Often, the after-effects of oral surgery are quite minimal, so not all of the instructions may apply. Common sense will often dictate what you should do as complications are rare and comfort is typically the goal. These are some general guidelines to follow.
DAY OF SURGERY
FIRST HOUR: 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 them for the first 30-45 minutes unless the bleeding is not controlled. The packs may be gently removed after this time. If active bleeding persists, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 30 to 45 minutes). It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning. If the area is not actively bleeding, gauze pressure is not required. Avoid disturbing the area, rinse vigorously or probe the area with any objects. You may brush your teeth gently. PLEASE DO NOT SMOKE for at least 48 hours, since this is very detrimental to healing and may increase risks for complications.
Intermittent bleeding or oozing overnight is normal. Bleeding may be controlled by placing fresh gauze over the areas and biting on the gauze for 30-45 minutes at a time. Pressure is most important to stop bleeding so be sure to position the moist guaze directly over the surgical site. Fortunately, significant bleeding after oral surgery is rare. If bleeding remains a concern, please call our office.
SWELLING is often associated with oral surgery and will often maximize 36 to 48 hours after the procedure. Swelling is very dependent upon the nature of the surgery such as the position of a lower wisdom tooth. A cold pack, ice bag or a bag of frozen peas wrapped in a towel and applied firmly to the cheek adjacent to the surgical area may be slightly beneficial. This can be applied twenty minutes on and twenty minutes off during the first 24 hours after surgery. Minor head elevation for the first day or two following surgery will also help minimize facial swelling.
PAIN: Most oral surgery is accompanied by some degree of discomfort. Most studies have shown that ibuprofen is extremely effective for oral surgical pain. Our usual regimen consists of a regular dose of an ibuprofen medication (600mg every 6 hours) for several days which can be augmented with a narcotic medication for more significant discomfort. Studies have also concluded that a combination of Ibuprofen and narcotic pain medication is more effective than the narcotic alone. Remember that the most severe pain is usually within six hours after the local anesthetic wears off; after that your need for medicine should lessen. If you find you are taking large amounts of pain medicine at frequent intervals, please call our office. If you anticipate needing more prescription medication for the weekend, you must call for a refill during weekday business hours. Narcotic medications cannot be called into pharmacies by law.
NAUSEA: Nausea is uncommon after surgery as most patients are given intravenous anti-nausea medication (Zofran). Narcotic pain medications are the most frequent cause of nausea and should be avoided if nausea an issue. Try to keep taking clear fluids and minimize dosing of pain medications, but call us if you do not feel better.
DIET: Eat any nourishing food that can be taken with comfort. Typically, it is not extremely painful to eat, yet is more difficult to chew with weakened jaw muscles. Often, the jaw muscles are tight to open wide and weak to bite down for some time after surgery. This can often extend to up to a week for more difficult lower wisdom teeth. Often foods like mashed potatoes, pastas, soups, smoothies, yogurt, or any other foods which are easier to chew with weak jaw muscles. It is best to avoid foods like nuts, sunflower seeds, popcorn, etc., which may get lodged in the socket areas. Over the next several days you may gradually progress to solid 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 a diabetic, maintain your normal eating habits or follow instructions given by your doctor.
SHARP EDGES: If you feel something hard or sharp edges in the surgical areas, it is likely you are feeling the bony walls which once supported the extracted teeth. Occasionally small slivers of bone may work themselves out during the following week or so. If they cause concern or discomfort, please call the office.
INSTRUCTIONS FOR THE SECOND AND THIRD DAYS
MOUTH RINSES: Keeping your mouth clean after surgery is essential. Use 1/4 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.
BRUSHING: Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth within the bounds of comfort.
HOT APPLICATIONS: After the first 24 hours, you may apply warm compresses to the skin over the areas of swelling (hot water bottle, hot moist towels, heating pad) for 20 minutes on and 20 minutes off to help soothe tender areas. This will also help decrease swelling and stiffness.
HEALING: Normal healing after tooth extraction should be as follows: The first 2-3 days after surgery are generally the most uncomfortable and there is usually some swelling. On or after the third day you should begin to be more comfortable and, although still swollen, can usually begin a more substantial diet. The remainder of the post-operative course should be gradual, steady improvement. You may be given a plastic irrigating syringe. DO NOT use it for the first three or four days. Then use it daily to irrigate the lower extraction sites until they have healed enough not to retain food particles.
DRY SOCKET: A dry socket is simply a period of increased soreness (usually the 4th and 5th day) of the jaw following the extraction of a lower tooth. This pain can radiate to the ear or down the neck. A dry socket is no reason for concern and will resolve within several days. Often warm salt water rinses and pain medication will suffice. Occasionally, these areas can be more significantly uncomfortable and not alleviated with pain medications. If this is the case, our office can place a small pack into the extraction site which typically improves symptoms until further healing takes place over several days.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call our office. A 24-hour answering service is available to contact the doctor on call for emergencies after hours. Calling during office hours will afford a faster response to your question or concern. PLEASE NOTE: telephone calls for narcotic (pain killer) prescription renewal are ONLY accepted during office hours.
Patient Care Line: (919) 461-0110
Office hours: Cary Office Monday-Thursday 8am-5pm
Garner Office Tuesday 8am-4pm