After Extractions, Surgical Exposure and Other Surgical Procedures

For proper healing to progress after tooth extraction(s), surgical tooth exposure, or other procedures, it is important that a blood clot forms to begin the healing process. Thus, we ask you to bite on a gauze pad for 30 - 60 minutes after the procedure. If the bleeding or oozing persists, place another gauze pad and repeat the process until the bleeding ceases.

Only gentle mouth rinsing should be done on the day of surgery. Avoid unnecessary touching or disturbing of the wound area on the day of surgery. Doing so may initiate bleeding which will prolong the necessary use of the gauze pads.
        
Take the prescribed pain medications as soon as you begin to feel discomfort or as the local anesthesia begins to wear off. Take your antibiotics as prescribed.

Place ice packs to the sides of your face - 20 - 30 minutes at a time - where the surgery was performed for 1 - 3 days as you desire. This will help reduce jaw swelling.

Post-Op Checkup/Follow-up Call  

Dr. Perry or his staff will phone you at home on the evening of your surgery or the next day. This enables him to ward off any problems which may arise following surgery. He is available at all times by phone 937-294-1980; if no answer there, call his cell ph. 937-620-9956. You may or may not receive a post-operative exam appointment within 1 - 2 weeks following your surgery. If you didn’t and need to be seen, please call the office and we will see you as needed. If you do have a post-op appointment, the wounds will be examined and irrigated at that time. Any further instructions will be given as well.    

Bleeding  

Wound bleeding is to be expected for 2 - 18 hours after surgery. Mild bleeding, oozing, or reddish-pink saliva commonly occurs as the bleeding diminishes. Excessive bleeding may be controlled by gentle rinsing, wiping any extruded clots from your wound(s) with a gauze and placing a gauze pad over the area with firm biting pressure for 30 - 60 minutes. Repeat as necessary. Constant removal of the gauze (every 5 - 10 minutes) to check for bleeding will promote more bleeding. If bleeding continues, place a moistened tea bag covered by a gauze pad directly on the wound for  30 - 60 minutes. The tannic acid in the tea bag helps promote clotting. Another “trick” involves rinsing out a fresh gauze pad with hot tap water, wringing it out and placing it over the wound. The heat promotes the clotting reaction as well. Please call the office or Dr. Perry if bleeding cannot be controlled.

Swelling and Jaw Stiffness

Post-operative swelling is a natural body response to surgery and varies greatly from patient to patient. It may peak in 2 - 3 days and may persist for 5 - 7 days. With the removal of molar teeth (especially lower molars), considerable jaw stiffness may occur with very limited jaw opening. It may persist for up to 3 weeks following surgery and will slowly subside. Chewing gum after the first week may help regain normal  jaw opening. TMJ pain or soreness may occur after the removal of difficult impacted or ankylosed teeth. This is due to the placement of a mouth prop for surgical access and the length of time needed to complete such difficult surgery with one’s mouth propped open. TMJ symptoms should resolve with limited jaw opening, a soft diet, and prolonged use of Ibuprofen - an anti-inflammatory pain medication. Please advise the office if you have prolonged  symptoms.

Pain

For mild to moderate pain - take one or two tablets of Tylenol or Extra Strength Tylenol every 3 - 4 hours  - OR - take 2 - 4 Ibuprofen (Advil) 200 mg tablets every 4 - 8 hours.

For more severe pain - take the narcotic tablets prescribed as directed - 1 - 2 tablets every 3 - 4 hours as needed for pain. Do not take Tylenol in addition to the narcotic medication as there is Tylenol in the narcotic medication.  The prescribed pain medicine may make you feel groggy and will slow your reflexes. Do not drive an automobile, operate any machinery or drink any alcoholic beverages while taking narcotic medication. Any pain or discomfort following surgery should subside daily. If pain either persists or increases, please call the office or Dr. Perry.

Diet

You should drink plenty of liquids after oral surgery. Avoid the use of straws and drink from a glass. The sucking action of straws can cause more bleeding  and may dislodge the blood clot. Cool or cold liquids and soft foods are best tolerated following surgery. You may resume eating soft foods by chewing slowly in areas away from the surgical sites. A high calorie, high protein diet is very important. Ensure liquid dietary supplement is helpful. Drink at least 2 quarts of liquid daily for the first 2 - 4 days. Inadequate oral intake of fluids can cause you to develop a fever. You should be voiding (urinating) 5 - 6 times per day. Urine should be pale yellow and almost clear. Dark urine is a sign of dehydration - a dangerous post-operative condition. You may eat most anything that doesn’t cause pain or bleeding as you recover. Avoid eating popcorn for 6 weeks after surgery as it may cause a delayed infection - especially in the lower jaw wounds.

Oral Hygiene/Wound Care

You may brush your teeth and rinse gently on the night of surgery. You may gently clean the surgical site with a Q-tip and mouthwash. Apply Peridex at bedtime only if it is prescribed.The day after surgery you should begin rinsing at least 5-6 times a day (after meals and before bedtime) with a cup of warm water mixed with ¼ tsp. of salt. Continue the warm salt water rinses until all soreness is gone. This may take 2 - 3 weeks. You may begin wound irrigation of any deep, open wound areas/ sockets (especially in the lower jaw) on the 4th - 5th post-op day. Fill the curved tip syringe with a mixture of equal parts warm water and your favorite mouthwash - place the tip half way down into the open wound and flush gently. Repeat at each site and perform this 4 times per day - after meals and before bedtime. Once the socket area has completely healed over, you may discontinue its use. Failing to perform irrigation greatly increases your risk of an infection of the socket and jaw/neck region.

Bruising

In some cases, bruising/discoloration of the skin will occur after surgery. It may appear as shades of black, blue, green, or yellow discoloration and is due to bleeding from the surgery sites beneath the tissues. This is a normal post-operative occurrence which arises 2-3 days post-operatively and may last for 7 - 10 days. Moist heat applied to the area may help accelerate the disappearance of the bruising.

Antibiotics

Take your antibiotic medication as directed. Antibiotics are given to help prevent infection and the prescription should be taken until it is gone. Do not refill your prescription unless directed to do so by Dr. Perry. Discontinue antibiotic usage in the event of a rash or other unfavorable reaction and call the office for further instructions. If you experience increased jaw or facial swelling, redness, difficulty with swallowing or opening, fever or pain, please notify our office at once. Delaying treatment of a deep jaw/neck infection can result in a prolonged hospitalization.

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 medicines. You should then sip/drink Gatorade or clear liquids (water, 7-Up or Sprite) as you are able. You should fill your prescription for Phenergan suppositories and place rectally with a finger cot which the pharmacist will provide. When the nausea subsides you may resume taking oral fluids and your diet as you are able. You may resume your prescribed medicines as soon as possible. If the nausea and vomiting are directly related to the narcotic pain pills, switch to Tylenol or Advil; if caused by the antibiotic, discontinue it and notify the office or Dr. Perry. If vomiting continues, notify Dr. Perry at once. A hospital admission is sometimes necessary for IV fluid replacement and anti-nausea therapy.

Sutures

Dr. Perry normally uses resorbable (self-dissolving) sutures. Please avoid disturbing these stitches with your tongue as doing so will cause even the best-tied sutures to unravel and to be lost prematurely. The sutures will normally last for 5-10 days before being lost. You may carefully trim any long ends with a scissor - or have someone you trust do the same - or call us and we’ll trim them for you. If you swallow any loose sutures, they will simply be digested. If they loosen and/or you remove them from your mouth, just avoid disturbing the wound area. Sutures that are lost in the first 3 -4 days are not normally replaced. Continue gentle oral hygiene and wound care both before and after the sutures have come out.

Dry Sockets

Dry sockets occur when the blood clot in the lower jaw socket(s) dissolves or becomes dislodged prematurely. This causes a constant throbbing dull ache, which is not relieved by pain medication. The onset of dry socket is anytime during the first 5 days following surgery. One cannot sleep or be comfortable at all. If this occurs, please notify the office and you will be seen immediately. Treatment involves the gentle irrigation of the socket and the placement of a resorbable dressing with oil of cloves. This normally provides almost instantaneous relief, which will last until the normal wound healing progresses. The healing of such wounds is normally delayed by ~ 1 week.

Immediate Dentures

Immediate dentures should be left in place following their placement. Leaving a denture out of the mouth for even a few hours can result in tissue swelling and the inability to wear the denture for 5 - 7 days. You may use denture adhesive sparingly if they have poor retention. You should see your dentist within 1 - 2 days of surgery for any necessary adjustments to the bite (occlusion) and/or denture base. Doing so will prevent unnecessary discomfort related to an ulcer of the gum tissue or to a shifted bite. You should contact your dentist directly with any questions related to the above. If the denture is removed for any reason, please soak it in plain water. Avoid the use of a soaking denture cleaner until you have healed completely.

Bonded Brackets and Chains

If you have an impacted tooth that is surgically exposed with a bonded bracket and chain, the gold chain will be tied to your braces on an adjacent tooth. Please take care to avoid both the exposed tooth and the short chain. Clean this area very gently with a Q-tip and mouthwash. Apply Peridex at bedtime, only if it is prescribed. Your orthodontist will see you 1 - 2 weeks after surgery and will remove this chain and will bond a different device to the exposed tooth. He(she) will then decide when to place a guiding force on the tooth to bring it into its proper alignment in the jaw arch.

Other Expectations/Complications

1. If numbness of the lip, chin, or tongue occurs, please advise the office or Dr. Perry.  As was discussed before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you must be cautious to avoid biting either the lip or tongue while chewing.  Dr. Perry will carefully evaluate this condition and advise you of it’s severity and likely long term outcome. Most of these nerve bruises resolve in a few weeks or months - some do not. Dr. Perry will gladly answer any questions which you may have regarding such a condition.
2. Slight elevation of temperature can arise immediately following surgery. If the elevated temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever. Good oral fluid intake is very essential to reduce a fever.
3. You may experience redness and cracking of the corners of your mouth after surgery.  Your lips should be kept moist with an ointment or cream such as Vaseline, Chap Stick, Burt’s Bees, or Aloe Vera.
4. A sore throat and pain with swallowing may occur after surgery.  These symptoms will normally subside in 5 - 7 days.
5. The pain and swelling should gradually subside each day following surgery. If your post-operative pain or swelling increases, please call the office for instructions.
6. There may be a socket/cavity that persists where the tooth was removed. This cavity will quickly heal with new tissue in 1 - 3 weeks.  You may irrigate this daily for the best wound healing - beginning 4 - 5 days after surgery
7. If you have any concerns or questions, please direct them to our staff and to Dr. Perry. Your case is individual, and no two patients are alike. Please do not seek or accept the well-intended advice of friends or family. The entire team that provides your service has many decades of experience; thus we appreciate being able to direct your care in the most efficient and effective way possible.

After the tooth is extracted you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours.
Use the pain medication as directed. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.
It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean.
After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call our office immediately at 937-439-5912.