After the Removal of Multiple Teeth
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
- The gauze pad placed over the surgical area should be kept in place one hour. After this time, the gauze pad should be removed and discarded. If bleeding continues, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding continues, a moist tea bag can be used for 30 minutes and avoid hot liquids and exercise, and elevate the head while lying down. If bleeding persists, call our office immediately. If you have an immediate denture, do not remove it unless the bleeding is severe. Expect some oozing around the side of the denture.
- Do not rinse your mouth for the first post-operative day, or while there is bleeding. Vigorous mouth rinsing or touching the wound area following surgery may initiate bleeding by causing the blood clot that has formed to become dislodged.
- 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. (One half teaspoon of salt in a glass of lukewarm water.).
- For severe pain use the prescription given to you. This will usually coincide with the local anesthetic becoming diminished. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, finish your prescription regardless of your symptoms.
- For mild discomfort use aspirin, Tylenol (325mg)or any similar medication, two tablets every 6 hours.; Ibuprofen (Advil, Motrin) 200mg can be taken 2-4 tablets every 6 hours.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable. • Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 24 hours only. Apply ice continuously while you are awake.
- Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day.
- Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.
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:
- The area operated on will swell reaching a maximum in two days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 36 hours after surgery (remember ice packs are used for the first 36 hours only).
- 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. There may be a slight elevation of temperature for 24-48 hours. If temperature continues, notify our office.
- 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. There may be a slight elevation of temperature for 24-48 hours. If temperature continues, notify our office.
- 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 dentures sores, which may prolong the healing process. After you have seen your dentist for denture adjustment, take out denture and rinse 3 to 4 times a day with the warm salt water rinse.
Commonly asked questions:
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 thirty minutes. Repeat if 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. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.
The swelling that is normally expected 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 surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four to six hours or Ibuprofen, (Motrin or Advil) two to four 200 mg tablets may be taken every 6 hours. For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should start to subside mostly after post-op day 3. If pain persists, it may require attention and you should call the office.
After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 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:
Good oral hygiene is essential to good healing. The night of surgery, if Peridex is prescribed use before bed. The day after surgery, the Peridex should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt water rinses (teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, as well, especially after meals. Brushing your teeth and the healing abutments is no problem. Be gentle initially with brushing the surgical areas.
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.
Nausea and Vomiting:
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.
- 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. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call Dr. Livesay or Dr. Carey if you have any questions.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
- You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute 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 Drs. Livesay or Carey.
- If the corners of your mouth are stretched, they may dry out and crack. 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 2-3 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 which will resolve in time.
Sutures are placed 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 form your mouth and discard it. If the sutures are not the dissolvable type , then they will be removed in 1-2 weeks. The removal of sutures requires no anesthesia or needles. 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 more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call my office for instructions. There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush. Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Drs. Livesay, Carey or your family dentist. 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 3-5 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.
Keep physical activities to a minimum immediately 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.
Wearing your Prosthesis:
Partial dentures, flippers, or full dentures in most cases can be used immediately after surgery. Follow up with your general dentist for adjustments of your partial, flipper or denture. This was discussed in the pre-operative consultation.