After Removal of Multiple Teeth
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 your 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.
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 the gauze packs for the first hour unless the bleeding is not being controlled. If active bleeding persists after one hour, place enough new gauze to obtain pressure over the surgical site for another 30-60 minutes, while maintaining sustained, firm pressure (i.e. no talking, eating, sleeping during this time). The gauze may be changed as necessary and may be dampened and/or fluffed for more comfortable positioning. When the main bleeding stops, usually in 2-3 hours, you may leave the gauze out. Over the next few days, oozing is normal, but gauze packs are not necessary. 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. Also, the act of talking removes the gauze from its position over the surgical sites/sockets, and is a very common reason for continued and persistent bleeding. Try not to talk, as this is very important, and then try repositioning fresh packs directly over the surgical sites. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in a moist gauze) for 20 or 30 minutes, while maintaining sustained, continuous pressure as described above.
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) taking 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 area. 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. Tightness of the jaw muscles may cause difficulty in opening the mouth, and this is normal. This should be much better within 7 days, however for some patients with pre-existing jaw joint/jaw muscle problems, this limited opening can last longer. Keep lips moist with cream or Vaseline to prevent cracking or chapping.
Unfortunately most oral surgery 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 affects of the local anesthesia (numbing medicine) begin to wear off. Taking you 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 hour after the local anesthetic (numbing medicine) wears off: after that your need for medicine should lessen.
If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone.
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.
Eat any nourishing food that can be taken with comfort. Do not use straws for 48 hours. Temperature of the food doesn’t matter, but avoid extremely hot foods. It is sometimes advisable, but not required, to confine the first day’s intake to bland liquids to pureed foods (creamed soups, puddings, yogurt, milkshakes, etc.). 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 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.
If you feel sharp edges in the surgical areas with your tongue it is probably the bony socket walls, which originally supported the teeth. Occasionally small slivers of bone may work themselves out during the first week or two after surgery. They are not pieces of tooth and, if necessary, we will remove them. You may also feel the stitches with your tongue. Try not to manipulate them with your tongue as this may unnecessarily hasten their loosening.
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 on the day after extraction. 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. Repeat 6 to 8 times a day for a week. Rinsing with commercial mouth rinses is also acceptable.
Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort. Small amounts of oozing when brushing is normal.
If you were given an irrigating syringe start using it on the third or fourth day after surgery to keep sockets clean. Fill it with warm water or mouth rinse and irrigate any open sockets gently, especially after eating and at night before bed until sockets heal and no hole is found. It is normal for the socket to slightly bleed during this process. This may continue for several weeks.
Normal healing after a tooth extraction should be as follows: The first 36 hours after surgery may not be accompanied by significant pain or swelling due to the action of a swelling/cortisone-type medicine that may have been administered in your IV. In these instances, you may feel the onset of pain and stiffness sometime during the second day and feel something is wrong, but it is not. Just remember to take it easy with food and talking during these first 36 hours even if everything seems to be going well, or you may experience rebound pain and swelling from post-surgical over activity. If corticosteroids were not administered IV, the first day of surgery is usually the most uncomfortable and there is some degree of swelling and stiffness. The second day you will usually be more comfortable and, although still swollen, you may begin a more substantial diet, if tolerated. From the third day on GRADUAL, STEADY IMPROVEMENT should mark the remainder of your post-operative course. Remember, discomfort is normal as long as there is steady improvement. It can take anywhere from 1 ½ to 2 weeks or longer for things to feel better or back to normal, but we need to see some improvement in your symptoms over time. You may experience a bad taste for several days due to slight oozing around the blood clot.
Pain After the First Week
Many times pain after the first week is not due to the extraction sites themselves; rather it is due to muscle spasms of the jaw muscles. This is most common in adults, and especially in females. Symptoms include pain which is usually worse at the end of the day or in the morning. The pain is more of a generalized one-sided jaw or facial pain than a localized pain in the healing socket. The pain is worse on chewing, talking, and opening the mouth. The inability to open the mouth very wide, or jaw muscle stiffness may be present. The jaw may feel swollen, but there is usually no physical distension of tissue visible. Ear pain may be present. Patients may be awakened in the early morning hours with severe pain if they have a tendency to grind their teeth. These muscle spasms are essentially due to jaw overuse and should be treated with jaw rest (maintain a soft diet and talk as little as possible) moist heat (ice can make it worse), ibuprofen (unless you have a medical condition that prohibits you from taking ibuprofen), and possibly a prescription muscle relaxant that our office can call in. Please note that taking a strong narcotic opiate pain medication for this problem can make this problem worse, because when the body is devoid of all painful inhibitions, it is easy to overuse the jaw muscle and further damage it. The measures taken above will provide pain relief and an opportunity for the joint/muscle complex to heal.
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.
* 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 the sensation. So be careful. Call our office if you have any questions.
* 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 (unless you have a medical condition which prohibits you from taking Tylenol or ibuprofen).
* You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids immediately after surgery. 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.
* 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. It can, however, last up to a week or two and still be considered normal post-operative jaw stiffness.
* There may be a hole in the gums where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses and an irrigating syringe.
* Your case is individual, no two mouths are alike. Do not hesitate to call the office for post-operative concerns. A surgical assistant can often alleviate your concerns over the phone and/or determine if you need an in office post-operative appointment.
* Brushing your teeth is okay - just be gentle at the surgical sites.
* If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.
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 and the doctor will contact you as soon as possible.
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..