Postoperative Instructions After Routine Dental Extractions

Immediately Following Surgery

The gauze pad placed over the surgical area should be kept in place for 20 - 30 minutes. After this time, the gauze pad should be removed and discarded.  It is not necessary to replace the gauze unless there is active bleeding.

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.

Over-the-counter pain medications are usually all that is necessary after routine surgical extractions.  If Dr. Digney has written a prescription, you may want to wait to see if the over-the-counter medications provide sufficient pain control.  If you feel that you need the prescription pain medications are still needed, you can then get the prescription filled at that point. You can the take the prescribed pain medications as soon as you get home, after you have had something to eat.

Restrict your activities the day of surgery and resume normal activity when you are off the prescription pain medication.

Place ice packs to the sides of your face where surgery was performed.

Bleeding

Some bleeding is to be expected following removal of teeth, but this is usually minimal. Even after biting on the gauze pads, it is  normal to have slight bleeding and oozing for the next 12-24 hours. Excessive bleeding is  characterized by mouthfuls of bright red blood, or large rubbery clots. If this occurs, please try  the following:

• Rinse the mouth (gently, not forcefully) with cool water.
• Wipe away any clots outside the socket with a clean gauze pad.
• Bite firmly on a moistened gauze pad placed directly over the extraction site for 30 minutes. If no gauze is available, you may substitute a moistened tea bag.
• Repeat all of the above as necessary.

It is important to avoid the use of any products that contain hydrogen peroxide, as these products may dissolve the blood clots at the site, and promote dry socket.  Strenuous exercise, jogging, or sporting activities that may cause an increase in the blood pressure should be avoided for the first 48 hours.

Some bleeding when brushing the teeth may occur for the first week following the surgery.  This is normal, and should not be a reason to avoid brushing in this area.

 If bleeding does not subside, call for further instructions.

Swelling

Some degree of swelling is normal after tooth removal, especially with the extraction of lower teeth.  This is the body’s normal inflammatory reaction to any injury.  When you get home, place ice packs on the face in the area adjacent to the surgical site. 

If swelling or jaw stiffness has persisted for several days after the surgery, there is no cause for alarm.  This is a normal reaction to surgery.

Pain

As with any surgical procedure, there will always be some postoperative pain and discomfort. We normally recommend that as soon as the patient returns home from their surgery, they take the pain medication, even though they are still “numb” and not experiencing any pain. This way, the pain medication can begin to take effect as the numbness wears off, making the transition easier than if you were to wait for the pain, and then try to take the pain medication.  With any pain medication, it is important that you have something soft and bland to eat before you take your pain medication. This is important, because most of our prescription pain medications (and even some of the over-the-counter pain medications) can be very irritating to the stomach. The presence of food in the stomach can help counteract this, and will usually help patients tolerate the pain medication more easily. We recommend semisolid foods, as just liquids alone may be insufficient to counteract the irritating effects of the pain medications. 

It is also important to remember that one should not drive cars or do anything that requires coordination or balance while taking the prescription pain medication

For minimal or moderate pain, Tylenol or Ibuprofen (Motrin or Advil) may be effective.   With the Ibuprofen, the maximum dose is 2400 mg per day, which can be taken as two 200 mg tablets every 4 hours, or three 200 mg tablets (600mg) every 6 hours, or four 200 mg tablets (800mg) every 8 hours.

Diet

We recommend that you maintain a relatively soft and bland diet for the first few days after surgery.  In general, most normal foods are O.K. after the first few days, but it would be best to avoid anything with seeds or particles, such as poppy seeds or sesame seeds.  You should avoid popcorn for at least a month after the surgery.  Contrary to popular belief, it is O.K. to use straws to drink liquids after surgery. The rationale was that the "suction" created when using the straw would "pull out the blood clots" and cause dry socket, or at least stir up bleeding.  There is so little suction created by using a straw, that it is not likely that this will cause any problems at the extraction sites, or stimulate any significant bleeding.  We actually prefer our patients to drink through a straw, as this allows the liquid to pass right by the surgical sites, without the liquid washing across the surgical sites that have just been operated on.  It would be best to avoid very hot foods, as they can dilate the blood vessels in the area and create more bleeding, and may cause the stitches to dissolve prematurely.

Hygiene

Do not forcefully rinse for the first several days.  You can brush your teeth the night of surgery but, use a very soft bristle brush, and rinse gently.  Expect to see a small amount of blood in the sink when brushing your teeth.  This is very normal, and does not mean that you should stop brushing.   Do not floss between the last two teeth near the surgical sites in all the extraction sites for at least 2 weeks. Remember to avoid any products that contain Peroxide, as this can very effectively dissolve blood clots, and contribute to dry socket formation. Check your toothpaste tube to see if there is any Peroxide present.  The popular whitening toothpastes often contain Peroxide, so be sure to check the list of ingredients.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, or yellow discoloration is due to a small amount of bleeding in the tissues just beneath the skin. This is a normal post-operative occurrence, and it may not be noticed until 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Infection

Infection is uncommon in routine tooth removal surgery, but on some occasions may still occur.  It is usually characterized by swelling that increases rather than decreases after the first several days.  If swelling is noted to increase after the first several days, contact the office. 

Nausea and Vomiting

Nausea is our most common postoperative problem that can occur after surgery.  It is most often due to the pain medications that are taken after the surgery.  Swallowing a small amount of blood after surgery is normal, and this can sometimes cause nausea as well. Usually, the intake of food will help settle the stomach, but sometimes, despite having eaten, the patient may still experience nausea.  In the event of nausea and/or vomiting following surgery, you can take medications such as Maalox or Pepto Bismol, which may help settle the stomach down.  Ginger Ale may also help in alleviating stomach irritation. When the nausea subsides you can resume taking solid foods and the prescribed pain medicine as necessary.

Other Complications

If numbness of the lip, chin, or tongue persists after the first postoperative day, please let us know. On the rare occasions when this does occur, it is usually temporary in nature.

Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, or becomes higher than 101.5 degrees, notify the office. Tylenol or Ibuprofen should be taken to reduce the fever.

You should be careful when going from the lying down position to standing.  The pain medications can sometimes make you dizzy.  It may be possible that you could get light headed or faint when you stand up suddenly. Before standing up, you should sit upright for one minute before attempting to 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. They will sometimes become exposed over time, and as they usually occur in the back part of the lower jaw, they can feel sharp to the tongue. If these sharp areas persist, contact the office, as they can sometimes be removed.

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.

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 which will resolve in time.

Sutures

There will be sutures in the surgical sites.  The sutures will come out by themselves over time.  These stitches usually come out after 4 - 5 days, but it is not uncommon to lose a stitch after the first couple of days. Often, a suture will dissolve to the point where it becomes untied, and you may feel a "string"  in the mouth.  If you are able to see this loose suture, you may reach in and gently remove it.  It you run into a "snag", it is acceptable to carefully cut it short with a nail scissors.  The remaining portion will dissolve and come out by itself.