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Post-Operative Instructions

After the Removal of Multiple Teeth

The removal of many teeth at one time is obviously more involved than the extraction of one or two teeth. These cases frequently require shaping and smoothing of the bony ridge prior to the insertion of a denture. 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.
  • If a denture is placed at the time of surgery, gauze pressure is placed on the denture to stop the bleeding. It takes longer to get the bleeding to stop than it would biting directly on the gauze.
  • 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.

Special Considerations for Immediate Denture Patients:

The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:

  • A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
  • If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline or Chap Stick.
  • Immediate dentures should be left in place overnight. The next morning it can be removed and cleaned with your toothbrush. Any remaining natural teeth should be brushed followed by vigorous rinsing of the extraction sites with salt water. The denture should then be carefully placed back in the mouth. If you leave the denture out for more than 30 minutes during the first 48 hours after surgery, the gums may swell enough that the denture will not fit for several days.
  • 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.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls which supported the tooth (the walls of the tooth socket). These projections usually smooth out spontaneously. You may not notice this for days to weeks after surgery. If the rough edges bother your tongue or cheeks, call the office so Dr. Smith can evaluate the area and smooth them down for you.

Bleeding:

  • A certain amount of bleeding is to be expected following surgery. On the skin where the surface is dry, bleeding clots in 10 minutes. In the mouth where things are wet, it takes 6-8 hours for the clot to gel up and the bleeding to subside. 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 an immediate denture is placed, the gauze pressure is applied to the denture over the extraction sites. Expect old dark blood to seep out from under the denture for the first 24 hours until the denture is removed for initial cleaning.
  • In a no denture is placed, if bleeding does not subside after 6-8 hours, call the office for further instructions (603-356-9755).

Bruising:

  • When the bone requires smoothing to allow for the fit of the denture, there is a good chance there will be some bruising on the surface skin over the area. The most common location is over the upper eye teeth (on the cheek and below the eye)
  • Bruising may not be obvious for a day or two. By the time it reaches the surface it may have already turned from purple to green to yellow in color.
  • Over several days the yellow color will settle down the neck to about the nipple line on the chest before it disappears.

Swelling:

  • The swelling that is normally expected is usually proportional to the surgery involved. You can expect more swelling when multiple teeth are removed than you would find when one or two teeth are removed.
  • If there was a fair amount of cheek retraction involved with your extractions, 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 and bruising can 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.

Temperature:

  • 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:

  • 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.

Antibiotics

  • Antibiotics are NOT given as a routine procedure after oral surgery. The over use of antibiotics leading to the development of resistant bacteria is well documented so careful consideration is given to each circumstance when deciding whether antibiotics are necessary. In specific circumstances, antibiotics will be given to help prevent infection or treat an existing infection.
  • 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.

Diet:

  • Drink plenty of fluids. Try to drink 5-6 eight ounce glasses the first day.
  • Drink from a glass or cup and don’t 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 don’t burn yourself.
  • Soft food and liquids can be eaten on the day of surgery. The act of chewing doesn’t 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.

Oral Hygiene:

  • 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.
  • No vigorous rinsing of your mouth for the first post-operative day, especially while there is active bleeding. After the first day, use a warm salt water rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. After you have seen your dentist for denture adjustment, take out denture and rinse 3 to 4 times a day.
  • 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.

Smoking:

  • No smoking for 48 hours after surgery. Smoking retards healing dramatically. Nicotine constricts blood vessels which slows the formation and expansion of the healing blood clot in the socket. This leads to the painful complication called a “Dry Socket”.
  • 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 socket. 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.

Activity:

  • 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