After Tooth Extraction
HOME CARE INSTRUCTIONS AFTER TOOTH EXTRACTION
General – After any surgical procedure performed in the mouth, one can expect some bleeding, some swelling, some discomfort. Those occurrences will be minimized if these instructions are followed carefully. Sometimes the after effects of oral surgery are minimal, so not all instructions apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office anytime for clarification, (518) 682-6400.
Instructions for the First 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 to 45 minutes). It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning. Before getting concerned, remember that the mouth and its wounds are constantly washed by saliva. What may appear to be excessive blood loss is more likely to be a lot of saliva tinged with a small amount of blood. Bleeding is minimized by not spitting, talking or rinsing. Place a bath towel or plastic bag over the pillow, as drooling is likely while sleeping.
**Remember it is normal to have mild oozing for the first 24 hours**
Avoid – To prevent loss of the clot, you should exercise extreme caution and observe the following. Do Not Disturb the surgical area today. Do Not Rinse vigorously or probe the area with any objects or your fingers. Do Not Smoke for at least 48 hours, since it is very detrimental to healing. Do Not Drink through a straw or spit after surgery for 2 weeks. These actions can pull the blood clot out of the hole where the tooth was, that can lead to a dry socket. It is most common when lower back teeth are removed and happens more often in smokers and women who take birth control pills. A sure sign of a dry socket is persistent, acute pain in the jaw.
Oozing – Intermittent bleeding or oozing is normal for as long as 2 weeks following surgery. It may be controlled by placing fresh gauze over the surgical area and biting down firmly for 30-60 minutes. Make sure the gauze is pressing on the surgical site not just between the teeth.
Steady Bleeding – Bleeding should never be severe. If it is, it usually means that the packs are being clenched between your teeth rather than exerting pressure on the surgical areas. Try replacing fresh packs. If bleeding persists or becomes heavy, you may substitute a tea bag (soaked in cold water, squeezed damp-dry and wrapped in moist gauze) for 60 minutes. If bleeding remains uncontrolled, please call our office.
Swelling – Often there is some swelling associated with oral surgery. Severe cheek swelling is also normal following this procedure. You can minimize swelling by using a cold pack or ice bag wrapped in a towel, and apply firmly to face or cheeks adjacent to the surgical area. This should be applied 20 minutes on and 20 minutes off during the first 72 hours after surgery. After 72 hours, if the swelling is decreasing, it is best to switch from ice to moist heat, otherwise continue ice. Remember most swelling occurs on the second and third days after surgery.
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 better manage post-operative pain. If you do not achieve adequate relief at first with the non-narcotic pain medications, you may supplement with the narcotic medication. Some patients find that narcotic 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. Alternating medications is typically more effective than taking both at the same time. Make sure to take prescribed pain medication as directed. Do not drive an automobile or operate heavy machinery while taking narcotic medications. No alcoholic beverages should be consumed while taking these medications.
Nausea – Nausea is not an uncommon event after surgery. Try to keep taking clear fluids and minimize narcotic pain medication. Call us if you do not feel better or if repeated vomiting is a problem. Cola drinks that have less carbon may help.
Diet – Please avoid hot liquids or foods during the first 2 days. A light soft diet with plenty of liquids is recommended. Examples include apple sauce, yogurt, cereals, milk shakes, ice cream, mashed potatoes, pasta and fish. Chew food on the opposite side of the surgical area if possible. Be sure to drink plenty of water (8 glasses/day). Avoid foods like nuts, sunflower seeds, popcorn, etc. that may get lodged in the socket areas. Over the next several days, you can progress to solid foods at your own pace. 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 diabetic, maintain your normal eating habits as much as possible and follow instructions from your doctor regarding your insulin schedule.
Instructions for the Second and Third Days
Oral Hygiene – Keeping your teeth clean after surgery is essential. Do not brush the teeth in the extraction area for 1 week, but do start to gently rinse as directed after 24 hours. Continue to brush and floss as usual outside the surgical area. A glass of warm water mixed with 1 teaspoon of salt is a good rinse for healing. You can do this every 3-4 hours, especially after meals. The cleaner you keep the surgical area, the faster it will heal. Do not use mouthwash for 2 weeks.
Warm Applications – If swelling is decreasing after 72 hours, you may apply warm compresses. Apply compresses to the skin overlying areas of swelling (hot water bottle, moist hot towels, heating pad) for 20 minutes on and 20 minutes off to help soothe those tender areas.
Dry Socket – Occasionally this occurs after a tooth extraction, and results from the blood clot not forming properly during the healing time, leaving the tooth socket exposed. A Dry Socket can be painful and typically develops 5-7 days after tooth extraction. Dry socket can be treated by Dr. Farren. This can be done by cleaning the tooth socket, removing any debris from the hole, and filling the socket with a medicated dressing or special paste to relieve discomfort. You may have to come back to the office every 1-2 days for a dressing change until the socket starts to heal and your pain lessens.
Rest – Sleep works wonders for the body, so take it easy for the rest of the day. Go to bed earlier than usual with your head slightly elevated.
Stitches – If stitches are used, the stitches are usually dissolvable and should disappear in 1-2 weeks.
Healing – Normal healing after tooth extraction should be as follows: The first two 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 don’t see continued improvement, please call our office.