The removal of a tooth or multiple teeth is an oral surgery procedure. Post operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.
The gauze pad placed over the oral surgery area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
Vigorous mouth rinsing or touching the wound area following oral surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
Restrict your activities the day of tooth extraction and resume normal activity when you feel comfortable.
Place ice packs to the sides of your face where oral surgery was performed. Refer to the section on Swelling for an explanation.
A certain amount of bleeding is to be expected following tooth extraction. 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 30 minutes. You may have to do this several times. Often times the gauze will act as a “wick” and be blood tinged or soaked when removed from the mouth. This “wicking” can last for 24 hrs or more. This is not unusual and does not constitute active bleeding. If you look at oral surgery site (after using the gauze for the prescribed time) and don’t see blood dripping like a slow faucet from the upper sockets or welling up to the naked eye from the lower sockets, there is usually not a problem. If bleeding continues, bite on a moistened tea bag for 30 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 our oral surgery office for further instructions.
The swelling that is normally expected is usually proportional to the tooth extraction involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to oral surgery and eventual repair. The swelling will not become apparent until the day following oral surgery and will not reach its maximum until two to four days post-operatively. The swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice, or ice packs should be applied to the sides of the face where oral surgery was performed. The ice packs should be left on continuously while you are awake. After 24 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 tooth extraction. Thirty-six hours following oral surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
For moderate pain following tooth extraction, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or ibuprofen (Motrin or Advil) two to four 200 mg tablets may be taken every three to four hours.
For severe pain, take the tablets prescribed as directed. 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 oral surgery should subside more and more every day. If pain persists, it may require attention and you should call the oral surgery office.
Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.
Drink liquids after general anesthesia or IV sedation for tooth extraction. Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the oral surgery site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. 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 five to six 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 tooth extraction, make sure you sit for one minute before standing.
Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after oral surgery. Brush your teeth as best you can. Rinse with warm salt water (one teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete.
REMEMBER: A clean wound heals better and faster.
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 oral surgery post operative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
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 oral surgery office if you have any questions.
In the event of nausea and/or vomiting following tooth extraction, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on clear liquids; water, 7-Up or ginger ale. You should sip slowly over a 15-minute period. Nausea usually passes during the first 24 hours if it occurs. 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 oral 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 Dr. Rotas if you have any questions.
A slight elevation of temperature immediately following oral 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 tooth extraction. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and 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 Dr. Rotas.
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 two to three days.
Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal oral surgery post operative event that will resolve in time.
Dissolving sutures are placed in the area of tooth extraction to minimize post operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures dissolve themselves in most cases approximately one week after oral surgery. Rarely, non-resorbable sutures are used and these will need to be removed. 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.
There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue over the next 6-8 weeks. In the meantime, 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: Dr. Rotas 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 increasing pain at the oral surgery site and even pain to the ear may occur a week following surgery when you feel you were getting better. Patients at higher risk for dry socket are females more than males, smokers and patients taking birth control medication. Call the oral surgery 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.
Nicholas Rotas, DDS
9241 Sierra College Blvd, Suite 150
Roseville, CA 95661
Dr. Nicholas Rotas is serving the communities of Roseville, Rocklin, Granite Bay, Lincoln, Folsom, Loomis, Auburn,
Antelope, Citrus Heights, Sacramento, El Dorado Hills, Cameron Park, Fair Oaks, Carmichael and Natomas
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