After Removal of Teeth (Extractions)
The removal of teeth is a surgical procedure. Post-operative care is very important. Unnecessary pain, bleeding, swelling and other complications can be minimized if these instructions are reviewed and followed carefully.
Instructions
Immediately Following Surgery
The gauze pad placed over the surgical area should be kept in place for a half hour if not removed by our office prior to leaving. After this time, the gauze pad should be removed and discarded. If you are moving around a lot prior to being restful, leave the gauze in until home and rested for about 10 minutes if possible.
Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
Pain and Pain Medicine
You will likely feel some discomfort after the anaesthetic (freezing) wears off. Take the recommended or prescribed pain medication as directed to relieve symptoms. The amount of pain you will have will vary, and may depend on the number of teeth removed and their difficulty. You may notice an increase over 2 to 3 days after the procedure, and this is usually normal. Also keep in mind that your medications may not completely eliminate pain, but should make it manageable. If not prescribed, and you were not warned by your surgeon or family physician otherwise, you may also use ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) as per the instructions on the bottle.
CAUTION
If your prescription medication contains any of these substances (e.g. Tylenol #3), be sure not to take them together or you may exceed the allowable dose. If there is any doubt, please call our office.
The discomfort will probably last at least several days, possibly even 1 or 2 weeks depending on the surgical difficulty and your individual response. In some cases, there may be no discomfort to speak of. If your pain is not tolerable, or seems to be worsening beyond the first three days, please call the office.
After I.V. Sedation or General Anaesthesia
If you had I.V. sedation or general anaesthetic for your surgery, you may not remember much about the procedure. Although you may soon feel awake and alert, the sedative drugs are still in your system for a period of time. It is important that you do not drive a motor vehicle, sign any documents of legal importance, operate any power tools, or do any high-risk activity for 24 hours after surgery. YOU MUST HAVE SOMEONE WITH YOU AT HOME FOR AT LEAST 24 HOURS.
Activity
You should be careful going from the lying down position to standing for the first day. You may not have been able to eat or drink prior to surgery, and it may be difficult to take fluids for a short period of time. Taking pain medications can also make you dizzy. For these reasons you could get light headed when you suddenly stand up, so you should sit for a minute before you get up. You should rest quietly for 24 hours following surgery and avoid vigorous exercise and heavy lifting for at least 3-5 days, particularly if multiple teeth were removed or sutures were required.
Diet
Drink liquids only after general anaesthesia or IV sedation for several hours. Do not use straws, as the sucking motion can cause more bleeding by dislodging the blood clot. Following this, you should eat soft foods (pudding, yogurt, soups, pasta, well-cooked veggies) by chewing away from the surgical sites. Because of the freezing it may be difficult to judge temperature for the first few days, so be careful with hot food/liquid. High calorie, high protein intake is very important. Try to avoid tough or crunchy foods (e.g. potato chips, raw vegetables) until healing seems complete, or be very careful to avoid the surgical sites. You may experience some difficulty swallowing in the first few hours because of the freezing, and for the next several days due to the discomfort. Difficulty opening your mouth widely for several days is normal. Your food intake may be limited for the first few days, but try to maintain a normal intake. You should prevent dehydration by taking fluids regularly. At least five to six glasses of liquid should be taken daily. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat. If you had only one or two teeth removed, and the procedure was relatively easy, you may eat whatever you like as long as you avoid the surgical areas.
Oral Hygiene
No rinsing of any kind should be performed until the day following surgery. Avoid brushing the surgical sites directly for one week. You can brush your other teeth the night of surgery but rinse/spit only very, very gently. The day after surgery you should begin rinsing gently at least five to six times a day with a cup of warm water mixed with a 1/2 teaspoon of salt, especially after eating. Continue rinsing each day until the tenderness is gone. It may take several weeks for the sockets to close over and until then you will probably notice that food gets stuck in them. This may cause bad breath and a bad taste in your mouth. This is normal and will go away with time.
Smoking
Avoid smoking and second hand smoke until the sockets are healed over. This could take 2-3 weeks. If you cannot hold off until then, it is in your best interest to avoid smoking as long as possible after the surgery, and then to minimize it. Smoking may lead to many complications, such as infection and dry socket (see below), and causes prolonged healing.
Antibiotics
If you have been placed on antibiotics, which is not always the case, take the medication as directed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions or concerns.
Sinus Precautions
If you had a perforation or are at high risk of a perforation into your upper jaws sinus due to removal of an upper tooth, you will be informed and given extra instructions to carefully follow. This is unusual, but not rare. These instructions highlight that you need to avoid creating any pressure or suction in your mouth or nose for at least 10 days, typically.
This means no vigorous rinsing, spitting, sucking on straws, blowing your nose, woodwind instruments, and preferably no flying or scuba diving during this time. If you must sneeze, be sure to keep your mouth open and not hold it in. Use a nasal decongestant and antibiotics if directed to do so. If after 2 weeks you feel the sensation of air or liquids passing between your sinus and mouth, please inform the office.
What To Expect
Swelling
Swelling of the face or jaws around the surgical sites is normal after surgery that requires stitches. If no stitches were needed, swelling is far less likely to occur and no particular instruction are necessary. However, if stitches were required and/or the surgery was difficult, swelling will generally increase for one to three days before it starts to slowly decrease. It is very helpful to apply cold or ice compresses to your face in the area(s) of surgery for the first 24-48 hours after the surgery. They can be used continuously while awake, but be cautious not to damage the skin with prolonged direct contact with ice. If your ice pack is very cold or not protectively wrapped, perhaps consider 20 minutes on, 20 minutes off. You may continue to use ice for several days if you feel it helps with the discomfort, but after about 2 days, warm compresses may speed the resolution of swelling.
Bruising
In some cases, discolouration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. It typically develops at the jaw line and may spread down your neck. This is a normal occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the disappearance of bruising.
Both swelling and bruising are extremely variable and unpredictable.
Bleeding
Some minor bleeding is to be expected following surgery, but is rarely serious. Please follow all the instructions in this document to minimize it, and see the Complications section below for more information.
Stitches
If you had stitches placed in your gums they will dissolve and fall out on their own in approximately 1 week. You may experience a few drops of blood in your saliva or minor discomfort when this occurs. If they come out earlier it is not usually a concern unless persistent bleeding occurs. They are harmless if swallowed.
Nausea & Vomiting
This can be due to the surgery itself, sedatives used during the procedure, and/or pain medication. It can even be as a result of unknowingly swallowing some blood after your surgery, which can make you feel nauseous. These feelings are usually normal and will subside over time. In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including any prescribed medicines. You should then sip on ginger ale, tea, or water. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicine again. Ensure you keep up a good fluid intake if recurrent vomiting occurs.
Complications
Bleeding
Immediately after you have a tooth removed, a blood clot will normally form in the tooth sockets or holes. This slows the bleeding and starts the healing process. However, a certain amount of bleeding is to be expected following surgery. You should avoid using a straw, smoking, or actively spitting during the first 24 to 36 hours, because these actions may disrupt the clot, increase bleeding, and delay the healing. Slight bleeding, oozing, or redness in the saliva is not uncommon for the first 2 or 3 days. Blood from your mouth often looks like more than it really is because it gets mixed with a significant amount of saliva. It is also normal to notice a few spots of blood on your pillow the next morning. Remember: what you see is usually mostly saliva with a bit of blood, despite its red colour. It is very important that you avoid putting your tongue, toothbrush, and rough foods (e.g. potato chips, raw vegetables) near the surgical site for several days.
Follow these steps if you think you are bleeding more than normal:
Dampen 2 or 3 gauze pads and fold them lengthwise. If you have no gauze at home you may use the corner of a facecloth or a moist teabag.
Place directly on the surgical site (socket) that is bleeding. Be careful NOT to simply bite on the gauze with the adjacent teeth or pressure will not be applied to the surgical site.
Bite down firmly for 30 minutes to apply pressure to the site.
NOTE: Make sure gauze is directly on the surgical site, not just between the adjacent upper and lower teeth, or adequate pressure will not be applied.
Repeat this procedure two or more times if necessary to stop the bleeding.
To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If this does not stop the bleeding, contact OMS Consultants for further instructions. If you feel the bleeding is extreme and the situation urgent, go to the closest Emergency Department or call 911.
Infection
Infection is very uncommon following extractions that did not require stitches (stitches often indicate more invasive surgery). You may run a mild temperature and feel generally unwell for 1 or 2 days after surgery. You may even feel nauseous and vomit. This can be due to the surgery itself, sedatives used during the procedure, and/or pain medication. These feelings are typically normal and will subside over time. Occasionally, an infection may occur days or even weeks following surgery. If swelling increases after the initial swelling period (2-3 days), or fails to decrease after several days you may have an infection. Typically, persistent or worsening pain also accompanies it. It can feel like a lump, most often along the side of the lower jaw, for an infection associated with a lower wisdom tooth. You may feel unwell and a foul-tasting fluid may drain from the infected site. If you think you may have infection, call the office.
Dry Socket
After a dental extraction, you may experience dry socket. It is recognized by the following symptoms:
The initial pain from surgery is better but then returns, despite no change or even decreased swelling.
It becomes very, very painful.
Pain medication does not relieve the pain.
Pain radiates to the front of the jaw and/or to the ear.
Dry socket occurs almost exclusively in the lower jaw, particularly at wisdom tooth sites. It may be more likely to occur in females, those on birth control pills, older persons, and smokers. Even though the condition is self-limiting and will usually resolve by itself in several days, you may wish to get the socket medicated to reduce the pain. If you think you may have dry socket and want treatment, contact us.
Delayed Healing
This sometimes has a cause such as smoking, but often has no obvious cause and cannot be explained very well. Symptoms are simply prolonged pain or tenderness, despite any clear signs or symptoms or either dry socket or infection. Perhaps a stitch came out early, or a small ulcer or sore has formed, or maybe your body is just taking longer to heal than average. There is no treatment for this, and time alone will allow the healing to eventually proceed and the symptoms to disappear. Delayed healing is diagnosed by excluding the above-described conditions first.
Other Information
If numbness of the lip, chin, or tongue persists beyond the first day or two there is no cause for alarm. 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 the office if you have any questions, or if the sensation persists more than a couple of weeks. In these cases we will usually want to see you back to examine the area.
Occasionally, you may feel hard projections in your mouth with your tongue in the area where the teeth were removed. They are not roots, they are exposed bony walls which supported the tooth. This is far more likely to occur if many adjacent teeth were removed, but is unpredictable and a normal occurrence. These projections usually smooth out, fall out or heal over spontaneously. If not, they can be removed by your surgeon. Occasionally a smoothing procedure may be required after multiple extractions if the areas heal irregularly and may cause sore spots under dentures.
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 or Lanolin.
Remember there will often be a socket, or hole, where the tooth was removed that may be immediately noticeable or may become apparent after several days. The cavity will gradually fill in with new tissue over the next several weeks. In the meantime, you may notice an opening or even some sensitivity on the adjacent tooth. The area should be kept clean with salt-water rinses and a toothbrush while the healing progresses.
Your case is individual. No two people or mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: your OMS Consultants surgeon or your family dentist.
With any questions or concerns, please seek our advice. Your care is our privilege.
