After Extractions and Denture Placement
After Removal of Multiple Teeth and Denture Delivery General Anesthesia/IV Sedation Patients
Patients who received a general anesthetic or an intravenous sedation should return home from the office immediately upon discharge. Lie down on your side with the head elevated until all the effects of the anesthetic have disappeared. You should not operate any mechanical equipment or drive a motor vehicle for at least 24 hours or longer if you feel any residual effect from the anesthetic. Watch out for dizziness. Walk slowly and take your time. Sudden changes of position can cause nausea and/or lightheadedness and even fainting. Having someone escort you to the bathroom (and any other necessary activity requiring walking) is a good idea and often necessary.
Do Not Remove Your Dentures(s)
It is very important that you do not attempt to remove your dentures before you see your family dentist for your initial denture adjustment which is generally at 24 hours. Your dentures are seated during your surgery, and the swelling of your gums may make it impossible for your dentist to adjust and replace your denture at the 24-hour appointment if you remove it ahead of that time. There are only two reasons to remove your denture before you see your family dentist the next day, and both are emergency situations. One is uncontrolled bleeding after all other measures have failed, and the other is uncontrolled pain after all other measures have failed. These two situations are exceedingly rare, and thus you should receive direction from our office or the doctor himself before removing your denture.
Your new denture(s) that has been placed should act like a band-aid of sorts over the extractions sites. Therefore firm biting pressure on the gauze that has been placed or even just biting on the dentures themselves is usually enough to establish a nice blood clot within the extraction sites. Please note that oozing of blood from beneath the denture and around the edges is normal. It is normal to see red in your saliva and even have some red on your pillowcase in the morning for up to three days. It is not normal for your mouth to fill up with blood in a few seconds or even minutes, and if this occurs please call the office immediately (918) 392-9970. Firm biting pressure should continue for about 1 hour. During this time it is important that you do not attempt to talk or eat, as these actions can dislodge the denture and/or underlying clots. After the first hour, 20-minute sessions of continuous, sustained pressure followed by a few minutes of rest, are sometimes needed to help further establish the underlying blood clots. Remember some oozing is normal and thus it should not be attempted to completely eliminate all signs of blood.
Swelling & Bruising
Swelling is to be expected and usually reaches its maximum in 48 hours (unless medicine for swelling was given in your IV or to you as a prescription). Once swelling peaks it will take several days to return to normal. You can minimize this by using a cold pack or ice bag wrapped in a towel and applied firmly to face or cheek adjacent to the surgical areas. This should be applied twenty minutes on and twenty minutes off during the waking hours for the first 24 hours after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed. Bruising may also occur but should disappear within 7–14 days. Do not be alarmed at swelling and bruising into the cheeks and underneath the eyes. Bruising (which is really blood just beneath the skin) can also travel down the neck and even into the chest due to the action of gravity. This is all considered normal, especially in those people who are on aspirin therapy. Also, swelling under the eyes is worse on awakening in the morning, and will go down some just with getting up and around.
Unfortunately the removal of multiple teeth with the placement of immediate dentures is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. You should not take a pain pill until you start to feel the effects of the local anesthesia (numbing medicine) begin to wear off. Taking your pain medication too soon can cause over-sedation and nausea. Effects of pain medicines vary widely among individuals. If you do not achieve adequate relief, you may supplement each pill with ibuprofen (unless you have a condition or take other medication in which ibuprofen is contraindicated). Some people may even require two of the pain pills at one time during early stages (but that may add to the risk of an upset stomach). Remember that the most severe discomfort is usually within the first six hours after the local anesthetic (numbing medicine) wears off: after that your need for medicine should lessen.
Nausea is not an uncommon event after surgery, and it is sometimes caused by stronger pain medicines. Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with a large volume of water. Try to keep taking clear fluids and minimize the pain medication, but call us if you do not feel better or if repeated vomiting is a problem. You may also have been given a prescription for nausea medicine.
If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone.
With your brand new dentures in, it is tempting to try and use them to chew. Please do not. Your dentures are not functional yet just after surgery, and some healing will need to take place before you begin to chew with them. You will need to start off with soups, creamed soups, puddings, yogurt, broths, and blenderized food. Your general dentist will guide you in the progression of diet as the adjustment period continues. The temperature of the food doesn’t matter, but avoid extremely hot 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 diabetic, maintain your normal eating habits as much as possible and follow instructions from your physician regarding your insulin schedule.
The sutures (stitches) that were placed in your mouth are dissolvable unless told otherwise. They will dissolve in 7–14 days, but may loosen and actually come out at any time after the procedure. If sutures come out early, it is common, normal, and nothing to worry about. The oral environment is not suture-friendly, and if they come out, they generally do not need to be replaced, unless you have been given other specific instructions. If the stitch is loose, hanging, or bothersome, you may remove it yourself if you wish. They may get loose underneath the denture, and again this is okay.
A procedure called alveoloplasty (the smoothing of the underlying jaw bone in preparation for dentures) was probably performed in conjunction with the extractions in an attempt to reduce or eliminate any sharp edges underneath the denture. However, in the normal healing process of the bony socket walls, some new sharp edges can form. These sharp edges will usually round themselves out during the first few weeks of healing. Normally, they will present as a “denture sore spot” and your general dentist will relieve your denture in that area (in one of your denture adjustment appointments) which will stop the discomfort. It is always better to start by adjusting the denture rather than “adjusting the patient” with another surgical procedure; however sometimes it is necessary to return for a touch-up bone smoothing procedure. Your general dentist will advise you and us if this is necessary.
The symptom of itching, in and of itself, is not an allergic reaction. It is most likely a SIDE EFFECT of the pain medication that was prescribed. If itching occurs and it is not bothersome, then nothing need be done. If the itching is bothersome, then decreasing the dose of your pain medication (take 1 tablet instead of two, take ½ tablet instead of 1) and supplementing it with ibuprofen or Tylenol (unless you have a medical condition that will not allow you to safely take ibuprofen or Tylenol) usually will take care of the problem. If the itching is severe, decreasing the dose of pain medicine and adding over-the-counter Benadryl for the itching (unless you have a medical condition that will not allow you to safely take Benadryl) will likely resolve the problem. Changing pain medication rarely resolves itching as a side effect because it is a side effect of the opiate class of drugs. Calling in another opiate rarely helps. Please note that itching combined with a rash (not just red marks from scratching) is a sign of an allergic reaction, and this is generally due to the antibiotic. If this is the case, please call our office (918) 392-9970 for further instruction.
Begin your mouth rinses only after your first denture adjustment by your general dentist. You will need to remove your denture(s) and rinse with warm salted water 3–4 times per day for the first week. Keeping your mouth clean after surgery is essential. Use one-quarter teaspoon of salt dissolved in an 8-ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Rinsing with commercial mouth rinses is also acceptable.
Pain After the First Week
Pain during the first week is generally from the extractions and alveoloplasty (bone smoothing). Pain after the first week is generally due to “denture sore spots.” These are areas where the acrylic of the denture is rubbing too hard on your underlying gums. This is usually due to the fact that the swelling is going down and the areas are healing and changing shape. Therefore, pain after the first week usually means you need to see your general dentist for a quick adjustment or relief of the denture.
Pain after the first week that is associated with actual swelling of the face (one side actually LOOKS bigger, not just feels bigger), a bad taste or foul odor in the mouth, redness, drainage, or swelling at the extraction site; is more likely due to a post-operative infection and will require a post-operative visit with the doctor. Antibiotics may be all that is necessary, however surgical intervention may be required in some cases.
Your 24-hour Follow-up Appointment
Most family dentists want to see their patients at 24 hours for the initial denture adjustment. This can vary of course with individual dentists, as some even like to see the patient the very same day of surgery, and some at 48 or 72 hours. This should be determined before the day of surgery. Remember, it is important that you not remove your denture before this appointment. The schedule of future denture adjustments will be made by your family dentist.
It is our desire that your recovery be as smooth and pleasant as possible. If you have any questions about your progress, please call during office hours, Monday through Thursday 8:00 to 5:00, Friday 8:00 to 4:00 at (918) 392-9970. In case of an after hour emergency, you may call (918) 740-3922.
What Constitutes an Emergency?
Uncontrolled bleeding (having your mouth fill up with blood in several seconds or minutes) despite using the methods mentioned above, is an emergency that cannot wait until the next day. Please call the after-hours emergency number (918) 740-3922.
Other questions and curiosities can usually be answered in detail by phone on the next business day.