- DO apply pressure to stop the bleeding by placing gauze directly over the extraction site. Bleeding and oozing is normal for the first 48 hours. Gauze does not need to be maintained for more than 30 minutes if bleeding is controlled.
- DO apply ice packs to your face to reduce swelling the day of surgery (20 mins each side only for today).
- DO eat soft foods, such as yogurt, pudding, applesauce, and Jell-O®. Nothing hot like soup or coffee until the numbness has worn off so not to burn your mouth. It will take a few hours for the anesthetic to wear off, then soups, mashed potatoes, scrambled eggs, and noodles work best for the first few days.
- DO take pain medication and antibiotics as prescribed.
- DO eat something before taking medications to prevent nausea.
- DON’T rinse your mouth or spit for the first day; it could loosen the blood clot.
- DON’T use Listerine; please use only the prescription mouth rinse or warm salt water rinses.
- DON’T drink through a straw.
- DON’T brush the teeth in the area of surgery until the day after surgery. Brush very gently.
- DON’T chew hard or “crunchy” foods in the area of surgery for at least one week.
- DON’T smoke for 1 week.
- DON’T overexert yourself
Do not drive, drink alcohol, or operate any kind of machinery for 24 hours after sedation. You will need a responsible adult to be with you for at least 4 hours after sedation. You should not be left unattended. You should be supported if you try to stand up or walk while still feeling the effects of sedation. Most people want to rest after sedation and should be allowed to do so.
After most procedures, it is advisable to take it easy for the rest of the day. Oftentimes, you should also take the second and third day off. Too much activity early on can cause a setback and prolong recovery. Avoid excessive exertion, working out, athletic competition, and band and choir participation for 3–4 days. Use common sense. If you feel weak or have an increase in pain, swelling, or bleeding, give yourself an additional day or two of rest.
Gently bite on the gauze with firm pressure. While the gauze is out, check the bleeding. If the bleeding continues, place new gauze packs over the surgical sites and reapply gentle pressure. In another half hour, remove the gauze and check the bleeding. Most people will have stopped bleeding by this point and can leave the gauze out. Minimal and intermittent bleeding/oozing is normal. Bleeding should never be severe. If it is, it usually means the packs are not in the proper place. Try positioning new packs and maintain firm pressure. If bleeding persists or becomes heavy, please call our office. If you experience heavy bleeding after office hours, please go to the ER. You may use tea bags to help control the bleeding. Soak the tea bag in cool water, squeeze it out, place over the surgical site, and apply gentle pressure for 20–30 minutes. Tea contains tannic acid that promotes clotting. Activity encourages bleeding. It is important for you to lie down, rest, and remain inactive for the first 24 hours.
Unfortunately, most oral surgery is accompanied by some degree of discomfort. It is not uncommon that pain will radiate forward to the other teeth, the throat, or the ear. You will usually be given a prescription for pain medication. The pain should be controlled with the pain medication that we will prescribe after surgery. Please take the first pill before the local anesthetic has worn off. We find that patients do better if they take the medication on a schedule and stay ahead of the pain. Remember that the most severe discomfort occurs in the first six hours after the anesthetic wears off. If you were prescribed an NSAID (for example, Motrin®/ibuprofen) and a narcotic (for example, Lortab®/hydrocodone or Percocet®/oxycodone), you can generally take these medications at the same time since they are in different classes and are metabolized differently by the body. We would recommend that you at least take the NSAID on a schedule and use the narcotic for breakthrough pain. It is fine to take the narcotic on a schedule if you need to. Narcotic medications can make you sleepy, so it is recommended that you do not drive, work with equipment, drink alcohol, or make important decisions while on these medications since judgment can be impaired.
Exparel® is a long-lasting anesthetic that can be infiltrated into surgical tissues during surgery. This medication reduces the need for post-operative medications, especially narcotics. Many young people are exposed to narcotics at the dentist office, and we recommend the use of Exparel to limit narcotic use. Please ask us about Exparel options before your surgery.
Often there is some swelling associated with oral surgery. The amount of swelling is usually proportional to the amount of surgery involved. Swelling of the cheeks and sides of the face is not uncommon. Remember that the swelling will not reach its peak until the third or fourth day. You can minimize the swelling by using an ice pack applied to the face over the surgical areas. Ice should be used for 20 minutes every couple of hours while awake for the first 24 hours. After this, do not apply ice, but rather, apply warm compresses to the skin over the areas of swelling for 20 minutes 3 times a day to decrease swelling and stiffness.
After the bleeding has stopped, you should begin drinking clear fluids stay hydrated. If you tolerate this well, you may begin taking other fluids including Jell-O, pudding, and ice cream. It is important to take extra fluids while you are healing. Dehydration can complicate your post-operative recovery.
Do not use straws as the sucking motion causes more bleeding.
Do not attempt to chew while you are numb because you may bite your lip.
Avoid very hot food or beverages. Eat any nourishing foods that can be taken with comfort. Over the next several days, you can progress to solid foods at your own pace. It may be a couple of weeks or more before you can eat hard or crunchy foods. It is important not to skip meals. If you take nourishment regularly, you will feel better, gain strength, and heal faster.
Nausea and Vomiting
Nausea and vomiting are not uncommon after surgery and are sometimes caused by anesthesia or pain medicines. Preceding each pain reliever with a small amount of soft food, then taking the pill with a glass of water, may reduce nausea. If nausea occurs, please call us to assist you.
Keep Your Mouth Clean
Keeping your mouth clean after surgery is essential. Starting the day after surgery, rinse with the prescribed Peridex™ or warm salt water (¼ tsp. salt to 8 oz. water) at least 2 or 3 times daily for the next 2 weeks. Repeat as often as you like. You may begin normal brushing and flossing the day after surgery. Soreness and swelling are normal, so brush gently. Be careful around the surgical sites, but please make every effort to clean your teeth within the bounds of comfort.
Depending on the type of local anesthetic used for your procedure, numbness can last for 6 to 8 hours. Do not do any chewing until the numbness of the lip and tongue has worn off. We do not want you to chew your tongue or lip while still numb. If the numbness continues into the next day, please report this to us.
Do not smoke for at least 1 week since this is very detrimental to the healing process.
Historically, antibiotics have been overprescribed. We try to use the latest scientific studies and our best clinical judgment when determining if antibiotics are needed. If you are prescribed an antibiotic, we recommend that you take it on a schedule as prescribed and take the entire course without missing doses.
Signs of infections include pain, firm swelling, and redness of the soft tissue, and the soft tissue may be warm to the touch. Fever is generally a late sign of infection and occurs after other signs have been present. Drainage of a milky white fluid can also occur during infection; however, this is a late sign as well. Infections occur in about 2% of patients after surgery. Infections can occur during the first week or up to a couple of months after surgery. Everyone has bacteria in the mouth. Infections are generally caused by bacteria from the mouth. If you suspect an infection, please call us right away so that we can get you treated.
Alveolar Osteitis (Dry Socket)
Osteitis, known as dry socket, occurs up to 20% of the time. This seems to happen when the blood clot that normally forms in the socket fails to form or is lost prematurely. The bony walls of the socket are then left exposed. Bacteria from the mouth can then colonize the bony walls and irritate the socket. This can lead to inflammation and pain. Uncontrolled pain during the first week after surgery is the main symptom of dry socket. This will heal on its own, but if the pain is intolerable, please call us, and we can get you treated.
Stitches are not required for every procedure. When stitches are required, dissolvable stitches are often used. The stitches will generally dissolve in 5–7 days. If sutures need to be removed, we will give you a return appointment.
Allergic reactions can occur after taking any medication. This includes antibiotics, pain relievers, or even anesthetics. The most common signs of an allergic reaction include rash, hives, and itching. If these occur, you should stop the medication, take an antihistamine such as Benadryl®, and call your doctor. In severe cases of allergy, swelling of the lips, tongue, and throat, a drop in blood pressure, a rapid pulse, as well as difficulty breathing can occur. These are signs of a severe reaction and can lead to shock, unconsciousness, cardiac arrest, and death. If a severe reaction is suspected, it is an emergency, and you should call 9-1-1 to get help right away.
Bruising can occur after oral surgery. Sometimes it may not show up for a few days. Gravity can pull the bruising down to the neck or upper chest.
Cracking at Corner of Mouth
Cracking at the corner of the mouth is common after oral surgery. Keep the area clean with some peroxide, and use Vaseline® or a lip balm after surgery to help this condition to be tolerable while it heals.
If you feel sharp edges in the surgical areas with your tongue, it is probably the bony walls that originally supported the teeth. Every now and then, a patient will have a small piece of dead bone, called a sequestrum, work its way through the gums at the surgical site. This can happen right away or a few months down the road. On their own, these usually just slough, but if it is bothersome, it may require evaluation and removal by your doctor.
Call with Questions
Call if you have any of the following: excessive or persistent bleeding, excessive or persistent swelling, severe or persistent pain, persistent nausea and vomiting, allergic reaction to
a medication, or prolonged numbness. If you suspect an infection or have questions about your instructions, please call 315-405-4005. If you have an emergency after hours, go directly to the Emergency Room.