Oral surgery is often is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the above instructions are followed carefully. The following information may be helpful.
Slight bleeding, oozing, or redness in the saliva is not uncommon for several days. Also an occasional bleeding episode can occur during the first week and is not of great concern if it can be readily controlled. Bleeding can be controlled by first rinsing or wiping any old clots from your mouth, then placing a tightly folded gauze pad over the bleeding area and biting firmly for 30 minutes. Be sure that the biting pressure is applied to the surgical site and not on adjacent teeth – it will probably hurt if it is in the right place. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. Tannic acid in the tea bag helps form a clot by contracting blood vessels. To minimize further bleeding, sit upright, avoid exercise and do not become excited. If bleeding does not subside, call the office.
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. Swelling will not become apparent until the day following surgery and will not reach its maximum until 2-4 days post-operatively. 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 can be left on continuously while you are awake. After 36 hours, ice has no beneficial effect.
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four hours or Ibuprophen, (Motrin or Advil) two-four 200mg tablets may be taken every 3-4 hours. Do not mix alcohol with Tylenol or other pain medications and if you have any medical condition you must be aware of the manufacturer’s precautions.
Be careful not to overdose on Tylenol. The maximum daily dose is 4 grams in 24 hours (8 extra strength or 12 regular strength). Tylenol must be stopped if you take the prescription pain medication unless you know it does not contain Tylenol (most of them do).
Effective pain relief can often be achieved by using over the counter Ibupropfen (Advil or Motrin). Take three Advil (200mg) every 6 hours. This can be taken in addition to most prescription pain medications since few contain Advil. Advil will provide an added pain relief benefit to the prescription medications. Advil is much more effective if taken consistently - be sure to take 3 Advil every 6 hours. You may be given a prescription for Motrin to use instead of over the counter Advil.
For severe pain take the tablets prescribed for pain as directed. Try to have food on your stomach to prevent nausea. Do not drive or work around machinery - the prescription pain medicine will make you groggy and slow your reflexes.
A dry socket is when a blood clot comes out or is dislodged from a socket about 4-5 days after surgery. It is not known why this happens. A blood clot protects the socket just as a scab protects an injury on the skin. Losing the blood clot from a socket is similar to pulling a scab off early. The jaw bone under the blood clot is no longer protected and it hurts. An untreated dry socket will remain painful for a week or more beyond the normal recovery from the surgery. Dry sockets cannot be prevented but following post-operative instructions will reduce your chances of getting one.
If pain in the lower jaw becomes more severe about 4-5 days after surgery, you may have a dry socket. A dry socket is not an infection and will heal normally on its own but the pain must be managed. Prescription pain medications are usually inadequate but placing a medicated gauze dressing into the socket is very effective. The medicated dressing controls the pain very well but the dressing may have to be replaced every few days to effectively control pain. When dressings are no longer needed (usually 5-7 days of treatment) they are removed and the socket heals normally.
After general anesthetic or I.V. sedation, cool liquids should be taken first and used until the numbness wears off. Do not use straws – 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. Take plenty of fluids regularly to prevent dehydration. Your food and liquid intake will be limited for at least the first few days so you should compensate for this by increasing intake. Try not to miss a single meal and supplement between meals with a snack. You will feel better, have more strength, less discomfort and heal faster with proper nutrition.
No rinsing of any kind should be done until the day following surgery The blood clots need time to form and harden. You can brush your teeth the night of surgery but rinse very gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating.. Rinse with salt water made from 1 teaspoon of salt in an 8 ounce glass of warm water.
Do not probe into sockets or use an irrigation devise for one week. Blood clots loose their red color in saliva and may appear as food debris – leave them alone! Even if food particles are caught in the socket and are not removed with rinsing they will soften in the saliva and be removed the next time you rinse. If your sockets look like they are trapping food when you come in for your follow-up visit we will give you a special syringe to wash out the sockets. This is usually necessary for wisdom teeth and you may have to rinse for several weeks or until the sockets fill in.
In some cases discoloration of the skin follows swelling. The development of black, blue, green or yellow discoloration is due to blood spreading in the tissue. This is an uncommon but normal post-operative occurrence which may happen 2-3 days post-operatively. This is cosmetically undesirable but is seldom harmful. Moist heat applied to the area may speed recovery.
Antibiotics will be given to treat an active infection or in some cases to prevent infection. Take the antibiotics you have been prescribed as directed. Do not discontinue the antibiotic until the prescription has been completed unless you develop a rash or other unfavorable reaction. Call the office if you have any questions.
Nausea and vomiting can be reduced by:
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medication. Then you can start sucking ice chips or sipping water, coke, tea, ginger ale or Gatorade. Don’t rush eating but when nausea subsides begin taking solid foods. Avoid prescription pain medications as long as possible.
If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary. You should be aware that if your lip or tongue is numb you could bite it and not feel it so be careful.
Slight elevation of temperature following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or Advil should be taken to reduce the fever.
Be careful going from lying down to standing. Anesthetics, lack of fluids and medications can make you dizzy. You could get light headed when you stand suddenly. Before standing 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 support the teeth. These projections usually smooth out spontaneously. If not, they can be removed by the doctor.
If the corners of your mouth are stretched, they may dry out and crack. Keep your lips moist with an ointment such as Vaseline.
Sore throats and pain when swallowing are not uncommon. The muscles get swollen. This will subside in 2-3 days.
Stiffness of the jaw muscles (trismus) may cause difficulty in opening your mouth for a few days following surgery.
This is normal and will resolve in time.