Oral Surgery Post Op Instructions

***PLEASE READ ALL OF THESE INSTRUCTIONS CAREFULLY*** Sometimes the after-effects of oral surgery are quite minimal, so not all of the instructions may apply.  for clarification Our number is (931) 525-6059.

FIRST HOUR: Bite down gently but firmly on the gauze packs that have been placed over the surgical areas.  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 and loosely fluff for more comfortable positioning.

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 48 hours, 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 with firm pressure for 30-45 minutes at a time.

PERSISTENT BLEEDING:  Bleeding should not 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.

SWELLING:  Swelling is often associated with oral surgery.  It can be minimized by using a cold pack, ice bag or a bag of frozen 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 24-72 hours after surgery.  If you have been prescribed medicine for the control of swelling, take it as directed. 

PAIN:  Most post-operative pain can be managed by taking NSAIDS (Ibuprofen/Advil) and/or Tylenol.  It is recommended and you will usually be given a prescription to take Ibuprofen (either 600mg or 800mg 3-4 over the counter tablets) 3 times a day for 5 days and then as necessary unless medically contraindicated. If you are unable to take NSAIDS, an alternative is to take 500mg of Acetaminophen 4 times a day.  If you wish to take these together alternating every 4 hours, unless medically contraindicated it is usually recommend for the best non-narcotic pain relief.  If you take the first pill before the anesthetic has worn off, you should be able to manage any discomfort better. You will usually have a prescription for a narcotic type pain medication which can’t be called into the pharmacy as necessary. It usually has Acetaminophen (Tylenol) in it so if you chose to use it be careful not to take extra Acetaminophen (Tylenol) in this situation.  It is recommended that stronger narcotic type pain medicine be used only after this approach and on an as necessary basis due to abuse potential, and possible side effects.  Some patients find that stronger pain medicine causes nausea, but if you precede each pain pill with a small amount of food, chances for nausea will be reduced.  The effects of pain medications vary widely among individuals.  Remember that the most severe pain is usually within six hours after the local anesthetic wears off; after that your need for medicine should lessen.  If you find you are taking large amounts of pain medicine at frequent intervals, please call our office.  PLEASE NOTE:  It is now not legal to phone in Narcotic (pain killer) refills.  An office visit and Rx is required.

NAUSEA:  Nausea is not uncommon after surgery.  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.  FLAT Classic Coca Cola may help with nausea.

DIET:  Eat any nourishing food that can be taken with comfort.  Avoid extremely hot foods.  Do not use a straw for the first few days 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, etc.)  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 weeks. 

MOUTH RINSES:  Keeping your mouth clean after surgery is essential.   If you wish to use a mouth rinse, salt water rinses consisting of 1/4 teaspoon of salt dissolved in an 8 ounce glass of warm water two to three times a day is recommended.  Alternatively 1/3 water, hydrogen peroxide, and mouthwash can be substituted.  A prescription antibiotic rinse may also be recommended.

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:  After 72 hours, 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 day is usually easier than then second or the third, and it is not uncommon for the fourth or fifth days to be the most uncomfortable as this is usually when any swelling peaks, or any bruising occurs.  By the fifth day you should be more comfortable and, although possibly still the most swollen, and you can usually begin a more substantial diet. The remainder of the post-operative course should be gradual, steady improvement, but it does take 7-10 days for the swelling to resolve, and 14-21 days for any bruising to fade.  It also takes 4-6 weeks for dental sockets to completely fill in.  If you don’t see continued improvement, please call our office because it is most likely that you have a dry socket, which is similar to a scab coming off to early, and is best treated by a medicated dressing.  If you are given a plastic irrigating syringe, DO NOT use it for the first five days.  Then use it daily according to the instructions until you are certain the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket.

BONE GRAFT PROCEDURE: If a non resorbable membrane has been placed it will require removal in 4-6 weeks.

SINUS PRECAUTIONS: Because of a very close relationship to the maxillary sinus, many times when a tooth is extracted it may leave a communication between the mouth and the sinus (nose). If this is noticed:  Take your prescriptions as directed, refrain from blowing your nose for two weeks, try to stifle all sneezes, do not use a straw, do not smoke, eat soft foods for several days chewing on the opposite side if possible, do not rinse the mouth too vigorously for several days.  In most cases, small mouth-sinus communications heal uneventfully and cause no problems.  We will check this area carefully at you post-operative visit.

BREAST FEEDING INSTRUCTIONS :  You will need to use either breast milk which you have pumped and stored prior to your surgery or a formula recommended by your pediatrician until 24 hours past you last  IV anesthetic or prescribed medication.  During this time, you will still need to pump your breasts and discard the milk in order to maintain proper let down.  We recommend discussing your surgery with your pediatrician prior to your appointment in order to have any specific questions regarding your infant’s nutritional needs answered.

SMOKING: Smokers are recognized to have a significantly higher risk of postoperative wound healing problems as well as operative and postoperative bleeding. Patients should discontinue smoking for two weeks before and after surgery. Although it helps to stop smoking for several weeks before and after surgery, this does not eliminate the increased risks of all complications associated with anesthesia and surgery resulting from long-term smoking.

**IMMEDIATE DENTURE;  Leave the denture in for 24 hours.  If there is oozing along the sides absorb with gauze.  After 24 hours, remove denture at night, rinse and gently brush.  Contact your restorative dentist for further denture adjustment, adhesive, and reline concerns.