Surgical Instructions

• Office Anesthesia
• After Dental Implant & Bone Grafting Surgery
• After Tooth Removal
• After Biopsy Surgery

After Tooth Removal

Immediately Following Surgery

• The gauze pad placed over the surgical area should be kept in place for 30 minutes. After this time, the gauze pad should be removed and discarded. Extra gauze will be given to you, however new gauze should not be placed unless you feel that there is continued oozing in the area of surgery. See the section on Bleeding. 
• Vigorous mouth rinsing or touching the wound area following surgery should be avoided in the first 48 hours. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
• Taking over the counter or prescribed medications prior to the novacaine wearing off will help to minimize discomfort.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.
• When necessary, dissolving stitches are placed in the area of surgery to help with healing. They will begin to melt at the knot the 3rd day after surgery and you may or may not see them come out.  Sometimes they become dislodged sooner.  This is no cause for alarm. Just remove the suture from your mouth and discard it.
• Restrict your activities the day of surgery. Strenuous exercise should be avoided for 48 hours.  You can resume most activity within 24 hours of surgery.

Bleeding

A certain amount of oozing and "redness" is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a cold water moistened gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. If you need to change the gauze or tea bag more than twice over 60 minutes, call our office for further instructions.

Swelling

Swelling can occur within the first 48 hours after treatment and is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon.  Swelling is usually not seen until the evening or the day following surgery and will not reach its maximum until two to three days after treatment.  Swelling can be minimized by the use of ice packs. Two plastic bags filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect.  Keeping your head elevated during sleep during the first 48 hours is also beneficial.  Although swelling typically subsides by the third or fourth day, jaw stiffness may persist for several days due to inflammation. This is a normal reaction to surgery. The application of moist heat to the sides of the face will help reduce inflammation but should not be started until the fourth to fifth day after surgery.

Medication

Pain medication should be started before the novacaine wears off.  For mild to moderate pain, 1-2 tablets of 500mg acetaminophen (Tylenol) may be taken every six hours or 2 tablets of 200mg ibuprofen (Motrin or Advil) may be taken every four to six hours.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine may make you sleepy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside significantly by the third to fourth day. If pain persists, it may require attention and you should call the office.

If you have been placed on an antibiotic, take as directed. When appropriate, antibiotics are given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

Diet

Liquids are very important after a surgical procedure. Room temperature or cold liquids will help to make the mouth feel the most comfortable and stabilize the blood clots.  Do not use straws when drinking from a glass in the first 24 hours. The sucking motion can cause more bleeding by dislodging the blood clot. Anything too hot in the first 24 hours will promote bleeding.  After the novacaine fully wears off, you can start with yogurts, puddings, jellos, frappes, smoothies, or similar foods.  You can try eating soft foods such as pasta, eggs, mashed foods, etc … away from the area of surgery after 24 hours.  Avoid hard or crunchy foods for 5 days.  Since your food intake will be limited initially, at least five to six glasses of liquid should be taken daily. 

Keep The Mouth Clean

No vigorous rinsing or spitting of any kind should occur in the first 48 hours to prevent dislodging the blood clots necessary for proper healing. You can brush your teeth the day after surgery but rinse gently. After 48 hours you should begin rinsing at least 3-4 times a day with a cup of warm water mixed with a teaspoon of salt (especially after eating) for 1 week after surgery.  The salt water rinses will also help stitches dissolve.

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 may occur two to three days after surgery. Moist heat applied to the area on day 4 or 5 after surgery may help to resolve the bruising more quickly.

Nausea & 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 clear liquids such as apple juice, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin food intake and the prescribed medicine.

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. Care should be taken to avoid biting your lip or tongue as you could bite it and not feel the sensation.  Please call the office to make a follow-up appointment.
• If a large upper molar or upper impacted wisdom tooth is removed, it is important that the sinus cavities are not disturbed during healing.  We recommend that you avoid blowing your nose for 1 week and use Afrin nasal spray, 2 puffs in the nostril on the side of surgery twice a day for 1 week after surgery.
• A slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
• You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery and your fluid intake may be limited immediately following surgery. Taking pain medications can make you dizzy. You could get lightheaded if you stand up suddenly. Before standing up, you should sit for one minute and then get up.
• Occasionally, patients may feel hard projections in the mouth with their tongue. These are not roots; they are the bony walls that supported the tooth. These projections usually smooth out spontaneously. If not, please call the office for an appointment and re-evaluation.
• 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 or Neosporin.
• Sore throats and pain when swallowing are not uncommon due to inflammation. This will subside in two to three days.
• Stiffness of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event that will resolve in time.

Finally

You should experience significant improvement in pain and swelling by day 5 after surgery.  If your post-operative pain or swelling persists or worsens, call the office for instructions.  Delayed or dry socket healing can occur when the blood clot gets dislodged prematurely from the tooth socket.  Symptoms of worsening pain at the surgical site and even pain to the ear two to three days following surgery may indicate delayed or dry socket healing. Call the office if this occurs.