The removal of impacted teeth is a serious surgical 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.
A certain amount of bleeding is to be expected following surgery. 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 thirty minutes. Repeat if necessary. Sometimes, biting on the gauze does not apply pressure in the correct area, so it may be helpful to hold the gauze in position with finger pressure. If bleeding continues, place a moistened tea bag over the surgical area and bite firmly for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, sit upright, avoid exercise and do not become excited. If bleeding does not subside, call for further instructions. Do not be surprised or concerned with occasional intermittent mild bleeding over the next few 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 eventual repair. The swelling will usually not become apparent until the day following surgery and will usually not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the use of ice packs. Plastic baggies filled with ice, bags of frozen peas or refrigerated cold 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. It is also appropriate to use one ice pack and alternate its use from one side to the other every 15 to 20 minutes. Most of the benefit from cold therapy in controlling swelling comes from its use on the day of surgery. Cold packs after the day of surgery may be used if it gives comfort to the patient, but otherwise, there is no significant benefit. Heat may be applied to areas of swelling after 36 to 48 hours to help reduce it. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery, is not unusual, and should not be worrisome. If it is accompanied by fever, foul taste, significant increase in discomfort, or increased difficulty opening the office should be contacted.
Pain medications are more effective if they are taken prior to the pain becoming severe. We suggest that you take the pain medications prior to the local anesthesia (numbness) wearing off, if possible. Please take medications as directed by your surgeon. You may be prescribed different medications to help with pain. For those able to safely use them, drugs such as ibuprofen (Motrin, Advil) and naproxen (Aleve) help in the prevention of pain and swelling by working in the tissues at the site of surgery. Drugs such as these should be started when the patient is able to take and tolerate fluids or food. It is helpful to continue these on a scheduled basis, regardless of how the patient feels, in order to continue to reduce pain and swelling. Narcotics such as codeine (Tylenol #3), hydrocodone (Lorcet, Lortab & Vicodin), and oxycodone (Tylox and Percocet) help with pain control in a different manner by working in the brain. As such, they have different side effects, most notably drowsiness and sometimes nausea. These narcotic drugs should not be taken on an empty stomach. If needed, it is okay to take the narcotics even if the patient has taken ibuprofen or naproxen.
After the local anesthesia wears off, you should consider the following guidelines:
After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding and dislodge the blood clot. You may eat anything soft by chewing away form 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 may be limited for the first few days so you should compensate for this by increasing your fluid intake At least 5-6 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 experience dizziness when you sit up or stand from a lying position, this may represent some degree of dehydration or the combination of factors including side effects from medications. First, when rising, do so slowly and sit upright for a short while before standing. As corrective action, be sure to drink ample fluids and always be careful about activities when taking narcotic pain medications.
Vigorous oral rinsing should not 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 with warm salt water (approximately 1/2 teaspoon in a cup of water) at least 5-6 times a day, especially after eating. You should continue rinsing until you can brush your teeth normally again.
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 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
Antibiotics are not required for most routine surgery of the mouth. If you have been placed on antibiotics, take the tablets or liquid as directed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.
The most common causes of nausea and/or vomiting after oral surgery are blood that may have been swallowed or pain medications. When swallowed blood is the cause, it is helpful to take fluids in very small amounts at a time. Many times it helps to begin with ice chips or small sips of cola, ginger ale or tea. Narcotic medications should be avoided until the nausea has resolved. If pain medications are needed, acetaminophen (Tylenol) is the best tolerated and least likely to contribute to stomach upset. When nausea persists, you may call the office for further instructions or, possibly, medications that may help. Diet and medications may be resumed when the nausea subsides. Reminder: Narcotic pain medications should not be taken on an empty stomach and some patients may not tolerate them at all.
Sutures are 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 form your mouth and discard it. If the sutures are not “dissolving” sutures, they will usually be removed one to two weeks after surgery. 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.
The pain and swelling gradually subside following surgery. Keep in mind that swelling often takes 2 to 3 days to reach its maximum, If your post-operative pain or swelling worsens after about three days or unusual symptoms occur, plesase call the office for instructions.
There is often a hole or depression where teeth are removed. Over the next month this will gradually fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with saltwater rinses, an irrigation syringe or a toothbrush.
Your case is individual, no two mouths are alike. Be careful about accepting well-intended advice from friends. Discuss your problem with the persons who know your individual situation and are best able to help you, your surgeon or family dentist.
Brushing your teeth is okay - just be gentle at the surgical sites.
A dry socket is when the blood clot, which is supposed to fill the socket, either does not form well or gets dislodged from the tooth socket. Symptoms of increased pain at the surgical site and often pain to the ear may occur 3 to 4 days following surgery. The condition itself is not serious. It is mostly a matter of pain and in most cases, localized treatment is more effective than pain medications alone. 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. If you get light headed, stop exercising. In addition, your blood pressue increases with vigerous exercise or straining. Such exercise too soon after surgery may result in throbbing discomfort, increased bleeding, and increased swelling.