POST-OPERATIVE INSTRUCTIONS FOR PATIENTS

Following post-operative care is very important. Please ready these instructions carefully.

Pain or complications of infection and swelling can be minimized if these instructions are followed. The after-effects of surgery vary per individual and procedure being performed. Therefore, not all the information may apply to you.

Please feel free to contact our office 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 anesthesia (Novacaine). The numbness should last approximately 2-4 hours. You will also be biting on a piece of gauze over the extraction sites.

  1. Emotional behavior and crying immediately after awakening are very common. Please do not be alarmed. This normal side effect of anesthesia is only temporary and has no long-lasting effects.
  2. Some bleeding and oozing are very common following surgery. Remove the gauze packs and replace with fresh ones every 30 minute until bleeding has subsided or under control. There should be constant, firm pressure at the extraction sites. Be Sure the gauze is applying pressure directly over the gum tissue where the bleeding is occurring.

You may notice blood tinged saliva for 24-48 hours. This is normal. Please do not be alarmed.

  1. NO VIGOROUS RINSING OR SPITTING when bleeding is active, as this will make it worse. If bleeding persists, you may use a moistened black tea bag directly over the extraction site and apply firm pressure for 30 minutes.
  2. Once bleeding has subsided or under control, Remove the gauze packs and attempt to drink thick liquids (without using straws), such as milkshakes, smoothies, pudding, or applesauce.
  3. Remember to stay hydrated and drink plenty of liquids to help with the healing process.

You should not use a straw and avoid carbonated beverages for three days following surgery.

  1. Avoid chewing solid foods for the first 2-3 days following surgery.

Some recommendations are:

  • Ice cream             
  • Pudding
  • Yogurt                   
  • Jell-O
  • Soups                   
  • Mashed Potatoes
  • Pasta                     
  • Scrambled Eggs

Please avoid foods such as nuts, seeds, popcorn, or rice, for the first week following surgery. These smaller items can lodge in the extraction site. If this happens, do not be alarmed. We will show you how to keep the sites clean of debris by flushing with a syringe at your one-week follow-up visit.  

  1. Nausea and vomiting are a very common side effect of general anesthesia and narcotic prescription pain medications. Especially, when taken on an empty stomach. Make sure you have thick liquids or soft food in your stomach prior to taking your first dose. If you are particularly sensitive, take only half a tablet.

Taking the narcotic medication is not required. Thus, if you don’t need it, you don’t have to take it. Pain or not, we recommend taking 2 tablets of Advil or Ibuprofen 400mgs every 6 hours and repeat for 48 hours immediately following surgery. This will help minimize swelling; this relieves pain.

  1. 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.
  2. Unless, you have been informed otherwise, most stitched are dissolvable. It will last 2-7 days. Dissolution of sutures within this time period is normal and do not need to be replaced.
  3. DO NOT SMOKE – The irritants in the cigarette smoke will greatly increase your chance of prolonged healing, risk of pain and complications. The risk is highest during the first week. Therefore, you should not smoke for at least ten days following surgery.
  4. Avoid strenuous work or vigorous exercise for 5-7 days following surgery.
  5. 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.                                                                                                                                                                 

2-4 Days After Surgery

  1. Your face and cheeks may swell dramatically. Typically, swelling reaches its peak 48 hours following surgery. Your doctor has given you medication during the surgery that minimizes swelling, but it cannot be completely eliminated. If swelling persist, continue to apply ice packs to your face for 20 minutes every 2 hours.
  2. Bruising and skin discolorations are not unusual. The discolorations can be yellow or black and blue. This is caused by the bleeding through the mucous membranes of the mouth beneath the skin. If often takes a week for this to disappear.
  3. Begin brushing your teeth by the second day. Brush normally being gentle around the surgical sites. Avoid brushing directly on the wound. Good oral hygiene will minimize the bacteria in your mouth, decreasing chance of post-operative infection.
  4. You should begin using warm salt water rinses as often as you like or at least 2-3 times daily and immediately after eating to keep debris from accumulating at the surgical site. Use ½ teaspoon of salt dissolved in an 8-ounce glass of warm water. Continue using warm salt water rinses until your follow-up visit with our office.                                                                                         

5-7 Days After Surgery

  1. If you have continued pain or swelling with no improvement, fever and a bad taste in your mouth, it is possible you have developed an infection at the extraction site. If you experience these symptoms after surgery and do not have a scheduled follow-up visit, please contact our office.
  2. A dry socket is a condition in which the blood clot that forms in the extraction site has either dislodged or dissolved. It is a very painful condition, often radiating along the jaw towards the ear and may cause teeth to ache. This potentially occurs 5-7 days following an extraction. Fortunately, it is a self-limiting process and with adequate pain control, resolves itself in 24-48 hours.                                                                    

Special Instructions for Sinus Exposures

Upper molar (back) teeth are usually very close to the sinus. Maxillary sinuses are air-filled cavities beneath your eyes and behind your cheekbones. A frequent complication of removing these teeth is exposure of the sinus floor. Most exposures will heal spontaneously or with minimal intervention as long as the following instructions are strictly adhered to after surgery:

  • Some intermittent nose bleeding is a normal occurrence. Please do not be alarmed.
  • Do NOT blow your nose vigorously for two weeks. There is a natural communication between your nose and sinus. Any positive pressure in your nose will be directly transferred to the sinus and subsequently to the fresh extraction site.

If you feel “stuffed up”, decongestants such as Drixoral, Dimetapp, or Sudafed will help reduce pressure in the sinuses.

  • As swelling subsides, you may feel like sutures are loosening up. Please keep your tongue away from the surgical site and do not cut them prematurely yourself.
  • Do NOT use straws for two weeks. The negative pressure generated from the straw will generate a breakdown of the extraction site.
  • Do NOT smoke for two to three weeks. Smoking has a much more profound influence on oral wounds than any other part of the body. Especially, since the effect of smoking is directly in contact with the healing wound. Wound breakdown and poor healing are ten times more prevalent in smokers than non-smokers.
  • Sneeze with your mouth open. Do NOT hold back a sneeze. The generated pressure must be released without transmitting to your sinuses.
  • Avoid anything that causes pressure in your nasal cavity. Such as: “bearing down” when lifting heavy objects, blowing up balloons, or playing musical instruments. Scuba diving and flying in pressurized aircraft may also increase sinus pressure. Therefore, should also be avoided.

Failure to adhere to these instructions could result in a permanent communication (fistula) between your mouth and sinus. This would require additional highly invasive surgery that would incur further cost and recovery time. Prevention is always the most prudent option.

Special Instructions After Exposure of an Impacted Tooth

Do not disturb the wound. If surgical packing was placed, leave it alone. The pack helps to keep the tooth exposed. If it gets dislodged or falls out, do not be alarmed.

You may have a bonded gold chain attached to your braces with a suture or an elastic band. Your orthodontist will use this chain to move the impacted tooth to the desired position. You can see your orthodontist one week following surgery to begin this process.

Please do not touch the chain, as the attachment may loosen.

                                                                                                

Special Instructions After Removal of Multiple Teeth and Denture Wearers

Leave your denture in place for 24 hours. This will help with clot formation and minimize bleeding.

Frequently, the denture will feel very loose. This is intentional to account for swelling. Please refrain from using any adhesives or denture paste until wounds are fully healed.

You will develop sore spots and ulceration where the dentures are in contact with your gums. These are normal occurrences and should improve with time, as long as you see your dentist for regular adjustments.

You must see your dentist within the first 72 hours after surgery to make the necessary adjustments to relieve these sore spots. Failure to do so may result in sever denture sores, which may prolong the healing process.

After seven days, routinely leave the dentures out at night. Wearing dentures excessively can cause superficial fungal infections and inflammation due to the chronic pressure.

Your dentures are only cosmetic for the first 4-6 weeks. It will take time for you to become comfortable wearing your new dentures. This is especially true for lower dentures. Please be patient.

                                                                                                                                                       

Special Instructions After Implants or Grafting Procedures

Frequently, any stiches for these procedures are NOT dissolvable. We need additional time for the wound to heal and protect the underlying implant or graft. The stiches will remain for up to four weeks. During this period:

  • DO NOT DISTURB THE WOUND and SUTURES. It will be a natural tendency for your tongue to touch the site. This may cause early wound breakdown and exposure of the implant or graft; resulting in a higher failure rate.
  • NO CHEWING on the implant site. Limit all chewing to the opposite side. Doing so may result in a higher failure rate.
  • Do NOT brush over the fresh wound for at least two weeks. Following the second day, we recommend gentle rinsing.
  • As swelling subsides, you may feel like sutures are loosening up. Please keep your tongue away from the surgical site and do NOT cut them.
  • Unless, instructed otherwise Partial Dentures or flippers should NOT be worn following surgery. Even when worn, temporizations should be utilized as little as possible during the healing period. It should not touch the surgical site or gums around the site. Doing so can cause ulceration of the wound edges and breakdown the suture margins. It can also lead to failure of the graft or implant. Please keep temporizations out when at home and whenever else possible.
  • If your doctor attached a temporary tooth to the implant, this is for esthetic purposes only and should NOT be used for chewing or function until the implant has fully healed (3-4 months). Doing so may result in a higher failure rate.
  • If you had a sinus grafting procedure. Please follow “Instructions for Sinus Exposures” in addition to.