Post-Operative Instructions

PLEASE READ THESE POST-OPERATIVE INSTRUCTIONS CAREFULLY. Sometimes the after-effects of oral surgery are quite minimal, so not all of these instructions may apply. Common sense should dictate what you should do. You can expect a smoother experience if you read and follow these guidelines. If you have any questions or problems call our office at any time.

1. Bleeding:

a. Bite firmly on the gauze pack(s) placed over the surgical area(s) for 15 minutes.

b. Remove the gauze, wait a minute or two, and look at the surgery area. If it continues to ooze, fold up a gauze sponge, moisten it with cold water, squeeze out the excess water, and place over the surgical area(s). Again, apply firm biting pressure for 15 minutes. Repeat as needed.

c. If bleeding persists after several changes you may soak a tea bag in warm water, squeeze it gently and wrap a moist gauze sponge around it, place over the surgical area(s) and apply biting pressure for 15 minutes. Oozing of blood may continue for a couple of days. Keep in mind that a little blood mixed with your saliva might seem like a lot. If bleeding remains uncontrolled, please call our office.

2. Medications:

a. Medication for discomfort may be necessary following oral surgery. We recommend TWO (200mg) tablets of ibuprofen (Advil, Motrin) before the local anesthesia (numbness) has worn off. This should be repeated every 4 hours (do not exceed 12 tablets in a 24 hour period). Naproxen (Aleve) or acetaminophen (Tylenol) can be taken instead but you must follow the recommended dosing. If you do not achieve adequate relief, you may also take the stronger pain medicine along with the ibuprofen. Remember, to minimize nausea, take your medicine with food in your stomach plus plenty of water.

b.An antibiotic mouth rinse (Chlorhexidine), if prescribed, should be used as directed. Do not use commercial mouthwashes or any solutions using peroxide.

c. An antibiotic, if prescribed, should be taken as directed.

d. If you take prescription medications for a medical condition (e.g., high blood pressure, diabetes, thyroid, etc.) please continue them on their normal schedule, unless otherwise directed.

3. Control of Swelling:

a. To minimize swelling you should apply a cold compress or ice pack to the area(s) 20 minutes “on” then 20 minutes “off” during the waking hours for the first 12 to 24 hours postoperatively.

Swelling will usually peak at 48 hours then gradually go away.

4. Diet:

a. Avoid eating until the local anesthesia (numbness) has worn off.

b. A soft diet is recommended for at least 48 hours after surgery. Creamed soups, yogurt, pudding, applesauce, mashed potatoes, oatmeal and cream of wheat are excellent sources of nutrition.

c. Drink plenty of liquids, especially fruit juices which are rich in vitamin C (apple, grape, pineapple, cranberry). Do not use a straw as this may disturb the blood clots and cause bleeding.

d. Proper nutrition is essential to healing and should be started as soon as possible. Advance to routine foods based on your level of chewing comfort.

5. Oral Hygiene:

a. Do not rinse or spit today. Starting tomorrow, gently rinse with a warm salt-water solution (mix 1/2 teaspoon table salt in 8 ounces of warm water). This should be used 3 to 4 times a day for one week.

b. Regular toothbrushing and flossing may resume the day after surgery. Be careful near the surgery sites but do not avoid them either.

6. Post-Anesthesia Instructions:

For patients who underwent surgery with IV Anesthesia or an oral sedative, the following special instructions apply:

a. Avoid driving a car or operating any potentially dangerous machinery/equipment for 24 hours after your discharge.

b. Please rest for 24 hours after your surgery/anesthesia. Avoid any strenuous physical activity.

7. Additional Concerns:

a. Stiffness of the jaw muscles may cause difficulty opening the mouth and resuming normal chewing. This usually gets better within two weeks. After the second postoperative day you may use moist heat on your jaws. Continued use of Ibuprofen or Naproxen will also help you feel more comfortable.

b. Bruising of the skin overlying the cheek, jaw, and neck may occur. This will gradually disappear.

c. Numbness of the lower lip, chin, gums, teeth and tongue may remain. This is usually a temporary condition which will improve over time.

d. Sensitivity to remaining teeth may bother you temporarily. Until this goes away, avoid extremes of temperatures with food and liquids.

e. Dry socket can develop if you lose your blood clot after the first two days. The symptoms begin on the third or fourth day and consist of constant pain, often radiating to the ear, as well as a bad taste/breath. Pain medicines no longer give relief. This indicates that some bone in the socket is exposed, and although not an emergency, please call so we can coordinate a time for you to return to the office to have a medicated dressing placed.

f. Sinus Precautions – when performing oral surgery in the upper jaw some roots are close to the sinus cavity. A small opening result and the following precautions apply. DO NOT blow your nose and if you must sneeze, do so with your mouth open. Additional medicines may be required so please follow you instructions.

g. Sharp edges may be felt with your tongue. You are feeling the bony walls which supported the tooth. Rest assured the entire tooth was removed! Occasionally small slivers of bone may work their way to the surface and occasionally have to be removed.

h. A low-grade temperature may occur for 1 to 2 days after surgery. This is normal and can be reduced by taking Acetaminophen (Tylenol) and drinking more water.

i. Smoking – Please do not smoke for 48 hours after surgery. The sucking action plus heat and chemicals from the tobacco can disturb the blood clot. This can lead to a dry socket, a longer healing period and more pain.

8. Unusual Conditions:

If any of the following occur during the post-operative period, please call for further instructions:

a. Severe, hard swelling after the third post-operative day.

b. Severe, bright red bleeding that cannot be controlled using the recommended measures.

c. Rash, difficulty breathing, severe vomiting after taking medications.

d. Temperature greater than 101 degrees after trying acetaminophen and drinking more water.