After an Apicoectomy
An apicoectomy is usually a simple procedure but it may be more involved depending on the circumstances of your case. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.
Immediately following surgery:
- Bite on the gauze pad placed over the surgical site for an hour. After this time, the gauze pad should be removed and discarded and replaced by another gauze pad. Refer to the section on BLEEDING for specific details.
- Avoid vigorous mouth rinsing or touching the wound area following surgery. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
- To minimize any swelling, place ice packs to the sides of your face where surgery was performed. Refer to the section on SWELLING for explanation.
- Take the prescribed pain medications as soon as you can so it is digested before the local anesthetic has worn off. Having something of substance in the stomach to coat the stomach will help minimize nausea from the pain medications. Refer to the section on PAIN for specific details.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable. If you are active, your heart will be beating harder and you can expect excessive bleeding and throbbing from the wound.
- NO SMOKING UNDER ANY CIRCUMSTANCES.
- A certain amount of bleeding is to be expected following surgery. Since the wound is sutured closed, the bleeding is usually clotted a short time after surgery. Slight bleeding or oozing causing redness in the saliva is very common. For this reason, the gauze will always appear red when it is removed. Saliva washes over the blood clots and dyes the gauze red even after bleeding from the sockets has actually stopped.
- Excessive bleeding may be controlled by first GENTLY rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for sixty minutes. Repeat as necessary.
- If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. This can be repeated several times.
- To minimize further bleeding, sit upright, do not become excited, maintain constant pressure on the gauze (no talking or chewing) and avoid exercise.
- If bleeding does not subside after 6-8 hours, call the office for further instructions (603-356-9755).
- The swelling that is normally expected is usually proportional to the surgery involved. An apicoectomy generally does not produce much swelling so it may not be necessary to use ice at all.
- If there was a fair amount of cheek retraction involved with your apicoectomy, then it would be appropriate to apply ice on the outside of the face on the affected side. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively.
- The swelling may be minimized by the immediate use of ice packs. Sealed plastic bags filled with ice, ice packs, or a bag of frozen peas or corn wrapped in a washcloth should be applied to the side of the face where surgery was performed.
- The ice packs should be applied 20 minutes on/20 minutes off for the afternoon and evening immediately following your extraction. After 24 hours, ice has no beneficial effect.
- Thirty-six (36) hours following surgery the application of moist heat to the side of the face may help some in reducing the size of any swelling that has formed.
- If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. Soft, puffy swelling that you can indent with your finger after oral surgery is very normal.
- Bright red, rock hard, hot swelling that does not indent with finger pressure which is getting bigger by the hour would suggest infection. This usually would develop around day 3-4 after surgery when you would expect swelling to be going down, not up. If this should occur, please call our office at 603-356-9755.
- It is normal to run a low grade temperature (99-100F) for 7-10 days following oral surgery. This reflects your immune response to the normal bacteria that are present in your mouth. A high temperature (>101F) might exist for a 6-8 hours after surgery but no more than that.
- 2 Tylenol or 2-4 Ibuprofen every 4-6 hours will help to moderate a temperature.
- A temperature >101F several days after surgery, especially if accompanied by rock hard swelling and increased pain, is usually indicative of infection. You should call the office for instructions if this should occur.
- Pain or discomfort following surgery is expected to last 4-5 days. For many patients, it seems the third and fourth day may require more pain medicine than the first and second day. Following the fourth day pain should subside more and more every day.
- Many medications for pain can cause nausea or vomiting. It is wise to have something of substance in the stomach (yogurt, ice cream, pudding or apple sauce) before taking prescription pain medicines and/or over the counter pain medicines (especially aspirin or ibuprofen). Even coating the stomach with Pepto Bismol or Milk of Magnesia can help prevent or moderate nausea.
- For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours.
- For severe pain take the tablets prescribed for pain as directed every 4 hours in addition to the Tylenol or Ibuprofen. The prescribed pain medicine will make you groggy and will slow down your reflexes.
- Do not drive an automobile or work around or operate heavy machinery if you are taking prescription pain medicine.
- Alcohol and prescription pain medicines do not mix!
- If prescription pain medications are required beyond 4 days, further treatment may be indicated. Please call the office and discuss your situation with us.
- If you have been placed on antibiotics take the tablets or liquid as directed. You should take them on schedule until they are completely gone.
- Discontinue antibiotic use in the event of a rash or other unfavorable reaction. You should call the office (603-356-9755) to report any such finding or if you have any questions.
- Drink plenty of fluids. Try to drink 5-6 eight ounce glasses the first day.
- Drink from a glass or cup and dont use a straw. The sucking motion will suck out the healing blood clot and start the bleeding again.
- Avoid hot liquids or food while you are numb so you dont burn yourself.
- Soft food and liquids can be eaten on the day of surgery. The act of chewing doesnt damage anything, but you should avoid chewing sharp or hard objects at the surgical site for several days.
- Return to a normal diet as soon as possible unless otherwise directed. You will find eating multiple small meals is easier than three regular meals for the first few days.
- You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
- Good oral hygiene is essential to proper healing of any oral surgery site.
- You can brush your teeth the night of surgery but rinse very gently. Vigorous rinsing should be avoided until the day following surgery.
- The day after surgery you should begin rinsing at least 5-6 times a day especially after eating. Salt water (cup of warm water mixed with a teaspoon of salt) is ideal but plain water is also OK.
- Mouthwash has an alcohol base to it so it may be pretty zingy when it comes in contact with fresh oral wounds. After a few days, dilute the mouthwash in half with tap water and rinse out your mouth. This will make it taste and smell better. You can gradually build up to full strength mouthwash as you feel more comfortable.
- No smoking for 48 hours after surgery. Smoking retards healing dramatically.
- After 48 hours, if you feel you need so much as one Tylenol or aspirin to control pain, you should avoid any smoking of any kind. This usually reflects that the clot has not grown enough to cover all the exposed bone in the surgical site. The exposed bone is filled with raw nerve endings. Until the nerve endings are covered with a healthy blood clot, they will cause pain. Smoking will just slow this process significantly and make the pain even worse.
- Therefore, if there is any question about smoking.....DON'T DO IT.
- You should keep physical activities to a minimum for 6-12 hours following surgery.
- If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising.
- Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.
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White Mountain Oral and Maxillofacial Surgery in North Conway, NH