Post Surgical Instructions
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If you have been placed on antibiotics, take the tablets or liquid as The removal of impacted teeth is a significant surgical procedure. Post-operative care is very important. Unnecessary pain and excessive swelling can be minimized if these instructions are followed carefully.
Immediately Following Surgery:
- The gauze pad placed over the surgical area should be kept in place for a half hour to an hour. After this time, the gauze pad may 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.
- Advil or Tylenol should be taken every four (4) hours the day of surgery. Take the prescribed pain medications in addition to the Advil or Tylenol as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
Bleeding
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is common. If bleeding persists, wipe old clots from your mouth with a large wad of gauze pad, repack gauze into the cheek pouch between the teeth and cheek as well as over the socket and bite firmly for one hour. Then, remove the gauze pads. Ignore the amount of red color and wetness. Wait five minutes. Insert more gauze and proceed as previously directed ONLY if a heavy flow of blood is seen. Red tinged saliva does not require gauze. To minimize bleeding sit upright, do not become excited, do not rinse the mouth and avoid exercise and physical exertion. If bleeding does not subside, call the office for further instructions.
Swelling
The normally expected post operative swelling is usually proportional to the extent of the surgery. Swelling around the mouth, cheeks, eyes and sides of the face is common. Swelling 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 two to three (2-3) days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. The ice packs should be used continuously while you are awake; on for forty-five (45) minutes and off for fifteen (15) minutes. You may also melt ice chips in your mouth near the surgical site. After 18 hours, ice has no beneficial effect, but if it is making you more comfortable, it is fine to continue using ice packs.
Pain
For moderate pain, an anti-inflammatory (e.g. Advil, Aleve, Ibuprofen) or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours.
For severe pain, take the tablets prescribed as directed along with the over the counter medications as explained above. The prescribed pain medicine may make you groggy and will slow down your reflexes. Do not drive an automobile or work near machinery. Avoid alcoholic beverages.
Diet
Initially following general anesthesia or I.V. sedation, only cold liquids should be taken. Do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot. After the numbness has subsided, 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 five to six (5-6) glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength as well as, less discomfort and heal faster if you continue to eat.
Caution: If you suddenly sit up or stand from a lying position you can 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. The day after surgery you should begin rinsing at least five to six (5-6) times a day, especially after eating, with a cup of warm water mixed with a teaspoon of salt. Three days after surgery you should gently brush the surgical area including the sutures.
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 two to three (2-3) days post-operatively and will slowly dissipate over a two to three (2-3) week period. Moist heat applied to the area may hasten the diminution of the swelling.
Antibiotics
Take the antibiotics as directed. Antibiotics are prescribed to help treat and prevent infection. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction. Call the office if you have any questions.
Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth, including the prescribed medicine, for at least an hour. You should then sip on cola, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you may begin taking solid foods and the prescribed medicine.
Other
Sequelae
- 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. Therefore, be careful. Call the office if you have any questions.
- Slight elevation of temperature immediately following surgery is common. If the fever 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 might become lightheaded if you stand up suddenly due to your inability to take fluids prior to surgery. In addition, the prescription pain medication can make you dizzy. Therefore, you should sit for a minute prior to trying to stand.
- Occasionally, a patient may feel hard projections in the mouth with his/her tongues. These are not roots but are the bony walls which supported the tooth. 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 Chap Stick or an ointment such as Vaseline.
- Sore throats and pain when swallowing are common. Since the muscles swell, the normal act of swallowing can then become painful. This will subside in two to three (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 that will resolve in time.
Finally
- Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. The sutures will be removed by the doctor at your postoperative appointment approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is minimal or no discomfort associated with this procedure. So it’s really nothing to worry about. Sometimes the stitches become dislodged; this is no cause for alarm. Just remove the suture from your mouth and discard it.
- Swelling peaks forty-eight to seventy-two (48 – 72) hours after surgery. After the third day following surgery the swelling should start to subside more and more each day. BUT, if you were given antiswelling medication (dexamethasone), you may feel more discomfort when that medication is finished.
- There will be a cavity where the tooth was removed. Over the next month, the cavity will gradually fill in with the healing tissue. In the mean time, especially after meals, the area should be kept clean with salt water rinses and a toothbrush.
- Your case is individual; no two mouths are alike. Do not accept well-intended advice from friends. Call us if there is a problem.
- Brushing your teeth is okay - just be gentle at the surgical sites.
- If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you become light headed, stop exercising.