Surgical Instructions

• Before Anesthesia
• After Implants
• After Wisdom Teeth
• After Exposure
• After Extractions
• After Multiple Extractions

After Wisdom Tooth Removal

The removal of impacted teeth is a complicated surgical procedure. Post-operative care is very important. Pain can be controlled and Post-operative problems can be minimized if instructions are followed appropriately.

Immediately Following Surgery

The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded if there is no active bleeding in the surgical site. Remember the old gauze will always appear bloody, the surgical site must be visualized to asses bleeding. If bleeding persists simply replace your old gauze with the new gauze provided. Repeat until bleeding ceases. Typically this takes 1 - 6 hours.

Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.

Take the prescribed pain medications before you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.

Restrict your activities the day of surgery and resume normal activity when you feel comfortable.

Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues beyond 6 hours, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag may help to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling

Swelling is normal and is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgical trauma. The swelling will not become apparent until the day following surgery and will not reach its maximum until two to three days post-operatively. It usually takes three to five days from that point to resolve. However, swelling may be minimized by the immediate use of ice packs. Two plastic bags filled with ice, commercial ice packs or frozen peas should be applied to the sides of the face where surgery was performed. The ice packs should be used continuously while you are awake, 20 minutes on and 10 minutes off. After 36 hours, ice has no beneficial effect. Thirty-six hours following surgery, the application of moist heat to the affected side may be beneficial in reducing the size of the swelling.

Pain

For moderate pain, one or two tablets of Extra Strength Tylenol may be taken every three to four hours or ibuprofen (Motrin or Advil) two to four 200 mg tablets may be taken every six to eight hours.

For severe pain, take the narcotic prescription as directed. This medication will cause drowsiness and slow your reflexes. Do not drive an automobile or operate machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside with each successive day. If pain persists rather than resolving daily call the office.

Diet

Eat soft foods and chew away from the surgical site(s). Food should be warm to cold, hot foods will promote bleeding. High calorie, high protein intake is very important. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least five to six glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.

CAUTION: If you suddenly sit up or stand from a lying position, you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

Keep The Mouth Clean

No rinsing, spitting or brushing, of any kind should be performed until the day following surgery. The day after surgery you should begin rinsing at least five to six times a day with a cup of warm water mixed with a half teaspoon of salt .Do not use mouthwash unless recommended by the doctor. Resume brushing after meals and at bedtime.

Discoloration

In some cases, discoloration of the skin accompanies swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the resolution of the discoloration.

Antibiotics

If you have been placed on antibiotics, take as directed. Antibiotics will be given to treat or to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and call the office.

Nausea & Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including prescribed medication You should then sip on Coke, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and resume taking all medications as prescribed. If nausea persists call the office.

Other Complications

If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. Call the doctor if you have any questions.

A slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen may be taken to reduce the fever.

Rapid movements can cause dizziness. Change position slowly and deliberately. If sedated, you were not able to eat or drink prior to surgery and it is difficult to take fluids postoperatively. Dehydration is common. Taking pain medications can also make you dizzy. You could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and then get up.

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. These projections usually smooth out spontaneously. If not, they can be removed by your doctor.

The corners of your mouth may have been stretched during surgery. Your lips should be kept moist with an ointment such as Vaseline.

Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in two to three days.

Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event that will resolve in time and responds to moist heat.

Finally

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia . It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.

The pain and swelling should subside with each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call the office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean especially after meals with salt-water rinses or a toothbrush.

Each case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problems with the doctor.

Brushing your teeth is okay – just be gentle at the surgical sites.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur two to three days following surgery. Call the office if this occurs.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.