General Post Operative Instructions Following Oral Surgery
Please review this information prior to your treatment. Following these instructions will assist in your recovery.
CONTACTING OUR OFFICE
If you have been treated by our office and have encountered an emergent situation after hours, please call our main office number Lethbridge Office Phone Number 587-425-1600 to contact Drs. Goth or Olsen. We prefer if you contact us first rather than your own dentist or family doctor; however, if you have difficulty breathing or are experiencing severe bleeding requiring immediate attention, proceed to the emergency room or dial 911. Calls for prescription refills and routine questions should be made during our regular office hours (Monday – Friday, 8:00 am to 4:00 pm).
You will receive a prescription for pain medication. Take the medication as prescribed on the bottle. It is advisable to start taking the pain medicine within two hours after surgery (before the numbing anaesthetic has worn off). The pain medication is best taken with food or fluids. If taken on an empty stomach, the pain medication may cause nausea and vomiting. If you only have mild pain, over-the-counter Acetaminophen (Tylenol) or Ibuprofen (Advil) may be used, provided you do not have any allergies or health reasons to avoid them. Consult your doctor or pharmacist if in doubt. The prescription pain medicine can be used for moderate to severe post-operative pain. Be aware it can cause dizziness or make you feel groggy. Avoid operating a motor vehicle, machinery, or any other activities where you may injure yourself or others while on prescription pain medication. If bowel habits become irregular, a mild laxative such as Milk of Magnesia may be taken.
You may receive a prescription for an antibiotic. Take the medication as prescribed on the bottle. Be sure to finish all the medication. It is not uncommon to feel slightly nauseated or itchy when beginning the antibiotics. If you develop a rash or other unfavorable reaction call the office for further information. Some antibiotics can interfere with birth control pills. Be aware that patients taking oral contraceptives should use alternate means of birth control for the remainder of the cycle.
Some bleeding is to be expected. A gauze pad will be placed over the operated area to help control the bleeding. It should be left in place for about an hour after leaving the clinic. Then, remove and replace it with a new folded, moistened gauze pad directly over the operated site. Press firmly on the pad with your teeth, but do not chew on it. Leave the new gauze pad in place for 45 – 60 minutes. Repeat these steps as needed at home until the bleeding slows. Avoid spitting. A moist tea bag can be used in place of gauze if oozing is persistent; the tannin in the tea bag may help to stop the bleeding. Sit or lie quietly with your head elevated. If excessive bleeding occurs or continues, call the office. It is not unusual to have a little blood on the gauze pad for several hours following surgery. It is also not unusual to have a little blood on the pillow or in the saliva for 3 – 4 days after surgery. Do NOT sleep with gauze pads in your mouth.
Dissolving sutures are routinely placed. These will dissolve 2 – 10 days. Loose sutures can be removed at home with tweezers or the long ends can be carefully trimmed.
SWELLING, BRUISING & DISCOMFORT
Swelling, bruising and discomfort may occur after surgery and are completely normal. Considerable swelling of the face and neck may result from surgical removal of teeth. Expect swelling to increase for 2 – 3 days following surgery, and then gradually subside. To help minimize the swelling, you can use an ice pack on the face for the first 2 days. Apply the ice on and off for periods of 15 minutes at a time (or simply switch the ice pack from side to side every 15 minutes during awake times). After 2 days stop using the ice packs, and switch to using heat packs in the same fashion. Use moist dressings, a hot water bottle or heating pad. Most swelling and discomfort will be resolved in about 4 – 6 days. Swelling, bruising, and discomfort may be greater on one side compared to the other regardless of the difficulty of the extractions.
Nausea may occur after anaesthesia. It is often related to medications or from swallowing blood. If this occurs, Gravol tablets or suppositories may be purchased at your pharmacy without a prescription. Follow the instructions on the package. Flat soda (Ginger Ale or 7-Up), or plain tea may also help alleviate nausea.
LIMITED MOUTH OPENING
This is caused by an accumulation of fluid in the jaw muscles to help healing. It is a normal protective mechanism and the limited opening will usually subside in 2 – 3 weeks.
Smoking impairs healing and leads to an increased risk of complications such as bleeding, infection, and dry socket. DO NOT smoke for at least 1 week following surgery. Preferably you should not smoke for 6 weeks after surgery.
Consuming alcohol may increase bleeding, and can interact with prescription pain medications, increasing the risk of complications. Do not drink alcohol for at least one week following surgery or until you are no longer taking prescription pain medication.
DIET & NUTRITION
Following oral surgery your jaw may be stiff, and your mouth and throat sore. You will be able to drink fluids and eat soft foods. After surgery your body requires adequate fluids and nourishment to support healing and recovery. It is not a good time to diet. It is critically important that you drink ample fluids, 2 – 3 litres/day, in small but frequent amounts. Fluid intake should start soon after your surgery, and can include water, sport drinks, fruit and vegetable juices, and soups such as chicken and beef broth. Diet supplements such as Ensure, Boost or instant breakfast preparations are helpful starting the day following surgery. A vitamin supplement may also be taken. Avoid using straws for the first few days as they can stimulate bleeding by creating suction in your mouth. Take solid food in a form that you can tolerate (blenderized, pasta, mashed etc.). Do not eat foods that break apart into sharp bits or foods with husks or tiny seeds (nuts, hard candy, chips, strawberries, popcorn etc.). They are easily lodged in the surgical sites, and may cause infection. Please avoid these types of food for 2 months. Eating hard or crunchy foods in the first four weeks after extractions or removal of third molars could result in a jaw fracture.
Do not rinse your mouth on the day of surgery as this can disturb the healing process and cause bleeding. Begin rinsing on the day following surgery. Use a teaspoon of salt in 8 ounces (250 ml) of warm water. Rinse frequently and always following meals. You may start gently brushing your teeth the day following surgery. Tooth sockets normally take 6 – 8 weeks to fill in and should be kept clean.
A dry socket is a rare complication that occurs in about 5% of patients following tooth extraction. It is related to a premature loss of the blood clot in the tooth socket. Localized inflammation may be present. If a dry socket is going to occur, it generally develops 4 – 5 days after surgery. If after 4 – 5 days you experience a sudden increase in pain, radiating down along the jaw line or radiating up into the ear, it may be a sign that a dry socket is developing. We can help treat this in our office with a sedative dressing. Contact our office if you have any concerns that a dry socket is forming.
Post-operative infections are rare. Signs of infection may include developing a sudden increased swelling or pain at the surgical site, feeling ill, and prolonged elevated temperature. Please contact our office if you think you have become infected.
It is normal to experience a temperature elevation of 38.5oC (101oF) for 2 to 3 days following oral surgery and anaesthesia. Acetaminophen or Ibuprofen can be used to reduce the temperature if no other health contraindications are present.
Occasionally bone spicules may be noticed in the surgical sites. These are not pieces of a tooth, but are thin shards of loose bone. These are usually not serious and will often disappear after several days. If they persist please call our office for a follow-up appointment.
Mouth ulcers are sometimes seen after oral surgery and usually last 7 – 10 days. They can be treated with baking soda mouth rinses; use one teaspoon of baking soda in 8 ounces (250ml) of warm water.
Numbness or altered sensation may occur in the lips, chin or tongue following oral surgery. This can occur secondary to post-operative swelling or because of the closeness of the nerves to the surgery site. The numbness or altered sensation, when it occurs, can last for several weeks or months. In rare situations normal sensation may not return. If you experience prolonged numbness or altered sensation of the lip, chin, or tongue, please call our office for a follow-up appointment.
Muscle stiffness and tenderness will occasionally result after general anaesthesia. This is usually confined to the chest, back of the neck and back of the legs. The sensation may be similar to a rigourous workout. This is not serious and will resolve after a few days. This can be minimized with rest. Ibuprofen also can be helpful if needed.