After Multiple Extractions
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 our office for clarification. Our number is 212 355-8500
Day of Surgery
FIRST HOUR: 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. 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. Smoking will retard healing, causing increased discomfort and increased chance of dry sockets. We strongly discourage smoking during the healing phase.
ORAL HYGIENE: It is important to keep the mouth clean. You should brush your teeth the night of surgery, but be gentle around the surgical sites. If there is minimal bleeding, saltwater rinses may begin 24 hours after surgery (mix 1 tablespoon of salt with 8 ounces of water.) Swish gently and allow the water to drip into the sink. Rinses should be done 2-3 times a day, especially after eating.
ACTIVITIES: Activities after surgery should be couch or bed rest for the first day. Bending, lifting, or strenuous activity will result in increased bleeding, swelling and pain. You should be careful going from the lying down position to standing. You could get light headed when you stand up suddenly. If you exercise regularly, be aware that your normal fluid and caloric intake is reduced. Exercise in the post-operative period may also result in increased bleeding, swelling and discomfort. Exercise should be avoided for 3-4 days following surgery.
OOZING: Bleeding will occur after surgery, and it is not uncommon to ooze blood for 24-48 hours after surgery. Keep in mind that oral bleeding represents a little blood and a lot of saliva. Placing a gauze pack over the area and biting firmly will control bleeding. If oozing is still active, replace gauze as needed every 30-45 minutes.
PERSISTENT BLEEDING: 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 begins again sit upright or in a recliner, avoid physical activity, use ice packs and bite on gauze for 1 hour or on a moistened tea bag for 30 minutes. The tannic acid in the tea leaves helps to promote blood clotting. If bleeding remains uncontrolled, please call our office.
SWELLING: Swelling is a normal occurrence after surgery and will not reach its maximum until 2-3 days after 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 hours after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed.
SUGGESTED WAY TO APPLY ICE: Fill two zipper lock bags with crushed ice. Cut a pair of pantyhose at the thigh and slide both ice bags halfway down the leg (to the knee area). Tie the ends of the pantyhose on top of the patients head and adjust ice to sides of face over surgical sites.
PAIN: Unfortunately 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 do not achieve adequate relief at first, you may supplement each pain pill with an analgesic such as aspirin or ibuprofen. Some patients may even require two of the pain pills at one time. 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.
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 days intake to liquids or pureed foods (soups, puddings, yogurt, milk shakes, etc.) Avoid chewing food until tongue sensation has returned. It is best to avoid foods like rice, nuts, sunflower seeds, popcorn, etc., which may get lodged in the socket areas. Over the next several days you may gradually progress to solid foods. 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.
NAUSEA: Nausea and vomiting can occur as a result of swallowed blood, discomfort, anesthesia or pain medicines. Post-operative nausea is usually self-limiting and sipping on flat cola or ginger ale often helps. Soda crackers also may be used. If nausea persists, stop taking the pain medicine and substitute an over the counter pain medicine for the next dose. If nausea persists call our office.
Second and Third Days
MOUTH RINSES: Keeping your mouth clean after surgery is essential. Use 1/4 teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily.
BRUSHING: Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing, but it is extremely important to clean your teeth within the bounds of comfort. Maintaining a clean environment adjacent to the healing surgical wounds is required for optimum and speedy healing.
HEALING: Normal healing after tooth extraction should be as follows: The first two days after surgery are generally the most uncomfortable and there is usually some swelling. On the third 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 don’t see continued improvement, please call our office.
DISCOLORATION OR BRUISING: The development of black, blue, green or yellow discoloration is due to bruising beneath the tissues. This is a normal post-operative occurrence that might appear 2-3 days after surgery. Beginning 36 hours after the surgery, moist heat applied to the area may speed up resolution of the discoloration.
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 week or so. If they cause concern or discomfort, please call the office.
DRY LIPS: If the corners of your mouth are stretched they may dry out and crack. Keep your lips moist with an ointment such as Vaseline.
SORE THROAT: This is not uncommon after oral surgery. The muscles get swollen and this may make swallowing painful. This should go away on its own in 2-3 days.
STIFF JAW MUSCLE: This may cause a limitation in opening the mouth wide for a few days after surgery. This is a normal post-operative event that usually resolves during the week after surgery. Stretching these muscles may help to speed up resolution of this problem.
If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process. After you have seen your dentist for denture adjustment, take out denture and rinse 3 to 4 times a day.
Your case is individual no two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the person best able to effectively help you your surgeon!
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 the office at 212 355-8500.