General Post-Operative Instructions
Some bleeding and oozing are to be expected. Please keep the gauze pack firmly over the surgery site for about one hour. The gauze pack can usually be changed out upon your arrival home. If no bleeding occurs upon removal, the gauze does not need to be replaced. If bleeding continues (which is more typical), a new gauze pack should be placed, and firm pressure should be applied for about 45 minutes to one hour. Repeat as necessary. A tea bag can be used if your gauze supply runs low. A thick washcloth dipped in ice water can also help control bleeding. It is not uncommon to have oozing of blood for several hours. Most bleeding problems are related to not placing firm, uninterrupted pressure on the bleeding sites.
Swelling will be at a maximum about 2 or 3 days after surgery. Often early in the morning, swelling is at a maximum. Keeping your head elevated (in a recliner or on several pillows) for approximately 3 days will reduce swelling. Ice packs are helpful for the first day or so.
CARE OF YOUR MOUTH
Do not rinse for the first 24 hours. It is best not to spit, use a straw, or brush your teeth with toothpaste the first day after surgery. You may brush your teeth gently with warm water; however, avoid rinsing. The following day, please begin rinsing your mouth with warm saltwater rinses (1 teaspoon of salt in a glass of warm water) approximately 3 or 4 times per day. Starting on the second or third day after surgery, you can resume normal oral hygiene as before surgery. You may have to be a little gentle around the wisdom teeth sites, but please remember that a clean surgical site is less likely to get infected.
For Wisdom Teeth Patients: The lower sockets tend to accumulate food debris during the healing process, mostly because the socket has to heal from below and gravity will allow the food to collect in these areas. Starting on day 5 after your surgery, it is important to take the syringe that we give you in your post-op supplies and start irrigating the food debris out of your socket once per day. It is probably best to do this at night before going to bed. Most infections related to wisdom teeth removal are the lower wisdom teeth sites that have not been irrigated out thoroughly. These infections usually occur at about 2–3 weeks after surgery. If you are having difficulty irrigating your sockets, please contact our office.
A dry socket is a relatively rare occurrence in our practice; however, it is a situation that can be painful and usually does not respond fully to pain medication. Most patients that think they have a dry socket are not irrigating the sockets properly to remove food debris and/or they are coming off the steroid dose pack and now need to be taking ibuprofen on a scheduled basis. Taking ibuprofen as described below (if medically permitted) takes care of most potential dry socket patients. If you have not responded well to the ibuprofen regimen on or around day 4 or 5, please give our office a call. If you have any questions as to if you have a dry socket or not, we welcome your phone call and will be glad to see you during the post-op time frame.
If you are a smoker, there will already be a chance of slow healing and the potential for more post-operative problems. Pre-operative smoking and smoking during the healing phase are both detrimental to oral healing. Ideally, you should quit smoking for at least 2 weeks before having oral surgery. Many patients do not feel like they can quit smoking, but cessation of smoking during the immediate time after surgery may also be beneficial to oral healing.
Please remember that if you have had a bone graft placed in a socket, the use of the syringe is contraindicated. There should be more detailed instructions in the Dental Implant Post-Operative Instructions that we will discuss verbally with you. Please remember that we do not recommend flushing out a socket that has had bone graft material placed.
Nausea can occur after general anesthesia or with the use of pain medication. Remember, do not take the pain medication on an empty stomach. If you were given medicine for nausea, you will find this very helpful. Nausea is rare and usually does not last very long.
ITCHING & RASH
Narcotics (pain medicine) can cause itching in certain circumstances. Without a rash developing, the itching is likely a side effect of the pain medicine. Benadryl (25 mg) can often lessen this side effect. If itching persists, we can get you different pain medicine. If you develop a rash, this could be a sign of an allergy, and we need to be notified.
Pain levels are relatively difficult to predict after oral surgery. Some patients experience very little pain, and others tend to have more discomfort. Our goal is to be sure you are comfortable during the post-operative time frame until you have healed properly. We will typically prescribe you a narcotic pain medicine, which is usually required the day of surgery. It is best to have a little something in your stomach before taking your first narcotic medication. Please remember that pain medicine can take 30–45 minutes to take effect; therefore, be sure you are planning ahead if you start experiencing any pain. Frequently, a steroid dose pack is prescribed after surgery, and this will reduce inflammation and pain. If you are prescribed a steroid dose pack, we will have you start this the day after surgery because we will have given you one steroid dose through the IV during surgery.
Several days after surgery, lower wisdom teeth sites in particular often require inflammation reduction to heal up completely. The steroid dose pack is prescribed for anti-inflammatory purposes, and it helps with swelling and post-operative pain. As the steroid dose pack is running out on about post-operative day 5 or 6, you may feel some increased discomfort in the lower wisdom teeth sites. One main reason for this can be food debris buildup in the sockets, and this is why we recommend starting the syringe on day 5. A second reason for this increased pain is that you are coming off of the steroid dose pack, and elevated inflammation is starting to occur at the surgery sites. This is a good time to begin ibuprofen (600–800 mg) every 6–8 hours for the next 2–3 days if medically tolerated. Most dry sockets are not truly dry sockets but can be managed with the above regimen. Please call our office if you have any questions or concerns about pain lasting longer than you feel like it should.
The day of surgery you should only consume liquids or very soft foods. It is usually best not to consume anything until 2 or 3 hours after surgery with general anesthesia. Antibiotics and pain medicine can be taken after a small amount has been consumed. It is very important to maintain good nutrition. If you had surgery on one side of your mouth only, regular food can be consumed with caution after you feel like the surgical sites have mostly healed (usually 2–5 days).
The following post-operative conditions may occur in some patients while healing is progressing normally:
- Swelling on one or both sides of the jaw.
- Numbness around the corner of the mouth or tongue. Please notify us if this persists for longer than 5–7 days.
- Mild, occasional bleeding from a healing socket.
- Bruising can occur; however, it is rare.
- Difficulty opening your jaw for a few days.
- Some tenderness around the IV site in your arm. If this should occur, elevate your arm (on pillows) and apply warm, moist heat. Call our office if this persists for greater than 24 hours.
- After anesthesia, the risk of fainting is higher. Please stand up slowly and ask for assistance immediately following surgery.
- Infections are rare after oral surgery. Usually, swelling within the first week is not related to an infection. The mouth will develop a yellow scab over a healing extraction site. This should not be confused with an infection.
- Small bone fragments can work their way to the surface during the healing process. Generally, these will resolve with time.
Please keep in mind that it is reasonable to expect your normal activities to be disrupted following a surgical procedure.
If any problems arise or if you have any questions, please call. We really do care!