BLEEDING
It is important that a blood clot forms on the extraction site to stop the bleeding, reduce pain and speed healing. Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. for 30-60 minutes. The packs may be gently removed and replaced earlier if completely saturated. Replace fresh gauze over the surgical site and bite or press down firmly for at least 30 minutes, or until active bleeding subsides. Do not forcefully spit or irritate the surgery site. This may cause further bleeding. If bleeding persists or becomes heavy you may substitute tea bag with tea leaves (not herbal tea) soaked in water, squeezed damp-dry and wrapped in a moist gauze. Bite down on it with firm pressure for 20 or 30 minutes. Slight bleeding after surgery is not unusual. Your saliva may be tinged with blood for up to twenty-four (24) hours. We recommend putting an old towel on your pillow case to avoid stains. Note: Sinus bone graft patients may experience bleeding through the nose for up to 24 hours after surgery. Allergy sufferer: If you find yourself sneezing or coughing, take medication to reduce
PAIN
Oral surgery can be accompanied by some degree of discomfort for several days after a procedure. You may be given a prescription for pain medication. Should you choose not to take prescription pain medicine, over the counter medications like ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) can be alternated to manage pain. The first day it is recommended to take medication even with minimal pain as it is easier to prevent pain than decrease it. 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 prescription pain medicine causes nausea, but if you precede each pain pill with food, chances for nausea will be reduced. Narcotic pain medication such as codeine, oxycodone, or hydrocodone may cause nausea, vomiting, drowsiness, dizziness, itching or constipation. If these side effects occur, discontinue the medication. The effects of pain medications vary widely among individuals. If you do not achieve adequate relief at first you may supplement each pain pill with an analgesic such as aspirin or ibuprofen. The most severe pain is usually within six hours after the local anesthetic wears off, after that your need for medicine should lessen.
To alternate regular strength over-the-counter pain medication you will take a dose of pain medication every three hours. We recommend that you follow this schedule around-the-clock for at least 3 days after surgery.
Important: Do not take more than 3000mg of Tylenol or 3200mg of Motrin in a 24 hour period.
• Start by taking 650 mg of Acetaminophen (brand name Tylenol) (2 pills of 325 mg)
• 3 hours later take 600 mg of Ibuprofen (brand name Motrin) (3 pills of 200 mg)
• 3 hours after taking the Ibuprofen , take 650 mg of Acetaminophen
• 3 hours after that, take 600 mg of Ibuprofen etc
SWELLING
After surgery, swelling around the mouth, cheeks, eyes, and side of face is very common. This is the body’s normal reaction to surgery and eventual repair. Swelling usually will not become apparent until the day following surgery and will not reach its maximum until 2-5 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Apply an ice pack to the outside of your face over the surgery site for twenty (20) minutes on, twenty (20) minutes off for the first twenty-four (24) hours. Prepare several cold packs by placing damp washcloths in small zip lock freezer bags. These should be placed in your freezer for use following surgery. Poly-vinyl bags of frozen peas work well also. After 48 hours, moist heat can be applied to the area as ice will increase swelling. Do not be alarmed if you are more swollen or bruised on one side. Sleeping with your head elevated above the level of the heart for the first two post-operative nights tends to lessen swelling. Avoid strenuous activities that may increase your blood pressure for the first 3 days. Take your pain medication as needed.
BRUISING
Bruising is also very common after surgery. Bruising may be present over the surgery site and to the lower chin area. 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 and last up to 14 days. Moist heat applied to the area may speed up the removal of the discoloration.
NAUSEA
Nausea may result from anesthesia medications or the drugs prescribed for pain. To minimize this possibility avoid taking any medications on an empty stomach. Take all medications with a small amount of food. If you feel nauseated or sick to your stomach drink clear liquids such as Ginger Ale, 7UP, apple juice, broth or try eating toast and crackers.
DIET
After surgery, drink lots of clear liquids and eat soft nutritious foods to speed healing. Avoid acidic foods such as tomatoes, orange juice, and citrus fruits until the surgery site has healed (2 weeks). Do not drink through a straw for at least 48 hours. If you had surgery on only one side of your mouth, favor the other side while chewing for the first few days. If you had an implant or bone-grafting procedure, avoid chewing near the surgical site until you are seen again by your surgeon.
ORAL HYGIENE
Hygiene should not be neglected as an accumulation of food and debris may promote inflammation and/or infection. You may rinse and brush your teeth starting the day after surgery. Brush your teeth as usual and rinse with warm salt water (1/2 teaspoon of salt in 12oz of water) after each meal beginning gently the night of surgery. Do not brush the surgical area for 4 – 5 days. If prescribed, chlorhexidine mouthrinse can also be started the following day after surgery. If you underwent an implant or bone grafting procedure, it is especially important to keep the surgical area and adjacent teeth very clean and free of plaque. If you were given a plastic irrigating syringe, begin using it on the 2nd or 3rd day by inserting the tip deep inside the wound to flush out food and loose debris. Continue doing so daily after each meal until the wound has healed completely.
ACTIVITY
Limit strenuous activity that would raise your blood pressure for the first 2 -3 days. This will reduce bleeding and minimize swelling. Strenuous work or exercise promotes bleeding and increases swelling which may delay healing.
FEVER
After surgery it is normal for the body temperature to be slightly elevated for 24 hours. Please remember to drink sufficient amounts of clear liquids to keep your body hydrated. Please contact the office if there exists a high temperature or if a low-grade temperature persists after the first 24 hours.
SMOKING / ALCOHOL
Smoking and alcohol use will delay healing and predisposes you to infection which can result in the failure of an implant or bone graft, or dry socket. This will result in possible surgical intervention, delay in treatment, and possible loss of implant/bone graft. Do not smoke or use alcohol until the incision line is completely healed (~ 2 weeks)
SUTURES
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 from your mouth and discard it. The sutures we place are often dissolvable and should disappear on their own in approximately 3-10 days. If they are still present, or non-resorbable sutures were used, our office will remove them on your post-op appointment.
MEDICATIONS
It is very important that you take all your prescribed medications from your physician as prescribed. DO NOT DISCONTINUE ANY MEDICATIONS (especially blood thinners) UNLESS INSTRUCTED TO BY YOUR PHYSICIAN. Additionally, take all medications that our office prescribes for you. Each medication has a specific role in the post-operative period of your surgery, which will decrease the possibility of infection, swelling, and pain. Discontinue the antibiotic medication if a rash develops or if an upset stomach persists. Report this immediately to our office. Women please note: If you are currently taking Birth Control Pills, be aware that taking antibiotics will decrease the effectiveness of the Birth Control Pills and alternative methods should be utilized.
SHARP EDGES
Its not uncommon to feel sharp bone near the surgical area. Often they are the bony walls of the extraction socket. Occasionally, small slivers of bone may work themselves out during the healing period. They can be removed at home typically, but if they cause concern or discomfort, please call the office.
WEARING YOUR PROSTHESIS
Partial dentures, flippers, or full dentures should not be used immediately after surgery, unless specifically instructed otherwise. If you have a temporary “flipper” to wear for esthetics, do not insert it until the numbness in the area is gone. When it is inserted, it should not touch the gums in the area of the surgery. If it does, this may cause ulceration of the wound edges and breakdown of the suture margins. This can lead to loss of the implant or bone graft. If you have questions about the fit of your flipper, partial or complete denture, do not wear it until your general dentist or our office can see you.
NUMBNESS
Be cautious until the anesthesia wears off as you have no feeling in the surrounding area and you may unknowingly injure yourself. After surgery you will have prolonged numbness in the surgical area. Care should be exercised in eating or drinking any hot fluids as you may cause injuries to the soft tissues. Ideally, eat and drink on the opposite side until the numbness subsides. Tingling and numbness can persist after 24 hours. If you have concern, please contact the office.