Post Operative Care 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. Common sense will often dictate what you should do. However, when in doubt follow these guidelines or call any of our office for clarification at (716) 362-4800.
DAY OF SURGERY
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. Do NOT place more gauze UNLESS active bleeding persists. 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 for more comfortable positioning making sure there is pressure against the surgical areas.
Do not disturb the surgical area today. You may brush your teeth gently today. Do NOT rinse vigorously or probe the area with any objects. You may rinse by tilting your head side to side and letting the rinse fall out of your mouth instead of swishing and spitting starting day 2. PLEASE DO NOT SMOKE for at least 48 hours since this is very detrimental to healing and may cause a dry socket, it is recommended not to smoke for 2 weeks.
Intermittent bleeding or oozing overnight is normal. It is common to have blood mixed with your saliva for a few days following surgery and you may experience bleeding when a suture comes out. Please cover your pillow with a cold towel or a t-shirt.
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 moist gauze) for 20 or 30 minutes. If bleeding remains uncontrolled, please call our office.
Dry socket is the term for when the clot is lost from the surgical site or does not form. Dry socket is very painful, and narcotics are typically not prescribed for dry socket. It can be caused by smoking, suction, and spitting. Avoid smoking, using a straw, and spitting for 2 weeks.
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 20 minutes on and 20 minutes off during the first 24 hours after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed. The worst swelling may be on days 3 or 4 and usually peaks within the first 5 days, then will gradually improve.
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, chances for nausea will be reduced. The effects of pain medications vary widely among individuals. If you can take Ibuprofen, it is recommended to start with Ibuprofen first then assess 3 hours later whether you need extra strength Tylenol or an opiate (if you were prescribed an opiate). You are encouraged not to take the opiate unless you have severe pain. It is recommended that you alternate between Ibuprofen and Tylenol every three hours for maximum pain control. 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. If you anticipate needing more prescription medication for the weekend, you must call for a refill during weekday business hours. NO NARCOTICS WILL BE PRESCRIBED AFTER OFFICE HOURS OR OVER WEEKENDS. If you think you will need pain medication over the weekend you must call before 4:00 p.m. on Friday.
Nausea is not uncommon after surgery. Sometimes pain medications or sedation 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. A medication for nausea may be prescribed to you.
Eat any nourishing food that can be taken with comfort. Avoid extremely hot foods. Do not use a straw for the first 2 weeks after surgery. It is sometimes advisable, but not absolutely required, to confine the first day of intake to cool liquids no straws or pureed foods (ice cream, nutritious smoothies such as Boost/Ensure/protein powder added, puddings, yogurt, milk shakes, pureed fruits/vegetables, etc). You may try soft foods that do not require chewing such as scrambled eggs, mashed potatoes, overcooked noodles, overcooked fish, and soups. It is best to avoid foods like nuts, sunflower seeds, popcorn, berries etc., which may get lodged in the socket areas. Over the next several days you may gradually progress to solid foods as tolerated. 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.
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 over the next couple of months. If they cause concern or discomfort, please call the office.
If your surgical site is in the upper back of your mouth, you may need to follow sinus precautions for at least 2 weeks. Do not blow your nose. Sneeze with your mouth open to release the pressure. Do not bear down. Do not play wind instruments. Do not submerge your head under water. You may have been prescribed additional medications please take those as directed. Antihistamines and decongestants may be used; however, if you have high blood pressure or heart disease speak with your pharmacist about alternative over the counter medications.
INSTRUCTIONS FOR THE SECOND AND THIRD DAYS
Keeping your mouth clean after surgery is essential. If you were not prescribed Peridex, you may use 1/2 teaspoon of salt dissolved in an 8-ounce glass of warm water and gently rinse with portions of the solution. Repeat saltwater rinses as often as you like, but at least two or three times daily. Rinse by tilting your head side to side instead of swishing. Let the rinse fall out of your mouth instead of spitting. You may use this in addition to Peridex.
Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing, but please make every e ort to clean your teeth within the bounds of comfort.
The majority of sutures placed are resorbable and typically go away in the first week or two. Your surgeon may occasionally place non-resorbable sutures that will need to be removed at a follow up appointment. You may experience bleeding when a suture comes out.
After the first 24 hours, you may apply warm compresses to the skin over the areas of swelling (hot water bottle, hot moist towels, or heating pad) for 20 minutes on and 20 minutes o to help soothe tender areas. This will also help decrease swelling and stiffness.
Bruising may occur and will travel down your face and neck and possibly chest over time and may appear concerning, but it is nothing to be concerned about. Bruising will gradually improve over time.
Normal healing after tooth extraction should be as follows: The first three days after surgery are generally the most uncomfortable and there is usually some 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 do not see continued improvement, please call our office. 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.
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 our office.
(716) 362-4800 option # 3 Calling during office hours will afford a faster response to your question or concern. Should you have an after-hours post-op emergency that cannot wait, call 716-362-4800 and choose the option for afterhours emergency.