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, if you have a question, follow these guidelines or call our office at (623) 584-3098 for clarification.
Day of Surgery
FIRST HOUR: Bite down 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 60 minutes. The gauze may then be changed as necessary (typically every 60 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 use any mouthrinse on the first day or probe the area with any objects. You may brush your teeth gently. PLEASE DO NOT SMOKE (including Vaping), SPIT, OR SUCK ON A STRAW for at least 1 week, since this is very detrimental to healing and may cause a dry socket. Also avoid any strenuous activity for 1 week to prevent bleeding and dry socket.
OOZING: Intermittent bleeding or oozing overnight is normal for the first 3-4 days. It is normal if you fall asleep and wake up with some blood in your mouth and on your pillow. Bleeding may be controlled by placing fresh gauze over the areas and biting on the gauze for 60 minutes at a time. It is normal for saliva to mix with the blood clot and have signs of blood for a few days after surgery.
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 becomes heavy, you may substitute a black tea bag (soaked in water, squeezed damp-dry and wrapped in a moist gauze) for 60 minutes. Do not switch out gauze or tea bag for 60 minutes and keep firm constant pressure. If bleeding remains uncontrolled, please call our office.
SWELLING/BRUISING: Swelling is often associated with oral surgery. It can be minimized by using a cold pack, ice bag or a bag of frozen vegetables (such as 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. Ice after 24 hours is not effective and if any compress should be used after that time, it should be a warm, moist heat after the initial 24 hours of ice. It is normal for the swelling to get worse in the first 3-4 days after surgery. The swelling should improve after that time. Bruising can also occur depending on the surgery and patient. Do not be alarmed if this occurs and it can also extend from the cheek or under the eye to the neck and follow gravity down to the chest sometimes. It is helpful to keep your head elevated with 2-3 pillows for the first 48 hours after surgery.
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, it will reduce the chance that nausea will occur. 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 and rotate these medications with the stronger one. 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. It is normal for the area to be increasingly sore in the first 3-4 days after surgery. 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.
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. Classic Coca Cola may help with nausea.
DIET: Avoid extremely hot foods (lukewarm is best). Do not use a straw for the first week after surgery. It is sometimes advisable, but not absolutely required, to confine the first 3-4 days intake to liquids or pureed foods (soups, puddings, yogurt, milk shakes, etc.). It is best to avoid foods like 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.
ANTIBIOTICS: If antibiotics were prescribed, start taking them the same day of surgery when you begin taking in food or fluids. Follow instructions given by the pharmacist. Ensure once antibiotics are started that they are finished in their entirety. It is common to have an upset stomach or diarrhea while taking antibiotics. Eating probiotic foods (like yogurt) or taking supplements such as Culturelle can help with these common side effects.
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.
SUTURES: Sutures placed in the mouth will fall out on their own. This can take up to 5-7 days, or a few weeks, depending on the suture material used. Do not be alarmed if they fall out earlier or take longer than normal to fall out.
Instructions for Second and Third Days
MOUTH RINSES: Keeping your mouth clean after surgery is essential. Use ¼ 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. DO NOT SPIT, simply allow the rinse to dribble from the mouth into the sink. If a prescription mouth rinse was prescribed (Chlorhexidine, Peridex), use it twice a day and stop using it after one week.
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.
HEAT APPLICATIONS: 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 2-4 days after surgery are generally the most uncomfortable and there is usually increased swelling/bruising. On the third or 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 don’t see continued improvement after the first few days, please call our office. It is also normal for the adjacent teeth to be sensitive after surgery.
IRRIGATING: If you are given a plastic irrigating syringe, DO NOT use it for the first week. After, use it daily after meals with warm salt water until you are certain the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket. Use by GENTLY placing the tip into the extraction site (behind the tooth that is in front of the extraction site) – sometimes you will have to place the tip under the skin of the mouth. Then gently flush out the food in the area and repeat after meals until the socket has closed. This is very important to prevent postoperative infections. It may feel like there is a hole in the area of the extraction for months – this is normal.
Special Considerations for Bone Grafts and Dental Implants
||Some of the bone graft material can fall out of the area and you can have granules in your mouth. Do not be alarmed – the area is always overpacked with bone so some loss of the material is normal
||DO NOT IRRIGATE sockets that have been bone grafted with a syringe, rinses are ok
||Bone grafts/implants can be intermittently sore for a few weeks due to the extended healing process when a bone graft/dental implant is placed
||Be gentle when brushing/flossing in areas adjacent to bone grafts
||Eat a soft diet for the first 3-5 days (nothing harder than scrambled eggs), then advance to normal foods as tolerated. Avoid chewing hard foods DIRECTLY on the bone grafted areas or implants for 8 weeks (2 months) after surgery.
||Purchase a Water Pik if a dental implant is placed or desired in the future – it is an extremely important part of ensuring the implant stays healthy and bacteria-free for the lifetime of the implant. DO NOT use one until after 2 weeks. Then use it daily (ideally twice a day). You can also gently brush the implant itself and use floss around the implant gently after 2 weeks of healing. Your dental hygienist/dentist should be cleaning the implant like a regular tooth in the future once it has completely healed.
Please follow any additional orders given by Dr. Nguyen.
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 where you had surgery. A 24-hour answering service is available to contact the doctor on call after hours. Calling during office hours will afford a faster response to your question or concern. PLEASE NOTE: telephone calls for narcotic (pain killer) prescription renewal are ONLY accepted during office hours.