Oral surgeon bowie, MD
The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and swelling as well as the risk of infection and other unwarranted outcomes can be minimized if the instructions are followed carefully.
IMMEDIATELY FOLLOWING SURGERY
- The gauze pad placed under pressure over the surgical areas should be kept in place for a 30- 60 minutes. During this time talking should be minimized. After the recommended time, the gauze pad should be removed and discarded.
- Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
- Take the prescribed pain medications preemptively, ideally you should attempt to take the first dose with some food within 1 hr of leaving the office. This allows the medication adequate time to become effective prior to the wearing off of the local anesthetic.
- Restrict your activities the day of and 24 hrs following surgery. You may resume normal activity when you feel comfortable.
- Place ice packs to the sides (outside) of your face where surgery was performed. Refer to the section on Swelling for an explanation.
A certain amount of bleeding is to be expected and anticipated following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first gently wiping any old clots from your mouth, then placing a moistened gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding persists, 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 office immediately for further instructions. Avoid the use of straws for 2 – 3 days after surgery.
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 is to be expected. The swelling will not become apparent until the day following surgery and will not reach its maximum until two to three days after surgery. However, the swelling may be minimized by the immediate use of ice packs following surgery.
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 for the first 24 hours following surgery. After 24 hours, ice has little beneficial effect at this point you may switch to using a warm compress or warm wet rag against the face to further minimize swelling. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm, it is common for swelling to last up to 5 days following surgery.
This is a normal reaction to surgery. However, please call us at 301-383-9883 if persistent swelling is associated with fever, severe pain or purulent discharge from the surgical wounds.
Take your pain medications as directed. Some prescription pain medicines can cause drowsiness and slow your reflexes. For this reason, you should not drive a car or operate heavy machinery while you are taking these medications. You should also avoid combining alcoholic beverages with these medicines.
The pain medicine given to you by the doctor can be supplemented with over-the-counter medicines. Tylenol can be taken as directed by the instructions on the bottle. Up to four 200mg tablets of ibuprofen (Motrin, Advil) can be taken at one time as needed for pain, but should be taken (6) six hours apart.
Please be aware that the prescription given to you by your doctor may already contain Tylenol or ibuprofen. Taking additional medicine could cause an overdose. If there are any questions about your medications please call our office at (301) 383-9883.
Do not take any of the above medications if you have an allergy or have been instructed by your oral surgeon or your physician not to take it. If your pain medicine does not seem to be working please call the office. Pain or discomfort from the surgery should subside gradually however pain will normally peak at 48hrs – 72hrs after surgery. If severe pain persists beyond 72 hrs, it may require attention and you should notify our office immediately.
Soft non-chew foods and liquids are recommended after most oral surgical procedures. Do not use straws for up to 3 days following surgery. The sucking forces can cause more bleeding by dislodging the blood clot or potentially lead to a dry socket. You may eat anything soft by chewing away from the surgical site(s). High calorie, high protein intake is very important for a speedy recovery. Try to maintain as close to normal a caloric intake as possible.
You should prevent dehydration by drinking fluids regularly. Your food intake will be limited for the first few days due to discomfort and lack of appetite. 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 regularly.
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 30 seconds to one minute before standing.
KEEP THE MOUTH CLEAN
No rinsing or brushing of any kind should be performed until the day following surgery. The day after surgery you should begin rinsing gently at least 3 times a day with a cup of warm water mixed with a teaspoon of salt especially after eating. You should also begin brushing gently with a soft bristle brush, taking care to avoid contact with the surgical sites.
In some cases, discoloration of the skin of the face follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal postoperative occurrence, which may occur two to three days after surgery and resolves over the next few days. Moist heat applied to the area may s peed up resolution of the discoloration.
Antibiotics are not always required following surgery but rather they are prescribed only when deemed necessary by your doctor to treat or prevent infection. If you have been placed on antibiotics, take the tablets or liquid as directed to completion. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and call the office immediately.
NAUSEA & VOMITING
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including prescribed medications. You should then sip on coke, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicines. In the rare event that nausea/vomiting persists, call our office immediately.
- 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 the office if you have any questions.
- A slight elevation of temperature immediately following surgery is not uncommon. If the elevated temperature persists longer than 48 hrs, 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 as you may feel light headed/dizzy. Before standing up, you should sit up for 30 secs to one minute.
- Occasionally, patients may feel hard or sharp projections in the mouth with their tongue. They are usually not tooth or remnants of teeth; they are the usually the bony walls that supported the extracted tooth. These projections usually smooth out spontaneously as healing occurs. If they cause severe discomfort or ulceration they can be surgically 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 as the muscles may become swollen. The normal act of swallowing can then become painful. This will usually 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 post-operative event that will resolve with time. You should perform jaw stretching exercises as well as apply heat to the face to help improve symptoms of stiffness in the jaw muscles.
- Sutures are sometimes placed in 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 from your mouth and discard it. The sutures will normally dissolve 7- 10 days after surgery unless otherwise specified by the doctor.
- 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 the office for instructions.
- There will be a cavity or hole where the tooth was removed. The cavity will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean especially after meals with salt-water rinses or medicated mouth rinse which is sometimes prescribed.
- If you are given sinus precaution instructions please adhere strictly to them.
- 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: your oral surgeon and staff.
- Brushing your teeth is okay beginning the day after surgery just be gentle at the surgical sites.
- A dry socket is when the blood clot gets dislodged prematurely from the extraction socket. A dry socket manifests as symptoms of severe, exacerbating pain at the surgical site and even pain radiating to the ear may occur usually starting three 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 or in some cases induce bleeding at the surgical sites. If you feel light headed, stop exercising.
In any case, you should avoid strenuous activities for two (2) days following surgery.
Smoking not only disturbs and delays the normal wound healing but it also increases risk of excessive post surgical bleeding as well as infection hence should be avoided for 3-4 days after surgery.