to relieve discomfort. Remember, narcotic-based pain relievers can cause drowsiness and decreased coordination. You should refrain from using alcohol or other sedative-type drugs while using them, if prescribed.
BITE: It is not uncommon for the bite to feel “different”, or that the lower teeth have “shifted” following third molar surgery. This is usually due to stiffness in the muscles resulting in a slight repositioning of the lower jaw or release of pressure on the adjacent molar teeth and thus a change in the way the teeth meet. This situation generally returns to normal in 1-2 weeks.
NORMAL POST-OP COURSE: 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 diet. From the third day on GRADUAL STEADY
IMPROVEMENT should mark the remainder of your postoperative course. If you do not see steady improvement during the first few days after surgery, don’t suffer needlessly. Some indicators that you may have post-operative problems which should be looked at are: persistent pain, swelling after the first 3-4 days, persistent jaw stiffness, and repeated bleeding or discharge from the surgical site. Call the office and report symptoms so you can be seen as soon as possible. You should return to the regular care of your general dentist for further care or routine visits as he/she directs.