Postoperative Instructions For Extractions

Dental Extraction Medications

You may have received a prescription for any of the following: pain medications, an antibiotic, or an oral rinse. Please have the prescriptions filled at a pharmacy on your way home. The antibiotics should be started within two to four hours following surgery. The oral rinse should be started the following day.

Pain Post-operative

Pain is a normal response of the body to any surgical procedure. The local anesthetic or freezing that was administered during your surgery will probably last from 2 to 4 hours. It is advisable to have pain medication on board prior to the freezing wearing off & pain is actually experienced. You will be given pain medication before you leave, please take another within 2 hours. As long as pain continues, use the pain medications as prescribed. The pain usually peaks in twenty-four to forty-eight hours. On the third day we expect the pain to level off & gradually start getting better. An increase in pain on the fourth day or later can indicate a problem & our office should be contacted. A throbbing or sharp shooting pain along the jaw line, 4 days or more after surgery may indicate the development of an incomplete healing or “dry socket”. This discomfort is easily relieved by a sedative dressing in our office. Please contact our office is this is a concern. Please Note: Pain medications taken on an empty stomach can result in an unsettled feeling and/or nausea & vomiting. This can also be caused by blood in the stomach. Please take food or fluids before your pain tablets. For nausea you should use Gravol which can be purchased at your pharmacy (suppositories are preferable if you are very nauseated or vomiting).

Control of Post-Operative Bleeding

It is normal to bleed or ooze for some time following oral surgery. It is not unusual to have blood on the gauze for the day & night of surgery. It is also not unusual to have blood on the pillow or in the saliva for 3-4 days after surgery. To control the bleeding, the gauze should be placed directly over the surgical site & firm pressure applied. Change your gauze every 30 – 45 minutes until you are seeing very little spotting or pink staining on the gauze. At this point you no longer require the gauze. If the oozing continues or reoccurs the following day reapply the gauze until it subsides. If you’re having difficulty controlling the bleeding, or run out of gauze, you may purchase more gauze or use a regular black tea bag moistened & placed over the surgical sites. Do not chew the gauze or tea bags; a constant firm pressure is most effective in controlling the bleeding.

Swelling & Stiffness

This occurs following almost all extractions & oral surgery. This is nature’s way of aiding the healing process by splinting & resting the surgical site. The swelling is at its maximum on the second or third day, following surgery & begins to disappear on the fourth day. In order to help minimize the swelling, ice packs should be applied for the first 2 – 3 days alternating ice, on & off, 20 – 45 minutes at a time during waking hours. By the third day the swelling should have peaked & cold will not be effective. A gentle massage with a hot face cloth should be used 15 minutes every hour you’re awake for 2 – 3 days. The swelling normally disappears in about a week. At times, swelling is an indication of infection. In such cases the swelling continues to increase beyond the fourth day, or suddenly reappears after initial healing. The patient could feel quite ill, & there is often an elevated temperature. If this should occur, please contact the office. A slight post-operative temperature elevation (for 2 – 3 days) is normal following surgery & anaesthesia. Careful attention to oral hygiene will greatly reduce the possibility of infection. Return of normal jaw movement may take up to 3 weeks; during this time, we recommend jaw exercises to reduce stiffness. These should start the day after surgery. Discoloration of the Skin Bruising of the facial tissues following oral surgery is not uncommon. The bruising may occur within the first 3 – 5 days & may appear dark purple to a greenish yellow color. The bruising occasionally migrates, due to gravity, into the neck or upper chest area & normally will disappear in seven to ten days. Gentle massage with a warm face cloth for fifteen minutes each waking hour will aid in a gradual return to normal. Diet & Nutrition Following oral surgery your body requires adequate fluids & nourishment. While your jaw is frozen, drink only liquids, or foods that require no chewing such as soup, Jell-O, pudding, yogurt, apple sauce, juices or pop. You should be drinking about 2 – 3 litres a day for the first few days. Once the freezing has worn off start with a soft diet, pasta, eggs, ground meat, casseroles, cooked vegetables, fish, chicken, etc. A gradual return to your regular diet as you are able to tolerate it is recommended. Avoid foods that break down into hard crunchy bits, chips, popcorn, nachos, pretzels, whole grain or crusty breads, seeds, nuts & raw vegetables. These foods are easily lodged in the surgical area, & are very difficult to rinse out, possibly causing an infection. Avoidance of these foods for 1 -2 weeks is advised.

Smoking – is discouraged during the healing period (2 – 4 weeks). Smoke is an irritant & will retard healing. It can increase post-operative bleeding & lead to increased risk of infection & dry sockets.

Sutures – Self dissolving sutures are routinely used. These will release or dissolve in 1 – 10 days. Loose sutures may be gently removed with tweezers or the long ends can be carefully trimmed.

Oral Hygiene

HYGIENE IS ESSENTIAL TO REDUCE INFECTION & ENHANCE HEALING. Rinsing should be started the day following surgery. Rinse frequently, first thing in the morning, following all meals, & before you go to bed. Gently swish rinse with warm salt water (1 tsp. Salt to an 8 oz cup of water). If salt water cannot be tolerated you may use a non-alcohol-based mouth wash (diluted half & half with water) or at the very least plain tap water. If you’ve been provided with a syringe, you may fill it with rinse solution then place it directly over the surgical sites or sockets & flush the area as necessary. You may notice food debris being washed from the surgical sites for a period of time. This is normal. Some people will have a prescription rinse, which should be used following the salt water rinses. It should be used 4 times a day until finished.

Temporary Numbness or Tingling in the Lip or Tongue Due to the position of many impacted teeth, sensory nerves supplying the lip or tongue are occasionally involved during surgery. Numbness or tingling or an altered sensation in the lower lip &/or tongue can occur requiring several weeks, months or even up to 2 years for normal function to return. In extremely rare situations, normal sensation does not return.

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