Sometimes the after-effects of oral surgery are quite minimal, so not all of the instructions may apply. Common sense will often dictate what you should do. However, if you have a question, follow these guidelines or call our office for clarification. If Dr. Raju has recommended other instructions or medications, disregard the instructions here and follow the directions he stated at your appointment.
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 controlled. The packs may be gently removed after one hour. If active bleeding persists, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 30 to 45 minutes). It is best to moisten the gauze with tap water so the newly formed blood clot does not stick to the gauze.
EXERCISE CARE: Do not disturb the surgical area today. Do NOT rinse vigorously or probe the area with any objects. You may brush your teeth gently. PLEASE DO NOT SMOKE for at least one week, since this is very detrimental to healing and may cause a dry socket.
OOZING: Intermittent bleeding or oozing overnight is normal. Bleeding may be controlled by placing fresh gauze over the areas and biting on the gauze for 30-45 minutes at a time.
PERSISTENT BLEEDING: Bleeding should never be severe. If so, it usually means that the packs are being clenched between teeth only and are not exerting pressure on the surgical areas. Try repositioning the packs. If bleeding persists or becomes heavy, you may substitute a tea bag (soaked in very hot water, squeezed damp-dry and wrapped in a moist gauze) for 20 or 30 minutes. If bleeding remains uncontrolled, please call our office. However, spotting and mild oozing often occurs during the first week after surgery.
SWELLING: Swelling is often associated with oral surgery. It can be minimized by using a cold pack, ice bag or a bag of frozen vegetables (such as peas) wrapped in a towel and applied firmly to the cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 48 hours after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed. Swelling peaks on day 2-3 before getting better. After 48 hours, a warm compress should be used for swelling management. Some degree of swelling is usually present for 10 days.
PAIN: Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first pill before the anesthetic has worn off, you should be able to manage any discomfort better. Some patients find that stronger pain medicine causes nausea, but if you precede each pain pill with a small amount of food, it will reduce the chance that nausea will occur. The effects of pain medications vary widely among individuals. If you find you are taking large amounts of pain medicine at frequent intervals, please call our office. If you are prescribed a narcotic pain medication, you may not drive, operate heavy machinery, or participate in other activities that will require good judgment.
TIERED PAIN MANAGEMENT PLAN: Patients will use up to three different medicines for pain. These medications are managed by different enzymes and organs of the body and can safely be taken at the same time at the prescribed intervals. The most commonly used medications and intervals are:
- ibuprofen (Advil, Motrin, OTC) 200mg — 2-3 tablets every 6 hours as needed for pain (often ibuprofen 600mg will be prescribed, only take 1 tablet in this case)
- acetaminophen (Tylenol Extra Strength, OTC) 500mg — 1 tablets every 6 hours as needed for pain
- tramadol 50mg OR acetaminophen 300mg/codeine 30mg — 1 tablet every 6 hours as needed for pain
It is recommended to take ibuprofen and acetaminophen on a regular schedule whether pain is present or not for three days as this allows you to stay ahead of the pain as well as helps with inflammation. Neither of these medications have significant side effects when used short term. Do not combine ibuprofen with other NSAIDs (naproxen, aspirin, etc.). Your daily intake of acetaminophen should not exceed 3000-4000mg from all medications in a 24 hour period.
For severe pain, add an opioid. Side effects of opioids are nausea, vomiting, dizziness, sleepiness, constipation, respiratory depression, tolerance, and depression. When combined, the three medications work synergistically. Some patients may receive different medications than those described depending on their medical condition(s).
NAUSEA: Nausea is common after sedation. Sometimes pain medications are the cause. Nausea can be reduced by preceding each pain pill with a small amount of soft food, and taking the pill with a large volume of water. Try to keep taking clear fluids and minimize dosing of pain medications, but call us if you do not feel better. Classic Coca Cola may help with nausea. Contact the office or doctor if you have persistent nausea.
DIET: Eat any nourishing food that can be eaten with comfort. Avoid extremely hot foods. Do not use a straw for the first week after surgery. It is sometimes advisable, but not absolutely required, to confine the first day’s intake to liquids or pureed foods (soups, puddings, yogurt, milk shakes, scrambled eggs, mashed potatoes, refried beans, etc.). It is best to avoid foods like nuts, sunflower seeds, popcorn, etc., which may get lodged in the socket areas. Over the next several days you may gradually progress to solid foods. 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 a diabetic, maintain your normal eating habits or follow instructions given by your doctor.
SHARP EDGES: If you feel something hard or sharp edges in the surgical areas, it is likely you are feeling the bony walls which once supported the extracted teeth. Occasionally, small slivers of bone may work themselves out during the following week or so. If they cause concern or discomfort, please call the office.
INSTRUCTIONS FOR THE SECOND AND THIRD DAYS
MOUTH RINSES: Keeping your mouth clean after surgery is essential. Use ¼ teaspoon of salt dissolved in an 8 ounce glass of warm water to make a saline solution 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. If you are given a plastic irrigating syringe, DO NOT use it for the first three days. After three days, gently irrigate the extraction socket(s) with the saline solution until you are certain the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket. Extraction sockets can take weeks or months to completely close.
BRUSHING: Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth within the bounds of comfort.
HOT APPLICATIONS: You may apply warm compresses to the skin over the areas of swelling (hot water bottle, hot moist towels, heating pad) for 20 minutes on and 20 minutes off to help soothe tender areas. This will also help decrease swelling and stiffness.
HEALING: Normal healing after tooth extraction should be as follows: The first three days after surgery are generally the most uncomfortable and there is usually increasing swelling. On the fourth day you should be more comfortable and, although still swollen, can usually begin a more substantial diet. The remainder of the post-operative course should be gradual, steady improvement. If you don’t see continued improvement, please call our office.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office where you had surgery or the doctor directly. Calling during office hours will afford a faster response to your questions or concerns.
If you have any questions or concerns, please contact our office.