Post Op Instructions

Surgical Instructions Section

Before Intravenous Anesthesia or Sedation

• You may not have anything to eat or drink (including water) for eight (8) hours prior to the appointment.
• No smoking at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery.
• A responsible adult must accompany the patient to the office, remain in the office during the procedure, and drive the patient home.
• The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
• Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and low-heeled shoes. No flip-flops shoes, please
• Contact lenses and dentures must be removed at the time of surgery. Jewelry and valuables are to be left at home.
• Do not wear lipstick, excessive makeup, or nail polish on the day of surgery.
• If you have an illness such as a cold, sore throat, stomach or bowel upset, please notify the office.
• If you take routine oral medications, please check with your doctor prior to your surgical date for instructions. In most instances, you should take your routine medications, unless you are otherwise instructed.

After Wisdom Tooth Removal

The removal of impacted teeth 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 instructions are followed carefully.

Immediately Following Surgery:

• The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and replaced periodically until bleeding is minimal.
• Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
• Take the prescribed pain medications as before you begin to feel discomfort. This will usually coincide with the local anesthetic wearing off.
• Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controled, by biting firmly on gauze pad and wiping any clots from your mouth. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding sit upright, avoid excess exercise, and do not become excited. If bleeding does not subside, call for further instructions.

Swelling

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 and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively and may last 6-7 days. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice and wrapped in a towel, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously, as much as possible, while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm, unless the swelling worsens or does not go away. This is a normal reaction to surgery. Thirty-six hours following surgery the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

For moderate pain, two tablets of 200mg Ibuprophen (Motrin or Advil) may be taken every four hours. If you are unable to take Ibuprophen, Tylenol may be taken instead, according to the package directions. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.  Before combining non-prescription pain medication with your prescription pain medication check with your doctor first.

For severe pain take the tablets prescribed for pain as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If severe pain persists, more than 3-4 days, it may require attention and you should call the office.

Diet

After general anesthesia or sedation, liquids should be taken at first. Do not use straws. Drink from a glass. 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. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, have less discomfort and heal faster if you continue to eat.

Caution: If you suddenly sit up or stand from a lying position you may become dizzy. Therefore, immediately following surgery, if you are lying down, make sure you sit for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be done until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin gently rinsing four times a day, especially after eating, with an 8 ounce cup of warm water mixed with one-half teaspoon of salt.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics take the tablets or liquid as directed. Antibiotics may be given to help prevent infection, but are not always necessary or helpful. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions, or if reaction to your medication occurs.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. Dramamine, an over-the-counter medicine indicated for motion sickness, will usually alleviate nausea and vomiting.

Other Complications

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, 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 it so be careful. Call the office if you have any questions about this.
• Slight elevation of temperature 24-48 hours following surgery is not uncommon. If the temperature persists, notify the office.
• You should be careful going from the lying down position to standing. As you were not able to eat or drink prior to surgery, and it is difficult to take fluids, and taking pain medications can make you dizzy, you could get light headed when you stand up suddenly. Before standing up, 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 supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by your Doctor.
• 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.
• Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
• Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.

Finally

• Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. If they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will come out on their own within approximately one week after surgery.
• The pain and swelling should subside more and more begining the 2nd or 3rd day after surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions.
• There will be a cavity or hole where the tooth was removed. The cavity will gradually over the next month fill in with new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses. An irrigation syringe may be given for use after your post operative visit.
• Your case is individual, no two mouths are alike. Do not take seriously well-intended advice from friends. Discuss your problem with the person best able to effectively help you: Your Doctor.
• Brushing your teeth is okay - just be gentle at the surgical sites.
• A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. Call the office if this occurs.
• If you are involved in regular exercise, be aware that your normal nourishment intake is reduced and exercise may weaken you. If you get light headed stop exercising. Routine exercise should not be performed for the first three days following surgery.

After Exposure of an Impacted Tooth

Do not disturb the wound. If surgical packing was placed leave it alone. The pack helps to keep the tooth exposed. If it gets dislodged or falls out do not get alarmed. It does not have to be replaced.

Bleeding

• Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding which results in your mouth filling rapidly with blood can frequently be controlled by biting with pressure on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding persists, bite on moistened tea bags. If bleeding continues after these measures, please call for further instructions.

Swelling

• Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag or a plastic bag or towel filled with ice cubes on the cheek in the area of surgery. Apply the ice continuously as much as possible for the first 24 hours.

Diet

• Drink plenty of fluids. Avoid hot liquids that could burn the mouth while still numb. Liquids and very soft food should be taken on the day of surgery. Return to a normal diet as soon as tolerated unless otherwise directed.

Pain

• You should begin taking pain medication as you feel the local anesthetic wearing off. For moderate pain, Ibuprofen (Advil, Motrin) may be taken and should be started when you get home. Ibuprofen bought over the counter comes in 200 mg tablets: 2 tablets may be taken every 4 hours as needed for pain. If you are unable to take ibuprofen, Tylenol may be taken according to package directions. For severe pain, the prescribed medication should be taken as directed, as the numbness begins to wear off. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.  Before combining non-prescription pain medication with your prescription medication check with your doctor first.

Oral Hygiene

• Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can. Rinse with warm salt water (1/2 teaspoon of salt in an 8 ounce glass or cup of warm water) four times a day. Continue this procedure until healing is complete. REMEMBER: A clean wound heals better and faster.

Activity

• Keep physical activities to a minimum immediately following surgery. If you are considering exercise, pain or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment which may weaken you, and exercise should be avoided the first three days following surgery.

After the Removal of Multiple Teeth

• A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding continues, a moist tea bag can be used for 30 minutes. You should avoid hot liquids and exercise. Keep your head elevated. If bleeding persists call the office.
• If an immediate denture has been placed, do not remove the dentures unless the bleeding is severe.  Expect some oozing around the sides of the denture.
• Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 24 hours only. Apply ice continuously while you are awake. Wrap ice in a towel so it is comfortably cool.
• For mild discomfort use Ibuprofen; two tablets every 4 hours. If you are unable to take Ibuprofen, take Tylenol according to package directions.  Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.  Before combining non-prescription pain medication with your prescription pain medication check with your doctor first. 
• For severe pain use the prescription given to you. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, finish your prescription.
• Drink plenty of fluids. If many teeth have been extracted the blood lost during surgery needs to be replenished by drinking plenty of fluids. Drink at least six glasses of liquid the first day.
• Do not rinse your mouth for the first post-operative day.  After the first day, use a warm salt water rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One half teaspoon of salt in an 8 ounce glass of lukewarm water.). Beginning the day after surgery, dentures should be removed and cleaned, and the mouth rinsed at least 4 times a day. Replace the denture immediately after rinsing.
• Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal you will be able to advance your diet.
• The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:
  • The area operated on will swell, reaching a maximum in three days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied beginning 36 hours after surgery (remember ice packs are used for the first 24 hours only).
  • A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
  • If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline. There may be a slight elevation of temperature for 24-48 hours. If temperature continues, notify the office.
  • If immediate dentures have been inserted, sore spots may develop. In most cases your dentist will see you after surgery and make the necessary adjustments to relieve those sore spots. If dentures are not adjusted, severe denture sores may occur, and may prolong the healing process.

After Placement of Dental Implants

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There may be a metal healing abutment protruding through the gingival (gum) tissue.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. A moistened tea bag may also be applied if bleeding persists. If bleeding continues please call for further instructions.

Swelling

Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, or a plastic bag or towel filled with ice on the cheek in the area of surgery. Apply the ice continuously, as much as possible, for the first 24 hours.

Diet

Drink plenty of fluids. Avoid hot liquids or solid food the first day. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as tolerated unless otherwise directed.

Pain

You should begin taking pain medication as you feel the local anesthetic wearing off. For moderate pain, Ibuprofen (Advil or Motrin) may be taken. Ibuprofen, bought over the counter comes in 200 mg tablets: 2 tablets may be taken every 4 hours as needed for pain, and should be started when you get home. If you are unable to take Ibuprofen, Tylenol may be taken according to package directions. For severe pain, the prescribed medication should be taken as directed, as the numbness begins to wear off. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it. Before combining non-prescription pain medication with your prescription pain medication check with your doctor first. 

Antibiotics

If an antibiotic has been prescribed, be sure to take the antibiotics as directed to help prevent infection.

Oral Hygiene

Good oral hygiene is essential to good healing. Warm salt water rinses (1/2 teaspoon of salt in an 8 ounce cup of warm water) should be used at least 4-5 times a day, especially after meals. Brushing your teeth and the healing abutments is no problem. Be gentle initially with brushing the surgical areas.

Activity

Keep physical activities to a minimum immediately following surgery. Routine exercise should be avoided for the first three days after surgery. If you are considering exercise, pain or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.

Wearing your Prosthesis

Partial dentures, or full dentures should not be used for chewing immediately after surgery or until you are so instructed by your doctor. Do not wear any false teeth over implants until authorized by your surgeon. Please contact the office if you have any questions about when to wear dentures or any type of false teeth over implants.