Removal of Teeth / Other Surgical Procedures

Important Instructions for Your Comfort at Home Following Removal of Erupted Teeth, Impacted Wisdom Teeth or Other Kinds of Oral Surgery.

Oral surgery procedures, whether extensive or limited, require proper post-operative care. Many surgical procedures are accomplished in the office while others are performed during a brief hospital stay. In both cases, continued post-operative care is required.

The following information is intended to provide you with the needed background to properly care for yourself or for others who have had oral surgery. This is designed to give you detailed post-operative instructions as well as reasons for these procedures. Please read this carefully and refer back to it throughout your post-operative period. Your understanding of proper home care following oral surgery is a very important part of a successful recovery.

If you have any questions concerning your post-operative care or the information provided here, please call our office.

Activities – Rest as much as possible. You should not drive a car, operate any machinery or undertake any responsible business matters for at least 24 hours.

Bleeding – Maintain the gauze pressure packs in your mouth for one hour after surgery. Replace and maintain a gauze pack over the surgical area until bedtime. This will not only help to minimize the bleeding but it will also help readapt the gum tissues that have been manipulated during surgery. Some mild oozing of blood is to be expected following surgery and this may continue for as long as 24 hours. Such oozing, combined with saliva, can often appear as noticeable bleeding. Keeping gauze in place will minimize the oozing. Rest and sleep with your head elevated by two pillows and place an old towel over the pillows. The towel will help to absorb any oozing that may seep out of your mouth. Persistent bleeding may be stopped by placing a moistened tea bag over the surgery area. The tannic acid in the tea bag helps to form a blood clot by contracting bleeding vessels. Apply an ice bag compress to the cheek. Do not become alarmed or excited. If you are unable to control bleeding, please contact the office.

Swelling – Swelling of the face following oral surgery is quite normal. Apply ice packs during the first 24 hours. Swelling will usually reach its peak during the first 48 to 72 hours. After 24 hours, if swelling or jaw stiffness has occurred, apply heat on the outside of the face using a warm, moist dressing. If you use a hot water bottle or heating pad, protect the skin with a moisturizing lotion and place a thin towel between the heat source and the skin. Do not use this heat continually. Apply it for about 20 minutes and then remove it for an equal interval. If swelling appears to be increasing rather than decreasing, you should call the office. This may be an indication of a wound infection.

Pain – Do not take pain medication on an empty stomach. At least swallow some milk prior to taking pain pills to reduce the potential of nausea. Take your pain medication as prescribed. Usually, you should take one of the prescribed pain pills within an hour following surgery. This will allow the pain pill to dissolve and get into the bloodstream by the time the local anesthetic wears off. Prescribed pain medications are generally needed during the first day. After that, acetaminophen (Tylenol®) is generally sufficient. If pain persists, please notify the office. Again, prolonged pain may be a warning of a wound infection. If you have been placed on any antibiotics (you will be told of this), take all of the tablets or liquid as directed. The drugs you may be given will minimize swelling, reduce discomfort, prevent infection, and promote healing.

Although most patients benefit from the prescribed drugs, occasional side effects such as dizziness, rash, nausea, excitement, constipation or diarrhea can occur. Should any of these occur, stop the drug immediately and notify the office.

Diet – You must guard against dehydration after oral surgery. Follow a liquid diet on the first day. Drink at least the equivalent of eight glasses of water, apple or grape juice, soups, milk shakes, 7UP®, ginger ale or milk the first day. Sucking on ice chips or crushed ice usually aids in masking some of the local discomfort. Avoid using a straw since the pressures involved may dislodge the blood clot. Also, avoid smoking as the hot smoke will easily irritate the fresh oral wound. Return to a normal diet within two or three days. This is not the time to initiate a new diet trend. You will feel better, have more strength, have less discomfort and heal faster if you continue to eat. If you are diabetic, maintain your normal caloric requirements and take your medication as usual.

Hygiene – Do not rinse until the morning after surgery. On the day of surgery, brush as many teeth as best you can when the numbness has worn off. Do not be overly intimidated by the presence of the stitches. Brush very lightly over the stitches. Good hygiene is imperative to good wound-healing. Food left in the wound retards healing and invites infection. A mouth rinse composed of a 1/4 teaspoon salt in a glass of warm water will soothe the wound. Commercial mouth rinses will also improve your breath and be somewhat refreshing.

Do NOT blow up balloons, play a wind instrument (trumpet, flute, etc.), run or participate in water activities in the immediate post-operative period. Refrain from excessive pressures within the mouth for two weeks.

If an opening into your maxillary sinus was noted at the time of the surgery (you will be told of this), do not blow your nose. If you sneeze, open your mouth. The object is to avoid forcing pressure back through the sinus and into the wound—this will cause the soft tissue closure over the socket to open up.

If prior to your oral surgery you had been taking medication prescribed by another physician or dentist, continue to take that medication unless you are advised otherwise.

Possible Side Effects

Presence or absence of side effects vary from patient to patient and certainly vary with the difficulty of the surgical procedure. The following conditions may occur, all of which are considered normal.

  1. The face and jaw will probably swell. Swelling is most marked within the first 48 to 72 hours. Swelling may take a week to disappear.
  2. Stiffness (trismus) of the jaws is nature’s way of splinting and resting the part that needs to be repaired. You should work vigorously at opening your jaw the first day after the surgery. This would include “prying” the teeth apart with your fingers. Prolonged or recurrent stiffness may be a warning of underlying infection. Please notify the office of stiffness if it seems prolonged or recurrent.
  3. Numbness of the lower lip, chin, and on the side of the tongue may occur on the day of the surgery. This is called “paresthesia,” and though it may be permanent, it is generally a temporary condition which will correct itself. It may remain anywhere from a few days to several months.
  4. Black-and-blue marks (ecchymosis) on the face are caused by seepage of blood beneath the cheeks, chin, or under the eye (black eye). This may appear initially as swelling, but often by the second or third day it may discolor the face. The color may progress from black-and-blue to yellow-and-green, and the color may progress down your face onto your neck. It will gradually disappear over a week or two. Moist external heat will assist in resolving the surgically created bruise.
  5. You may have a slight earache or a sore throat.
  6. Other teeth will possibly ache temporarily. This is symptomatic or referred pain and is only temporary.
  7. Your “bite” may seem to have shifted. This also passes quickly but often happens when you alter your chewing pattern such as during your immediate post-surgery diet of yogurt and ice chips.
  8. If the corners of the mouth are stretched, they may dry out and become cracked. The lips should be kept moist with a cream or ointment.
  9. There will be a cavity where the tooth was removed. This area should be rinsed following each meal. In a few cases, vigorous rinsing is not totally effective and the small syringe provided for you may be used to gently irrigate the surgical area. Do not use the syringe for the first 48 hours. During the course of normal healing, this cavity will fill in with new bone tissue.
  10. During the healing process, small sharp fragments of bone may work up through the gum tissue. This is especially true after multiple extractions and is nature’s way of reshaping the ridge. This process of “shedding” slivers of bone may last anywhere from two to four weeks. If there is difficulty with some of these slivers, please call the office and arrange for an appointment. Impressions for bridges, partial dentures, or full dentures should be postponed until the ridge is well-healed—usually six weeks.
  11. There may be a tender and ropy feeling to the vein used to administer the sedative at the time of the surgery. This is a local phlebitis (irritation of the vein) and is usually self-limiting. Local heat and elevation of the arm will help. In time (two to four months), the vein will soften and blood will flow through it again, or it will shrink and become thread-like and unnoticeable. If the area becomes swollen, red, warm, and very tender, most likely there is an active phlebitis in the vein. Please notify the office if you have any concerns.
  12. You may have a slight temperature elevation for 24 to 48 hours. If fever persists, it can be a warning of infection or dehydration. Drink fluids and, if fever persists, notify the office.
  13. Rarely, a localized abscess occurs in the surgery site two, three, or even four weeks after the surgery. If you have a sensation of pain, swelling, stiffening of the jaw, or fever, please contact the office.
  14. Antibiotics prescribed for your treatment may interfere with the effectiveness of oral contraceptives. The use of additional birth control methods is recommended during the 30-day cycle in which the antibiotics have been used.
  15. Return to the office for post-operative treatment and suture removal. Feel free to contact us if any doubt arises concerning your progress and recovery.
  16. For after hours emergencies, please call the Physician’s Exchange: Honolulu Office Phone Number (808) 973-3747.