Oral surgical wounds usually heal quickly, and without complication, if simple precautions are taken. Sometimes the after effects of oral surgery are quite minimal, and not all of the following 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.
Listed below are post-operative instructions for all oral surgery procedures.
Day of Surgery
THE FIRST FEW HOURS: 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 or two unless the bleeding is not controlled. The packs may be gently removed after one hour (the greater the surgical procedure, the longer the packs should remain in place). If active bleeding persists, place enough new gauze to maintain pressure over the surgical site for another 30 to 60 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 fold it for more comfortable positioning. Additionally you should not sleep with the gauze in your mouth.
WOUND CARE: A good blood clot will help healing, so do not disturb the surgical area today. Do not rinse vigorously or probe the area with any objects. You may brush your teeth gently, avoiding the surgical area. Avoid vigorous exercise for the first several days. If you smoke, please do not smoke for at least 48 hours, since this is detrimental to healing and may cause a dry socket. Avoid alcohol for the next several days.
OOZING: Intermittent bleeding or oozing overnight is normal. This may be controlled by placing fresh gauze over the areas and biting on the gauze for 30-45 minutes at a time.
PERSISTENT BLEEDING: Bleeding should never be severe. If so, it usually means that the packs are being clenched between the teeth only and they are not exerting pressure on the surgical areas. Try repositioning the gauze 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 to 30 minutes. If bleeding remains uncontrolled, please call our office.
DRY SOCKET: This is an occasional complication after tooth extraction, especially with 3rd Molars (Wisdom Teeth) and lower teeth. It is caused by the blood clot dissolving too early, and it is identified by increased pain/discomfort after the first few days of normal healing. While this process is self limiting, it can be uncomfortable. Please call our office as soon as possible so we can treat you and relieve your pain.
PAIN: Unfortunately, most oral surgery is accompanied by some degree of discomfort depending on the procedure and patient. 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 the discomfort better. The effects of pain medication vary widely among individuals. If you do not achieve adequate relief at first, you may supplement each pain pill with an analgesic such as ibuprofen. Rarely, some patients may initially even require two pain pills at one time. It is best to limit as much as possible the use of pain medication, as overuse can lead to negative side effects, without any added beneficial effects. Remember that the most severe pain is usually within six hours after the local anesthetic wears off. After that, your need for pain medication should lessen with time. If you find yourself needing to take large amounts of pain medicine at frequent intervals, please call our office. Also do not drive while taking this medication.
If you have received intravenous anesthesia, you should rest for the remainder of the day, and during recovery time (normally 24 hours), you should not drive, operate complicated machinery or devices or make important decisions such as signing legal documents, etc.
NAUSEA: Nausea is not uncommon after surgery. Also, pain medications are sometimes the cause. In the event of nausea and/or vomiting following oral surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on Coke, tea, or ginger ale. You should sip slowly over a 15-minute period, and when the nausea subsides, you can begin taking solid foods and the prescribed medicine. Nausea can be reduced by preceding each pain pill with a small amount of soft food, and taking the pill with a large amount of water.
DIET: Eat any nourishing food that can be taken with comfort. Avoid extremely hot or cold foods. Do not use a straw for the first few days after surgery, It is usually advisable to confine the first day's intake to liquids or pureed foods (soups, pudding, yogurt, milk, fruit shakes, etc). Avoid hard foods, which may be lodged in the socket areas. Over the next several days you may gradually progress to solid foods. If you had an implant(s) placed do not eat anything hard over the implant site for about 3 months. If you are diabetic, maintain your normal eating habits or follow instructions given by your doctor.
SHARP EDGES: If you feel something hard or sharp edge 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 our office.
ACTIVITY: If you received any intravenous medications at our office, it is extremely important not to drive a car or engage in activities that require your alertness for at least 24 hours after your appointment. Taking prescribed narcotics after intravenous is safe, but you must still avoid hazardous activity. Likewise, do not use alcohol for the 24 hour period following intravenous medications (or as long as you are taking narcotic medication)!
Your return to work or recreation must be guided by your level of strength. The pressures of today's busy lifestyles work against better healing in that regard. The rate of healing is affected by many factors, only some of which are within our control. But a major controllable factor is merely "listening to your own body." Different patients heal at different rates. The same patient heals at different rates depending on his or her physical reserves. Many people mistakenly feel that they "should" heal at the same rate as a relative, a classmate, or a friend. Don't place that unnecessary psychological frustration on yourself. Rest until you feel your strength return.
Lastly, if you smoke, please do not smoke for 5 days from the time of your surgery. Smoking can cause a dry socket which is a painful condition that warrants further treatment.
Instructions for the next few days
ORAL HYGIENE: Keeping your mouth clean after surgery is essential. Begin your normal oral hygiene routine as soon as possible after surgery, normally the day after surgery. Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth within the bounds of comfort. Do not rinse and/or brush your teeth on the day of the surgery. Beginning the day after your surgery, you should rinse with warm salt water several times a day as well as after eating. Use 1/4 teaspoon of salt dissolved in a 8 ounce glass of warm water and gently rinse portions of this solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily preferably after meals for one week after surgery. Avoid commercial mouth rinses, as they contain a small amount of alcohol in them.
You may start to brush your teeth the day after surgery, be careful around the surgical sites; light brushing only around the surgical sites. You may utilize a Water-pik device or a plastic syringe (provided by our office) to assist in rinsing your mouth. If you had an implant(s) placed you may brush lightly around the implant and utilize the syringe or water-pik.
HEALING: Normal healing after tooth extractions should be as follows:
The first two days after surgery are generally the most uncomfortable and there is usually some swelling and/or bruising in the affected area. 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 a gradual steady improvement. If you don't see continued improvement, please call our office.
Common temporary post-operative symptoms:
If numbness of the lip, chin, or tongue occurs, there is no cause for alarm. This is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call Dr. Ghobadi if you have any questions.
Other common post-operative symptoms:
- Jaw stiffness with difficulty in opening
- A slight earache on the side of the surgery
- Your other teeth may ache. This is "sympathetic" pain.
- The corners of your mouth may be dried, cracked or bruised. Use cream or ointment to keep the area moist and to promote healing.
- Black and Blue discolorations or bruising may occur on the face in the area of surgery. This should resolve itself within several days.
- There may be elevation of body temperature for 24 to 48 hours (Up to 101 F). If temperature persists, please call our office. Remember, you just had a surgical operation. Be kind to yourself. It is our desire that your recovery is as smooth and pleasant as possible. Following these simple instructions will assist you in your recovery, but if you have any questions about your progress, please call our office.