The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.
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, then placing a moistened gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. 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 two to three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two plastic bags 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.
Unfortunately, most oral surgery is accompanied by some degree of discomfort. Dr. Jachimowicz uses long acting local anesthesia on his patients, allowing them enough time to get comfortable. Effects of pain medications vary widely among individuals. You may be given a prescription for pain medication, and if you take the first pill before the anesthetic has worn off completely, you will be able to manage any discomfort better. If a narcotic pain medicine is prescribed by Dr. Jachimowicz, it is important not to take the pain medication on an empty stomach as this will cause nausea. If you do not have any contra indications to taking ibuprofen or Tylenol, most dental surgical pain may be alleviated with a regimen of Tylenol (1000mg) and ibuprofen (600mg). These medicines can be taken alternately every 3 hours. This treatment has many advantages including decreasing postoperative nausea, decreasing swelling after surgery and avoidance to the drowsiness associated with narcotic pain medication. Remember that the most severe discomfort is usually within the first six hours after the anesthetic wears off, after that your need for medicine should lessen.
For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.
After general anesthetic or IV sedation, liquids should be initially taken, This will prevent dehydration. Do not use straws for the first two weeks. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. Eat any nourishing food that can be taken with comfort. Temperature of the food doesn’t matter, but avoid extremely hot and spicy foods. It is sometimes advisable, but not required, to confine the first day’s input to bland liquids and pureed foods (creamed soups, puddings, yogurt, milk shakes, etc.) Avoid foods like nuts, sunflower seeds, popcorn, etc., that may get lodged in the socket areas. Over the next several days you can progress to solid foods at your own pace. It is important not to skip meals! If you are a diabetic, maintain your normal eating habits as much as possible and follow instructions from us, or your physician, regarding your insulin schedule.
CAUTION: If you suddenly sit up or stand from a lying position, you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing especially if you have been taking narcotic pain medicine.
No rinsing of any kind should be performed 24 hours following surgery. Brushing your teeth the night of surgery is acceptable, however, please avoid brushing near the extraction site as well as avoid rinsing vigorously. 24 hours after surgery, gentle rinsing can begin with a cup of warm water mixed with a teaspoon of salt. 48 hours after surgery you should begin rinsing at least 4 times a day, especially after eating. Dr. Jachimowicz may give you a special syringe to aid in rinsing hard-to-reach areas of the mouth after surgery.
In some cases, discoloration 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 postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics may be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.
The most common cause of nausea and/or vomiting after surgery is taking the stronger pain medicines with an empty stomach. In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed antibiotic and pain medicine. You should then sip on coke, tea or ginger ale. Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with a large volume of water. Try to keep taking clear fluids and minimizing the pain medication, but call the office (317) 844-7626, if you do not feel better or if repeated vomiting is a problem. When the nausea subsides you can begin taking solid foods and the prescribed medicine.
Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.
The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call the office for instructions.
There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean especially after meals with salt-water rinses or a toothbrush.
Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Jachimowicz or your family dentist.
BRUSHING your teeth is okay – You can begin the day of surgery, but remember to rinse gently and avoid the surgical sites with the toothbrush since there will be sutures over the surgical sites in most instances.
MOUTH RINSES – Keeping your mouth clean after surgery is essential. Starting 24 hours after surgery, use one-quarter 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 three to four times daily for the next five days. Avoid over the counter mouthwashes as they contain alcohol which can irritate the wound. Do not use Hydrogen Peroxide or mouthwashes that contain Peroxide.
IRRIGATING SYRINGE – If you were given an irrigating syringe, you can begin using this 4 to 5 days after surgery to keep the sockets clean. Fill it with the warm, salt water and irrigate any open sockets gently, especially after eating.
DRY SOCKET is when the blood clot gets dislodged prematurely from the extraction socket of primarily the lower teeth. You may experience a persistent throbbing pain in the jaw unrelieved by any measure. Activities that contribute to dry socket include sucking through a straw, smoking, vomiting, aggressive exercise, aggressive mouth rinsing too early after surgery, spitting, or any activity that may cause the clot to dislodge. Typically dry socket occurs at day 4 or 5. Contact our office if pain feels like it is worsening.
EXERCISE – 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. Remember, no exercise or contact sports the first week, 75% of your normal routine the second week, and back to 100% the third week. Keep in mind that everyone is different, and some people heal faster than others.
SMOKING: DO NOT smoke at least 72 hours (3 days) prior to or for at least 3 to 5 days after surgery, since it is very detrimental to the healing process and will greatly increse your risk of DRY socket.
DO NOT drink through a straw for the first 2 weeks after surgery, as this will increase your risk of DRY socket.