The Day of Surgery

Bleeding: Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure that they remain in place.

Do not change them for the first hour unless the bleeding is not controlled. If this is the case, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary. If bleeding persists, you can soak a tea bag in warm water, squeeze it dry and bite down firmly on the site for 30 minutes. If bleeding is still uncontrolled, call us at
(212) 319-9700. Please note that oozing overnight is normal.

In general, exercise care – do not disturb the surgical area today. No vigorous rinsing. You may brush your teeth gently, avoiding the surgical site so as not to disturb the clot. Please do not smoke for at least 48 hours as it is very detrimental to healing. Nicotine can break down the clot and cause a dry socket (continued discomfort). Avoid taking aspirin for pain after surgery, as it causes bleeding. A daily aspirin for medical purposes can be maintained. If you take Coumadin and it was discontinued prior to surgery, take the Coumadin again the evening following your surgery.

Pain: Unfortunately, most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first pill before the anesthetic wears off, you should be able to manage your pain better as the most severe pain is usually within 6-12 hours after the local anesthetic wears off. The effects of pain medications vary widely among individuals. If you do not achieve adequate relief at first, you can supplement each pain pill with an analgesic such as ibuprofen or Tylenol. Avoid aspirin as above. Some patients may require two of the pain pills at once. If you find you are taking large amounts of pain medication and/or the pain is not controlled, please call us at
(212) 319-9700 immediately. Also, if you think that you’ll need medication for the weekend and are running out, please call us during weekday business hours. Considerable pain 3-4 days after an extraction may be due to a dry socket which needs treatment at our office, so contact us to come in if those symptoms are present.

Swelling: Swelling is often associated with oral surgery. In can be minimized by using a cold pack, icebag, or a bag of frozen peas wrapped in a towel and applied to the face adjacent to the surgical area 20 minutes on and off for 24 hours. If you’ve been prescribed medication for the control of swelling, be sure to take it as directed. Swelling that increases over 2-3 days is normal and can be accompanied by bruising. Painful swelling can also represent postoperative infection and you should inform us if it is present or if it appears unusual.

Diet: Eat any nourishing food that can be taken with comfort. If you eat regularly you will feel better, gain strength, have less discomfort and heal faster. Avoid extremely hot and spicy foods and do not use a straw for a few days after the surgery. It is sometimes advisable, but not absolutely required, to confine the first day’s intake to liquids or pureed foods such as soups, puddings, jello, milkshakes or yogurt. It is best to avoid foods like nuts, rice, sunflower seeds, popcorn etc. that can lodge in the socket areas. Over the next days you can progress to solid foods. It is important not to skip meals. If you are a diabetic, maintain your normal regimen or follow instructions given by your doctor.

Nausea: Nausea is not uncommon after surgery. Sometimes pain medications are the cause. If this is the case, precede each pain pill with a small amount of food and take the medication with a large volume of water. Try to keep taking clear fluids and minimizing dosing of medications. Coca Cola (Classic) or Pepto Bismol may help, but call us if you feel very ill after surgery or are vomiting.

Antibiotics: Rashes, itching, nausea and vomiting may occur with antibiotics. If this occurs, call us immediately. Also, women using birth control pills should use an alternate contraceptive method when taking antibiotics.

If You’ve Had IV Sedation and General Anesthesia:

• Do not engage in strenous activities for the remainder of the day.
  
• Do not drive a car, operate machinery or perform hazardous tasks.
  
• Do not ingest alcoholic beverages.
  
• Avoid heavy meals; a light diet of liquids and toast will be adequate for the day.
  
• The area of injection in the arm may be tender for several days and appear bruised.
• Application of a hot, moist towel to the site may be beneficial. If pain, swelling or redness at the site persists, please call us immediately.
• Nausea may occur after the procedure, which is normal. If it persists, resting/lying down and/or drinking carbonated beverages (ginger ale or cola) may make you feel better. Notify us if you have persistent vomiting or if you can’t tolerate liquids or foods.

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 5 minutes to use the entire glassfull. Repeat as often as you like, but at least 2-3 times daily. If you have high blood pressure, do not use salt – just rinse with plain warm water. Mouthwash such as Listerine is also satisfactory, but may need dilution. Hydrogen Peroxide can also be used if diluted.

Brushing: Begin your normal 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. Avoid tooth brushing of the surgical sites.

Hot Applications: After the third postoperative day, 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. This will help soothe tender areas and will also help decrease swelling and stiffness.

Additional Conditions: In addition to those mentioned, the following conditions may occur, all of which are considered normal:

• Stiffness of the muscles and jaw joint. (Chewing gum at intervals may help.)
  
• A slight earache or sore throat.
  
• A slight fever for 24-48 hours. If persistent, call us.
  
• Your other teeth may ache. This is temporary sympathetic pain.
  
• Black and blue discolorations on the outside of the face and neck. (This should resolve in several days.)
  
• The corners of your mouth may be dry and cracked. Keep them moist with a cream or Vaseline.
  
• Numbness about the lip, chin or tongue on the side of the surgery. (This is usually temporary and will correct itself.)
  
• If you feel something hard or sharp edges in the surgical area, it is likely you are feeling the bony walls that once supported the extracted tooth. Occasionally, small slivers of bone work themselves out within several weeks or months. If this causes concern or discomfort, please call our office.

If you were given a plastic irrigating syringe, do not use it for the first five days. Then use it daily according to instructions until you are certain the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket.

Healing: Normal healing after tooth extraction should be as follows: The first two days after surgery are generally the most uncomfortable and there is usually some swelling. On the third day you should 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. If you do not see continued improvement, please call us at
(212) 319-9700 immediately. Report continued or increased pain, swelling, bleeding, nausea, dizziness or vomiting.

Follow-Up: It is often advisable to return for a postoperative visit to make certain healing is progressing satisfactorily. A follow-up visit will be scheduled. In the meantime, maintain a healthful diet, observe rules for proper oral hygiene and visit your dentist for regular checkups.

Sinus Precautions

Because of the close relationship between the upper back teeth and the sinus, a communication between the sinus and the mouth sometimes results from surgery. This complication often heals slowly and with difficulty and may require additional surgery for closure. If this has occurred in your case, certain precautions will assist healing. We ask that you faithfully follow these instructions:

1. Take prescriptions as directed.
   
2. Do not forcibly spit for several days.
   
3. Do not smoke for several days.
   
4. Do not use a straw for several days.
   
5. Do not forcibly blow your nose for at least two weeks, even though your sinus may feel “stuffy” or there may be some nasal drainage.
   
6. Try not to sneeze as it will cause undesired nasal pressure. If you must sneeze, keep your mouth open and avoid pinching nostrils closed when nose blowing.
   
7. Eat only soft foods for several days, always trying to chew on the opposite side of your mouth.
   
8. Do not rinse vigorously for several days. Gentle salt water swishes or mouthwashes may be used.

Slight bleeding from the nose is not uncommon for several days after surgery.

Please keep our office advised of any changes in your condition, especially if drainage or pain increases. It is important that you keep all future appointments until this complication has resolved.