Instructions After Surgery

Please read and follow these instructions carefully, since post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed.  The after-effects of surgery vary per individual, so not all of the information may apply.  Please feel free to contact us at anytime should you have any questions or concerns.

Immediately Following Surgery

You will awaken to numb lips and teeth due to the residual effects of the local anesthetic (Novocaine).  The numbness should last approximately two hours.  You will also be biting on a moist piece of gauze which will have been placed over the extraction sites.

1. Emotional behavior and crying immediately after awakening is very common.  Please do not be alarmed.  This normal side effect of anesthesia is only temporary and has no long lasting effects. 
2. Remove the gauze in 30 minutes.  If oozing continues, then replace it with fresh gauze for an additional 30 minutes.  There should be constant, firm pressure on the extraction sites.
3. When the bleeding has been controlled, you should attempt to drink some full liquids without using straws, such as milkshakes, smoothies, pudding or applesauce.
4. If you are able to tolerate liquids in your stomach, you should take the Ibuprofen prescribed to you by your doctor as soon as you are able. This is prescription strength and much stronger than the Ibuprofen or Advil you get from the pharmacy.  You should take only ONE at a time and NO MORE THAN FOUR PER DAY.  It should be taken around the clock every six hours for the first 48 hours after surgery.  It will provide good baseline pain relief without the side effects of the narcotics.
5. Do not take the narcotic pain medication, Vicodin or Percocet, until 4-6 hours after the surgery.  Nausea and vomiting is a very common side effect of the general anesthetic and narcotic prescription pain medicines, especially when taken on an empty stomach.   Be very careful with your first dose.  Make sure you have some thick liquid in your stomach, and if you are particularly sensitive, take half a tablet for your first dose.  If you don’t need the narcotic medication, you do not have to take it.
6. In the event of nausea and/or vomiting following surgery, you should not take anything by mouth for at least an hour, including the prescribed medicine.  You should sip on Coke, tea, or ginger ale. You should sip slowly over a 15-minute period.  Do not take the narcotic pain medication, i.e. Percocet or Vicodin, for at least four hours if you are feeling nauseous or vomiting, as these medicines are the likely cause for your symptoms.  The cause of the nausea is due to the residual effects of the anesthesia and the narcotic pain medication, i.e. Percocet or Vicodin.  In most cases, the Ibuprofen by itself should not cause nausea.
7. Apply ice packs to your face for 20 minutes every 2 hours for the next 24 hours.  Keep your head elevated at all times to decrease the pressure in your head and jaws.
8. Remember to keep hydrated and drink plenty of liquids to help with the healing process.  However, you should not use a straw and you should avoid carbonated beverages during the recovery period.
9. You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery, and taking pain medications can make you dizzy. You could get light headed when you suddenly stand up.  If you are lying down following surgery, make sure you sit for one minute before standing.
10. DO NOT SMOKE.  The irritants in the cigarette smoke will greatly increase your chance of prolonged pain and complications.  The risk is highest in the first week; therefore, you should not smoke for at least ten days.
11. Some bleeding and oozing is very common over the first 24 – 48 hours.  If the wound is actively bleeding, apply rolled up gauze over the extraction site and firmly bite down for 30 minutes.  Be sure that the gauze is putting pressure directly over the gum tissue where the bleeding is occurring.  THERE SHOULD BE NO VIGOROUS RINSING OR SPITTING WHEN ACTIVELY BLEEDING, as this will make it worse.  If bleeding persists, you may use a moistened tea bag directly over the extraction site and apply firm biting pressure for 30 minutes.
12. Unless otherwise stated, most stitches (sutures) are dissolvable.  They will last in the wound between 2-7 days.  Dissolution of the sutures within this time period is normal and they need not be replaced.
13. You should consume only nonsolid foods for the first 2-3 days.  High calorie, high protein intake is very important to help in healing.  Some recommendations are:

Please avoid carbonated beverages for the first three days following surgery
Please avoid nuts, seeds, popcorn, and chips for the first week after surgery.

Next 2-3 Days After Surgery:

1. Your face and cheeks could become dramatically swollen in the next 48 hours.  Your doctor has given you medicines during the surgery that minimize the swelling, but it cannot be completely eliminated.  The swelling should reach its peak by the second day after surgery.
2. Bruising and skin discolorations are not unusual.  The discolorations can be yellow or black and blue, depending on the fairness of your skin, and are usually limited to the neck or cheek area near the surgical site.  This is caused by bleeding through the mucous membranes of the mouth beneath the skin.  It often takes a week for this to completely disappear.
3. You should be able to brush your teeth by the third day.  Brush normally in areas away from the surgical site, but avoid brushing directly on the wound.  Good hygiene will minimize the bacteria in your mouth, decreasing your chance of an infection.
4. By the third day following the surgery, you should use warm salt water rinses 2-3 times a day after eating to keep debris from accumulating at the surgical site.  Use one-half 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 as often as you like, but at least two or three times daily and always after eating for the next 7 days.
5. You should avoid any strenuous work or vigorous exercise for 5-7 days.
6. If you were prescribed an antibiotic and are currently taking oral contraceptives, you should use an alternate method of birth control for the remainder of this cycle.
7. By the third or fourth day, you should be able to advance to a soft diet, consisting of minimal chewing, such as soft pasta, macaroni and cheese, pancakes, etc.  Avoid foods like nuts, sunflower seeds or popcorn, which may get lodged in the socket areas.  Over the next several days, you may progress to more solid foods
8. Numbness of the lower lip and chin is a potential complication of extracting lower teeth, especially wisdom teeth.  If you experience these symptoms one week after surgery, please contact our office.  The injury is usually temporary, but full recovery can take up to six months.

One Week After Surgery:

1. If you have continuing pain, swelling, fever and a bad taste in your mouth, it is possible that you have an infection at the extraction sites.  If you experience these symptoms a week after the surgery, please contact our office for a visit.
2. A dry socket is a condition in which the blood clot that has formed in the extraction socket has either dislodged or dissolved.  It is a very painful condition which occurs 5-7 days following the extraction along the surgical site, often radiating toward the ear and forward along the jaw which may cause other teeth to ache.  Fortunately, it is a self-limiting process and with adequate pain control, resolves itself in 24 - 48 hours.