Post-Operative Instructions: Extractions

Care of Mouth After Oral & Maxillofacial Surgery

• Do not rinse or spit for 24 hours after surgery.
• Keep fingers and tongue away from the socket or surgical area.
• Use ice packs on the surgical area (side of face) for the first 48 hours. If not using provided wrap, please apply ice 20 minutes on and 10 minutes off. Bags of frozen peas and corn work well. If you have the Cool Jaw^®, it can stay on the face and does not have to be removed in 20 minutes.
• Swelling will peak the morning of the third day after surgery.
• For mild discomfort, take Tylenol^® or ibuprofen every 6 hours.
• For moderate-to-severe pain, use the medication prescribed to you.
• Drink plenty of fluids (do not use a straw).
• If the muscles of the jaw become stiff, chewing gum at intervals will help relax the muscles, as well as the use of warm, moist heat to the outside of your face over these muscles (after 48 hours).
• After the first post-operative day, use a warm salt-water rinse following meals for the first week to flush out particles of food and debris which may lodge in the surgical area. (^1/2 teaspoon of salt in a glass of warm water. Mouthwash (alcohol-free) can be added for better taste.)
• Diet may consist of soft foods which can be easily chewed and swallowed. No seeds, nuts, rice, popcorn and avoid hard crunchy food for 2 weeks.
• A certain amount of bleeding is to be expected following surgery. Bleeding is controlled by applying pressure to the surgical area using small rolled up gauze for 90 minutes. After that time remove the gauze and then you may eat or drink. If bleeding persists, a moist tea bag should be placed in the area of bleeding and bite firmly for one hour straight. This will aid in clotting blood. Repeat if necessary. If bleeding still persists, call our office.
• We suggest that you do not smoke for at least 5 days after surgery. Nicotine may break down the blood clot and cause a dry-socket. We also recommend avoiding marijuana in all forms for 2 days after surgery.

DAY OF SURGERY

FIRST HOUR: Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not controlled. The packs may be gently removed after one hour. If active bleeding persists, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 30–45 minutes). It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning.

EXERCISE CARE: Do not disturb the surgical area today. DO NOT rinse vigorously or probe the area with any objects. You may brush your teeth gently. Please do not smoke for at least 48 hours since this is very detrimental to healing and may cause a dry socket.

OOZING: Intermittent bleeding or oozing overnight is normal. Bleeding may be controlled by placing fresh gauze over the areas and biting on the gauze for 30–45 minutes at a time.

PERSISTENT BLEEDING: Bleeding should never be severe. If so, it usually means that the packs are being clenched between teeth only and are not exerting pressure on the surgical areas. Try repositioning the packs. If bleeding persists or becomes heavy, you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in moist gauze) for 20 or 30 minutes. If bleeding remains uncontrolled, please call our office.

SWELLING: Swelling is often associated with oral surgery. It can be minimized by using a cold pack, ice bag or a bag of frozen peas wrapped in a towel and applied firmly to the cheek adjacent to the surgical area. This should be applied 20 minutes on and 20 minutes off during the first 48 hours after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed.

PAIN: Unfortunately, most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first pill before the anesthetic has worn off, you should be able to manage any discomfort better. Some patients find that stronger pain medicine causes nausea, but if you precede each pain pill with a small amount of food, chances for nausea will be reduced. The effects of pain medications vary widely among individuals. If you do not achieve adequate relief at first, you may supplement each pain pill with an analgesic such as aspirin or ibuprofen. Some patients may even require 2 of the pain pills at one time. Remember that the most severe pain is usually within 6 hours after the local anesthetic wears off—after that, your need for medicine should lessen. If you find you are taking large amounts of pain medicine at frequent intervals, please call our office. If you anticipate needing more prescription medication for the weekend, you must call for a refill during weekday business hours.

NAUSEA: Nausea is not uncommon after surgery. Sometimes pain medications are the cause. Nausea can be reduced by preceding each pain pill with a small amount of soft food and taking the pill with a large volume of water. Try to keep taking clear fluids and minimize dosing of pain medications, but call us if you do not feel better. Classic Coca Cola^® or 7UP^® may help with nausea.

DIET: Eat any nourishing food that can be taken with comfort. Avoid extremely hot foods. Do not use a straw for the first few days after surgery. It is sometimes advisable, but not absolutely required, to confine the first day’s intake to liquids or pureed foods (soups, puddings, yogurt, milkshakes, etc.) It is best to avoid foods like nuts, sunflower seeds, popcorn, etc., which may get lodged in the socket areas. Over the next several days, you may gradually progress to solid foods. It is important not to skip meals! If you take nourishment regularly, you will feel better, gain strength, have less discomfort, and heal faster. If you are a diabetic, maintain your normal eating habits or follow instructions given by your doctor.

SHARP EDGES: If you feel something hard or sharp edges in the surgical areas, it is likely you are feeling the bony walls which once supported the extracted teeth. Occasionally, small slivers of bone may work themselves out during the following week or so. If they cause concern or discomfort, please call the office.

INSTRUCTIONS FOR THE SECOND AND THIRD DAYS

MOUTH RINSES: Keeping your mouth clean after surgery is essential. Use ^1/4 teaspoon of salt dissolved in an 8-ounce glass of warm water and gently rinse with portions of the solution, taking 5 minutes to use the entire glassful. Repeat as often as you like, but at least 2–3 times daily.

BRUSHING: Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth within the bounds of comfort.

HOT APPLICATIONS: You may apply warm compresses to the skin over the areas of swelling (hot water bottle, hot moist towels, heating pad) for 20 minutes on and 20 minutes off to help soothe tender areas. This will also help decrease swelling and stiffness.

HEALING: Normal healing after tooth extraction should be as follows: The first 2 days after surgery are generally the most uncomfortable and there is usually some swelling. On the third day, you should be more comfortable and, although still swollen, can usually begin a more substantial diet. The remainder of the post-operative course should be gradual, steady improvement. If you do not see continued improvement, please call our office. If you are given a plastic irrigating syringe, DO NOT use it for the first 5 days. Then, use it daily according to the instructions until you are certain the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office where you had surgery. A 24-hour answering service is available to contact the doctor on call after hours. Calling during office hours will afford a faster response to your question or concern. PLEASE NOTE: Telephone calls for narcotic (pain killer) prescription renewals are ONLY accepted during office hours.

DRUG TAKING INSTRUCTIONS

MOTRIN^® OR IBUPROFEN: If you are not allergic to Motrin, you will be given a prescription for this drug. You will be given a concentration of between 400mg and 800mg. Please take this drug every 6–8 hours for 5 days or until you have finished your prescription. This drug will help with the pain and help reduce the swelling.

PERCOCET^®, NORCO^®, VICODIN^®: Unless you are allergic to one of these drugs, you will be given a prescription for one of them. These drugs are strong narcotic pain medications. DO NOT mix them with alcohol, other narcotics, or other drugs without specific permission from your doctor. DO NOT operate machinery or take care of others while taking this medication. These drugs can make you drowsy or nauseated. Take these drugs as prescribed, do not take anymore than that. Take these drugs as you need them only. You may turn in what you don’t use to the pharmacy or to your doctor.

ANTIBIOTICS: You may be given an antibiotic if you have an infection. If you are given an antibiotic, take it all until it is gone as your doctor prescribes it. Be aware that antibiotics can decrease the effectiveness of birth control pills.

AFTER TAKING ANY MEDICATION YOU EXPERIENCE ANY ITCHING OR RASH OR ANY ABNORMAL BODY REACTION, STOP TAKING THE MEDICATION IMMEDIATELY AND CALL YOUR DOCTOR!

SINUS EXPOSURE POSTOPERATIVE INSTRUCTIONS: If you have been giving sinus precautions. Please follow below instructions: Because a close relationship exists between upper teeth and our natural sinus anatomy, a possible communication may develop after extraction of these teeth. In most cases, following the instructions below will assist your healing phase. But the possibility exists that a second procedure may be required to close a communication if it develops between your mouth and the sinus. You may even notice slightly red nasal secretions after blowing your nose. Do not be alarmed.

INSTRUCTIONS TO FOLLOW:

1. Take all prescriptions as directed.
2. Refrain from forcefully blowing your nose for 14 days.
3. Try not to sneeze. If you do, try to keep your mouth open.
4. Do not use a straw for consumption of liquids for 14 days.
5. Refrain from smoking for 14 days, to include cigars and a pipe.
6. Eat soft foods for several days. Chew your food on the opposite side as much as possible.
7. Refrain from vigorously rinsing your mouth for 14 days.

SOCKIT!^® ORAL HYDROGEL WOUND DRESSING INSTRUCTIONS:

• Start using Sockit! the day of your procedure. Apply as often as needed for pain relief, but at least 4 times each day until the syringe is empty for optimal healing.
• Unscrew cap from syringe and attach curved tip. Apply to the affected area. If there is resistance, gently pull back on the plunger and then continue the application.
• Remove the curved tip and rinse with warm water. Recap the syringe and store at room temperature. Do not freeze.
• Do not rinse with a salt solution or any other product, as this will rinse the gel out. Rinse the socket before you place the Sockit!
• Sockit! contains no drugs, is non-toxic, and is safe when swallowed. There are no medical, pharmacological or age restrictions associated with Sockit!
• Store Sockit! at room temperature (between 59 degrees Fahrenheit and 86 degrees Fahrenheit); avoid excessive heat. Do not store in direct sunlight.
• If you have any questions regarding the use of Sockit!, please call our office or visit www.sockitgel.com.