There are a number of reasons that your dentist might recommend a tooth extraction. Some dental patients suffer from tooth decay; others need to remove teeth hindering orthodontic treatment, whereas various patients simply need wisdom teeth removal. While a tooth extraction can be a serious dental procedure, aftercare is just as critical as the procedure itself. As the dental patient, it is important to understand that pain and the risk of infection can be lessened with proper care.

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SURGICAL EXTRACTION/SEDATION POST-OPERATIVE INSTRUCTIONS

1.       POST IV ANESTHESIA:  Patients who received IV anesthesia should be escorted home and cared for during the remainder of the day.  Immediately lie down with your head elevated until all the effects of the anesthesia have subsided.  Anesthetic effects vary by individual and you may feel drowsy for a short period of time or several hours.  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.  Local anesthesia will be present for 1-4 hours.  To avoid injury, do not bite or pinch your lip or tongue until the numbness wears off.

2.       BLEEDING:  Maintain firm biting pressure on the gauze packing for 30-40 minutes after your surgery. Some bleeding or “oozing” is normal for the first 24 hours.  Do not be alarmed.  For persistent bleeding, gauze may be replaced for an additional 30 minutes.  If excessive bleeding persists longer than a few hours, contact the office for further instructions.

3.       MEDICATIONS / PRESCRIPTIONS:  For moderate pain, you may take 1000mg of Tylenol every 6-8 hours. You may also take up to 800mg of Ibuprofen (Advil or Motrin) three times daily, or every 4-6 hours. Ibuprofen may be taken in conjunction with Tylenol, alternating medications every 1-2 hours.  For severe pain use the prescription that is given to you by the doctor.  Pain medicine should be taken before the local anesthetic wears off.

·         Take all medications as prescribed.

·         Do not take pain medications on an empty stomach. (1 cup of clear liquids should be taken before medications are given).

·         Do not mix medications with alcoholic beverages.

·         While taking narcotic pain medication that may make you sleepy, it is very important to avoid driving a vehicle or operating any heavy machinery.

·         IMPORTANT: If an antibiotic is prescribed, all female patients utilizing birth control pills must be advised that you need to use an alternative method of birth control during this time.

·         **Prescriptions will not be refilled outside of regular business hours.  In the rare circumstance that a refill is needed, you must be seen by the doctor during regular business hours. **

4.       SWELLING and BRUISING:  Swelling is normal and usually peaks at about 48-72 hours after surgery. Apply an ice pack for the first 24 hours after surgery. (20 minutes on-20 minutes off) Bruising may be present at varying degrees.  It will subside over a period of 5-14 days.

5.       BRUSHING AND RINSING:  Do not brush, rinse or spit for the first 24 hours.  After that use a warm salt-water rinse following meals and before bedtime. (1 teaspoon of salt in an 8oz.glass of warm water.) Continue to do so over the next few weeks.  Gentle brushing may be resumed after the first 24 hours.

6.       DIET:  Diet may consist of soft foods that can be easily chewed and swallowed.  Avoid hot temperature foods until the numbness subsides.  Avoid hot and spicy foods, seeds, nuts, popcorn, etc.  Drink plenty of fluids.  Avoid using a straw for 24 hours; doing so may dislodge the blood clot and delay healing. Supplements such as Ensure or Carnation Instant Breakfast provide excellent added nutrition.  Advance diet as tolerated.

7.       SUTURES:  If sutures were placed, they will dissolve on their own within 7-14 days, or they will be removed at the appropriate post-operative appointment.

8.       SMOKING:  Smoking is detrimental to healing.  Do not smoke or use smokeless tobacco for several days to decrease the chance of delayed healing and infection.

9.       ACTIVITY:  Limit physical activity during the first 3 days after surgery.  Over exertion may lead to post-operative bleeding and discomfort. 

IMMEDIATE DENTURE INSTRUCTIONS

         The denture that was placed in your mouth immediately after surgery will serve as a surgical bandage. Do not remove the denture for 24 hours.  Usually a follow up visit with your dentist is needed 1 to 2 days after insertion of your denture.

 POSSIBLE CONDITIONS AFTER SURGERY

 DRY SOCKET:  A dry socket is when part of the blood clot either dissolves or falls out of the surgical site.  This is not a serious complication but is often a painful one.  Symptoms include severe throbbing pain in the jaw that radiates toward the ear, usually 3-5 days after surgery.  If this is the case, please contact the office, as a medicated dressing may need to be placed into the site to improve comfort as the healing progresses.

ANTIBIOTICS:  May cause diarrhea or upset stomach.  Eating active yogurt culture may help decrease the incidence. 

FEVER:  Your temperature may rise slightly for a day or two after surgery and is usually of no concern. If you feel warm or sweaty, we recommend that you take and record your temperature.  If your temperature is persistently raised, please contact our office and continue drinking plenty of fluids.

MUSCLE STIFFNESS:  Tenderness and stiffness within the chewing muscles may develop during the post-operative period and should not alarm you.  It can be treated with moist heat therapy or ice.  It will slowly resolve over a 5 to     10-day period. 

IV INJECTION SITE:  The point where the needle entered the vein may develop a bluish color, which will change to yellow and then to normal in a matter of days.  There may be a slight tenderness to the area and perhaps some small lumps.  These signs and symptoms are usually of no concern and are best treated with a hot moist towel and elevation of the arm.  Should the arm begin to swell or tenderness progress up toward the shoulder, please contact our office.

NUMBNESS:  Loss of sensation of the lip and chin may occur, usually following lower wisdom teeth removal.  This is usually temporary and subsides within a few days or weeks.  Occasionally, some numbness may persist for months.  We will need to document and discuss this numbness during your follow up visit.

NAUSEA/VOMITING:  Sipping 7-Up, ginger ale, or cola may help.  If severe nausea or vomiting persists, please contact our office.

SHARP BONY EDGES:  Small pieces of bone may work out of the surgical area for as long as 5-6 weeks following surgery.  This may resolve on its own over a period of a few weeks.  If necessary, removal of bone spicules is a simple and routine procedure.

SORE LIP/CHEEKS:  The corners of your mouth may be dry and cracked after surgery.  This is best treated by gently applying Vaseline.

LOCAL EXTRACTION POST-OPERATIVE INSTRUCTIONS

1.       BLEEDING:  Maintain firm biting pressure on the gauze packing for 30-60 minutes after your extraction. Some bleeding or “oozing” is normal for the first 24 hours.  Do not be alarmed.  For persistent bleeding, gauze may be replaced.  If excessive bleeding persists longer than a few hours, contact the office for further instructions.

2.       MEDICATIONS / PRESCRIPTIONS:  For moderate pain, you may take 1000mg of Tylenol every 6-8 hours. You may also take up to 800mg of Ibuprofen (Advil or Motrin) three times daily, or every 4-6 hours. Ibuprofen may be taken in conjunction with Tylenol, alternating medications every 1-2 hours.  For severe pain use the prescription that is given to you by the doctor.  Pain medicine should be taken before the local anesthetic wears off.

·         Take all medications as prescribed.

·         Do not take pain medications on an empty stomach. (1 cup of clear liquids should be taken before medications are given).

·         Do not mix medications with alcoholic beverages. While taking narcotic pain medication that may make you sleepy, it is very important to avoid driving a vehicle or operating any heavy machinery.

·         IMPORTANT:  If an antibiotic is prescribed, all female patients utilizing birth control pills must be advised that you need to use an alternative method of birth control during this time.

·          **Prescriptions will not be refilled outside of business hours.  In the rare circumstance that a refill is needed, you must be seen by the doctor during regular business hours.**

3.       SWELLING and BRUISING:  Swelling may vary depending on the difficulty of your extraction.  Apply ice packs for the first 24 hours (20 minutes on-20 minutes off.) Bruising may be present at varying degrees.  It will subside over a period of 5-14 days.

4.       BRUSHING AND RINSING:  Do not brush, rinse or spit for the first 24 hours.  After that use a warm salt-water rinse following meals and before bedtime. (1 teaspoon of salt in an 8oz. glass of warm water.) Continue to do so over the next few weeks.

5.       DIET:  Diet may consist of soft foods that can be easily chewed and swallowed.  Avoid hot temperature foods until the numbness wears off.  Avoid hot and spicy foods, seeds, nuts, popcorn, etc.  Drink plenty of fluids.  Avoid using a straw for 24 hours; doing so may dislodge the blood clot and delay healing.  Supplements such as Ensure or Carnation Instant Breakfast provide excellent added nutrition.  Advance diet as tolerated.

6.       SUTURES:  If sutures were placed, they will dissolve on their own within 7-14 days.

7.       SMOKING:  Do not smoke or use smokeless tobacco for several days to decrease the chance of delayed healing and infection.

8.       ACTIVITY:  Limit activity during the first day after surgery.  Over exertion may lead to post-operative bleeding and discomfort.

9.       MUSCLE STIFFNESS:  Tenderness and stiffness within the chewing muscles may develop during the post-operative period and should not alarm you.  It can be treated with moist heat therapy or ice.  It will slowly resolve over a 5 to 10 day period.

Note:  Local anesthesia will be present for 1-4 hours.  Do not bite or pinch your lip or tongue until the numbness wears off.