After Tooth Extraction

MEDICATIONS

You may have received a prescription for any of the following:

Pain medications, antibiotics, anti-inflammatories or on oral rinse.

Please have the prescription filled at a pharmacy on your way home from the facility.

The antibiotics should be started on the day of surgery, usually within two to four hours following surgery. The oral rinse should be started the day following surgery.

 Antibiotics and pain medications should not be taken on an empty stomach as they may produce nausea and vomiting.

Please always take medication with non-dairy and dairy products such as: chocolate milk, yogurt, soymilk, almond milk, or lactose-free milk. Nausea and  vomiting may also be caused by blood in the stomach. If the nausea persists, you may use Gravol®, which can be purchased at your local pharmacy. If vomiting is active , o rectal suppository is the preferred administration of Gravol®. If an allergic reaction occurs to any of the medications, stop all medications and call our office. If the reaction is severe, causing difficulty swallowing or breathing, proceed to the nearest emergency deportment or call 911 .

PAIN

Postoperative pain is normal after any surgical procedure. The local anesthetic (freezing) that was used during the procedure will last 4 to 6 hours. It can last for as long as up to 20 hours. Prior to leaving, you will receive a dose of pain medication from the recovery room nurse. Continue taking the prescription pain medication regularly for the next 20 hours or until the freezing wears off. As long as the pain continues, follow the nurses instructions on the use of non-prescription and prescription pain medication. Postoperative pain usually peaks within 48 to 72 hours. It is expected that the pain will level on the fourth day and gradually decrease. An increase in pain after the fourth day may indicate the presence of a problem that may require professional care. Should this happen, please contact our office. A throbbing, shooting pain or an earache four or more days following surgery may indicate the development of a “dry socket”. If you experience this, please contact our office to have the issue addressed.

CONTROL OF POSTOPERATIVE BLEEDING

It is normal to bleed or ooze for some time following oral surgery. It is also not unusual to have blood on the pillow or in the saliva for three to four days after surgery. To control bleeding from the extraction socket, it is necessary to place the gauze directly over the surgical site and apply firm pressure. Change the gauze every 30 to 45 minutes until only pink staining or spotting is present on the gauze. At this point, the gauze is no longer required. To drink, eat, and sleep, remove the gauze from the area. If oozing continues or recurs, the following days, reapply gauze with firm pressure on the site until bleeding stops.

If you are having difficulty controlling the bleeding, or run out of gauze, you may purchase more gauze. Do not chew the gauze. A constant firm pressure is most effective in controlling the bleeding.

It is important to note that for wisdom teeth surgery, the gauze must be folded and placed directly behind the lost molar tooth. If it is not placed directly over the bleeding site, it may act as a wick and appear that you  are  bleeding significantly more than you are.

SWELLING AND STIFFNESS

Swelling and stiffness con occur following the removal of teeth and all minor oral surgery. This is a response to the surgical trauma created by the removal of the tooth/teeth. The swelling should be at its maximum on the 3rd To minimize the amount of swelling, ice packs should be applied to the face for the first 72 to 96 hours. The ice pack should be applied to the face constantly (3 to 4 days). After the fourth day, cold is not effective. A gentle facial massage with a warm cloth should be used to start bringing swelling down. It should be used for 15 to 20 minutes every 3 to 4 hours while awake. It is important to exercise the jaw. This should take 15 to 20 minutes with movement to  the left and right, forward and vertically opening. In most cases, the swelling should resolve within 5 to 7 days. In more extensive surgery, the swelling  may persist longer.

If the swelling increases or is persistent after 4 to 5 days, this may be a sign of infection. It is very important that you contact our office to determine what is going on and whether you require an appointment. If the swelling is persistent and on elevated temperature is present, this is a sign of a postoperative infection. A slight temperature for 2 to 3 days following surgery is normal. Careful attention to oral hygiene will greatly reduce the possibility of infection.

DISCOLORATION OF THE SKIN

Bruising of the facial tissues following oral surgery is not uncommon. The bruising may occur within the first to 7 days and may appear dark purple to greenish-yellow color. The bruising occasionally migrates into the neck or upper chest area and normally will disappear in 7 to 10 days. Gentle massage with a warm face cloth for 15 minutes each waking hour will aid in a gradual return to normal.

DIET AND NUTRITION 

Following oral surgery, your body requires adequate fluids and nourishment. While your jaw is frozen, drink only liquids or foods that require little or no chewing, such as Jell-O, pudding, yogurt, applesauce, juices, or pop. You should drink 2 to 4 liters 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 normally get stuck in the teeth. These include potato chips, popcorn, nachos, nuts, and anything with seeds. These foods ore easily lodged into the socket and are difficult to rinse out and may lead to infection. Avoiding these foods for 12 to 16 weeks is advised.

SMOKING

Smoking is discouraged for a period of at least 6 weeks post-surgery. Smoke contains chemicals that will retard healing. It may lead to increased bleeding, an increase in postoperative infection, wound breakdown and the development of dry socket.

SUTURES

Self-Dissolving sutures are routinely used. They will release or begin to dissolve within 1 to 10 days. They may take as long as a few weeks to a few months to fully dissolve. Occasionally, non -dissolving, sutures ore used. They will require removal 7 to 21 days following surgery. You will be notified if non-dissolving sutures were used for your surgery.

ORAL HYGIENE 

Rinsing should be started the day following surgery. Rinsing with mouthwash (may be  diluted 50/50) should occur every 2 to 3 hours while awake. Rinsing should follow all meals for eight weeks. The purpose of rinsing is to remove all food debris from the sockets, particularly from the lower jaw.

 If you have been provided with a Monoject syringe, fill with mouthwash, place the rip directly over the surgical sites, and flush the area. You may use a WaterPik set on the lowest setting. You may notice food debris being washed from the surgical sites for a period of time and this is normal.

TEMPORARY NUMBNESS OR TINGLING

Because of the position of the roots of many impacted teeth and their relationship to the sensory nerves in the lower jaw, there may be a change in normal sensation of the lip, chin, teeth, tongue and/or gums. Numbness and tingling may occur for  several weeks, months or as long as 2 years. In extremely rare occasions, normal function does not return.

INTRAVENOUS SEDATION AND GENERAL ANESTHETIC PATIENTS

Patients who have had general anesthetic may experience muscle pains, especially around the neck and shoulders, although this can occur anywhere including chest, back, legs, and arms. The pain is often like that which occurs after heavy exercise. It is caused by on anesthetic drug. Although it is inconvenient and uncomfortable, it is not unusual or dangerous to experience these symptoms. The stiffness and discomfort usually lasts for only 2 to 3 days but can linger for up to one week. It is best treated by rest, heat, and postoperative pain medications. Patients that have had a general anesthetic will have had a  nasal-breathing tube while they were asleep. It may appear that you have had a nosebleed or your nose may be stuffy. It is recommended that you NOT blow your nose on the day of surgery. Nasal sprays or decongestants may be used to relieve these symptoms. It is not uncommon to have a sore throat from this tube. The sore throat is best treated with your pain medication, plenty of fluids and lozenges such as Bradosol or Sucrets.

IV SITE – Most patients will have had an Intravenous started (IV). Occasionally patients will experience slight discomfort or bruising at the IV site. This is normal. If redness or discomfort persists at this IV site for more than 7 days, please call the office.

HERE ARE A FEW THINGS THAT MUST BE OBSERVED

DO NOT leave patient alone until the morning following surgery .

ABSOLUTELY NO driving or operating any machinery for the first 24 hours following surgery.

ABSOLUTELY NO alcohol or recreational drugs while taking pain medication.

If you have any questions or problems, please do not hesitate to contact our office. Please call during regular office hours (8 a.m. to 4 p.m.). The phone number is 780-454-6565, or 1 -800-379-9474. After hours, the answering service will receive your call. If there is a delay in answering, please hang up and call again in five minutes. High call volumes con occupy the incoming line.

There is on Oral and Maxillofacial Surgeon available for after hour emergencies. Emergency calls only. Please be considerate of the fact that the surgeon covers calls from the entire Edmonton region including many hospitals and may be attending the needs of other patients. The surgeon will respond to your call as promptly as possible. He may be in the operating

room and his response may be delayed. Please call the afterhours on-call oral surgeon only when you perceive on actual emergency condition. Routine questions and clarifications can be best handled during normal office hours.

Please advise Kingsway Oral and Maxillofacial Surgery Immediately should you (the patient) be admitted to the hospital for any reason within 10 days following your surgery.