After Dental Extractions
PAIN: Some degree of pain is normal for all patients after the procedure. Pain near the extraction site is, of course, normal, but pain can radiate - so it isn’t uncommon to experience pain in your jaws, TMJ, and ear. Unless contraindicated, we generally recommend taking ibuprofen (also known as Motrin, Advil). If pain is not controlled with ibuprofen alone after 1 hour, you can take EITHER a plain acetaminophen (also known as Tylenol) OR the acetaminophen-narcotic combination painkiller (Norco, Percocet, Vicodin, Tylenol#3 / codeine) to control pain. Do NOT mix plain acetaminophen (Tylenol) if you are currently taking another medication that already contains acetaminophen such as one of the painkillers mentioned above to avoid an acetaminophen-overdose. Lingering pain can/may continue throughout the week and even up to 14 days, but overall, pain should be improving gradually after the first few days after surgery.
Please note: Narcotics are habit-forming medications, so use as little as possible. Please be aware that narcotics cause drowsiness and sometimes nausea; do not drink or drive while on these medications, or combine with other medications that cause drowsiness without speaking to your doctor first. Always consult a physician or your surgeon prior to using any additional medications or methods that were not discussed prior to your discharge.
BLEEDING: Slight oozing of blood from your surgical sites is normal for the first day or so after surgery. In the event of excessive/pulsatile bleeding that cannot be controlled; place plain black tea bags directly over the site and apply firm constant pressure. If the bleeding doesn’t stop or is saturating the occlusive with bright red blood within a few short minutes, inform your doctor immediately and/or report to the nearest emergency room.
If you see something hanging out on top of your extraction site and looks like a blob of grape jelly and is oozing, please completely wipe off that blob (known as a Jelly-Clot), gently rinse with cold water, and bite down on moistened black tea bags for 45 minutes. If no relief, please call our office.
Remember, slight bleeding is acceptable. When the saliva in your mouth is mixed with a small amount of blood, it creates a more drastic appearance than is actually the case (like a drop of red food coloring in a glass of water).
Do NOT spit, smoke, or drink from a straw: these will dislodge the necessary and protective embedded blood clots in the surgery site. When dislodged; bleeding, pain, dry-socket, and a delay in healing can result.
SWELLING: Some swelling is also normal after this surgery. This will peak by about day 3 or 4 after surgery and then should gradually resolve on its own. In order to lessen the amount of swelling, please use Ibuprofen unless you are unable to take it, sleep with your head elevated using pillows, and apply ice packs to your face for the first 2-3 days.
STITCHES/SUTURES: Sutures are placed to help facilitate closure of the gums, reduce bleeding and swelling, and prevent food from seeping into the extraction sockets. Most stitches are dissolvable and are supposed to unravel or fall out on their own. Rarely, we use black-silk stitches, but these need to be removed at your follow up visit. If any of these sutures fall out or unravel before your follow up visit, it is usually of no consequence.
The only two instances where early loss of stitches is concerning is in the presence of excessive bleeding (Call immediately) or if a bone grafting procedure was performed in conjunction with your extraction ( Not an emergency, but do call us first thing during business hours)
CARE OF THE NOSE AND SINUSES: If you had surgery on your upper jaw (maxilla), it is important to know that the necessary surgical treatments occurred in the area in close proximity to your nose and sinuses. You may have even had surgery directly within your sinuses. This is why many patients complain of sinus congestion and difficulty breathing through their nose. This is normal, though it is important to take certain measures to ensure a good surgical outcome and optimize your own comfort.
For the next 4-6 weeks, you should avoid blowing your nose, sneezing through your nose, or bending over.
Remember, Nasal congestion may create a feeling of not being able to breathe. If this occurs, stay calm and take an “over the counter” decongestant to relieve it, like a nasal spray or pill, (if ok with your MD) taking care to following the instructions on the bottle. A humidifier and propping yourself up with pillows at night will also help.
Sometimes minor nose bleeding can occur after nose or sinus surgery; this is common and nothing to be concerned about. The bleeding should be minimal and resolve on its own with some light squeezing of your nose. If the bleeding is excessive or is not stopping, call us immediately.
DIET: Please wait for all the effects of the local anesthesia wear off before you begin to chew anything, liquids are fine. When the anesthesia does wear off, and for the next week, you should only be eating food that is soft/easy to chew. Do NOT eat anything spicy, hot, acidic, crunchy, tough, or anything through a straw.
• A list of foods to avoid and ones that are ok can be found HERE
• Do NOT use straws. Using straws will cause bleeding and dry socket.
• We encourage eating yogurts and/or probiotics while taking antibiotics.
• Always rinse your mouth out gently with water after every meal.
• Chew NORMALLY! Do NOT try to chew one side of your mouth to avoid your surgery site, it will be fine!
HYGIENE: On the day of your surgery – skip all brushing and flossing, but please use a mouthrinse after twice during the day and once before bedtime. The Over-the-counter rinse “Listerine Zero” is perfect. When using mouthwashes/ rinses, do NOT spit (just lean over the sink and let the fluid fall out of your mouth). The following day, you should resume your regular brushing routine, just be gentle near the site of surgery. Bleeding after brushing near the surgery site is normal and is perfectly harmless. It is normal to have a hole in your mouth where the tooth was extracted. The hole may take a couple weeks to completely close up. Try to keep it clean by rinsing your mouth out to avoid post-op infections, bad breath, or bad taste in your mouth from retained food/debris.
ACTIVITY: You should avoid the gym and/or any strenuous activity or exercise for the next 5 days. Light out-of-bed activity (walking, shopping, etc.) starting the day of your surgery is mandatory to prevent blood clots and other pulmonary issues. Most patients are able to return to work/school after two days. Remember, a gradual return to your normal daily activity is the most sensible approach. Smoking is strictly prohibited; smoking will jeopardize the success of your case and can result in delayed healing, infections, implant/graft failure, dry-socket and pain.
WARNING SIGNS OF COMPLICATIONS: Please be aware of these possible complications and inform your doctor if you encounter them. In the event of a life-threatening emergency, or if you cannot reach your doctor, please call 911 and report to the nearest hospital emergency room.
• Numbness/tingling sensation of the lips/chin/tongue 8+ hours after the procedure (Call ASAP).
• Excessive bleeding refractory to pressure over the site (Call ASAP).
• Sensation of water going “up your nose” when drinking or swishing liquids (Call ASAP)
• Pain that has worsened after the 5th day post-surgery (lingering, but improving pain is not concerning)
• Swelling that is so severe that it has extended near your eyes or below you lower jaw bone.
• Fevers > 100.3 measured with a thermometer (after the 3rd day post-surgery).
• Diarrhea (especially while taking antibiotics)
• Nausea ( Especially while taking narcotics like hydrocodone or oxycodone)
• Difficulty breathing or swallowing liquids (Call ASAP)
AFTER-HOUR CALLS:
If you have an extremely urgent matter that cannot wait until the following business day, you can get in touch by calling the office and waiting for the operator’s prompts. If for whatever reason you are unable to reach the on-call doctor, and your issue is extremely urgent, never hesitate to seek consultation at your nearest emergency room.