IMMEDIATELY FOLLOWING SURGERY
- The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded. Repeat as necessary for two hours and then use moist tea bags instead.
- Start antibiotic (amoxicillin or clindamycin, for example.)
- Start taking ibuprofen and/or Tylenol BEFORE the local anesthesia wears off. Take the ibuprofen every six hours for five days; you may combine Tylenol with the ibuprofen or take three hours after each dose of ibuprofen.
- If prescribed, start Medrol dose pack. See instructions on insert to box. Regardless of what time your surgery is on a given day, take all of the first day’s doses before going to bed on the day of surgery.
- DO NOT start chlorhexidine (“Perioguard”) mouthrinse until tomorrow. Vigorous mouth rinsing or touching the wound area immediately following surgery should be avoided. Doing so may initiate bleeding by causing the blood clot that has formed to become dislodged.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth followed by placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. Also, sit upright, avoid exercise, and limit talking. Talking relieves pressure on the site and will delay clot formation. If bleeding does not subside, call for further instructions.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days postoperatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs, should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
Moderate Pain: Take 200mg-600mg of ibuprofen every six hours for five days. Alternatively, you may take Tylenol every four to six hours. You may take these both at the same time or staggered. Your doctor will alert you if this needs to be modified due to other medications or medical conditions.
Severe Pain: Continue taking ibuprofen and/or Tylenol as a baseline. You may be prescribed a narcotic option to be taken as well. DO NOT take this medication unless you are in severe pain. DO NOT plan to leave your house, exercise, or operate machinery when taking narcotic pain medications. DO NOT combine narcotic pain medications with other sedatives or alcohol.
Sometimes, after three or four days postoperatively, patients may experience sudden worsening of pain in the extraction site (usually the lower teeth.) If ibuprofen and/or Tylenol do not control this discomfort, you may have dry socket. Call the office to discuss. Dry socket resolves on its own, but you may benefit from additional local measures to keep you comfortable until healing occurs.
After intravenous sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, experience less discomfort, and heal faster if you continue to eat. 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
KEEP THE MOUTH CLEAN
No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but do so gently. The day after surgery you should begin rinsing as directed with either the chlorhexidine mouthwash or warm salt water.
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent or treat infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions. Never take antibiotics on an empty stomach.
In some cases, discoloration or obvious bruising of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration. Call the office if you have any questions.
Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged; this is no cause for alarm. If this occurs, simply remove the suture from your mouth and discard it. The sutures usually dissolve approximately one week after surgery. Brushing your teeth is okay – just be gentle at the surgical sites.
NAUSEA AND VOMITING
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. Your doctor may prescribe an oral dissolvable form of Zofran to help reduce symptoms of nausea and vomiting.
- 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 Drs.Twersky, Alkhatib, and Horne 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.
- You should be careful going from the lying down position to standing. You might not have eaten anything prior to or since your 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.
- Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Drs.Twersky, Alkhatib, and Horne.
- 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 postoperative event which will resolve in time.