Sometimes the after-effects of oral surgery are quite minimal, so not all of the following instructions may apply. If you have questions about the instructions, please call our office for clarification. Our number is: (703) 436-4633.
First Hour: Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not controlled. The packs may be gently removed after one hour. If active bleeding persists, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 30 to 45 minutes). It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning.
Exercise Care: Do not disturb the surgical area today. Do NOT rinse, spit or brush your teeth on the day of surgery. PLEASE DO NOT SMOKE for at least 48 hours, since this is very detrimental to healing and may cause a dry socket.
Bleeding: Intermittent bleeding or oozing overnight is normal. Bleeding may be controlled by placing fresh gauze over the areas and biting on the gauze for 30-45 minutes at a time. A pinkish tinge to your saliva is normal.
Persistent Bleeding: Bleeding should never be severe. If so, it usually means that the packs are being clenched between teeth only and are not exerting pressure on the surgical areas. Try repositioning the packs. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in very hot water, squeezed damp-dry and wrapped in moist gauze) for 20 or 30 minutes. If bleeding remains uncontrolled, please call our office.
Swelling: Swelling is often associated with oral surgery. The areas around the mouth, cheeks, eyes and sides of the face are not uncommon. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days afterwards. However, it can be minimized by using a cold pack, ice bag or a bag of frozen peas wrapped in a towel and applied firmly to the sides of the face where the surgery was performed. This should be applied twenty minutes on and twenty minutes off during the first 24 hours after surgery. If you have been prescribed medication to control swelling, be sure to take it as directed. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to 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 has worn off, you should better be able to manage any discomfort. Numbness from the injection site usually wears off in 2-8 hours after surgery. Some patients find that stronger pain medication causes nausea, but if you precede each pain pill with a small amount of food, chances for nausea will be reduced. The effects of pain medications vary widely among individuals. If you do not achieve adequate relief at first, you may supplement each pain pill with an analgesic such as ibuprofen. Some patients may even require two of the pain pills at one time. Remember that the most severe pain is usually within six hours after the local anesthetic wears off; after that your need for medication should lessen. If you find you are taking large amounts of pain medication at frequent intervals, please call our office. If you anticipate needing more prescription medication for the weekend, you must call for a refill during weekday business hours.
Nausea: Nausea is not uncommon after surgery. Nausea can be reduced by preceding each pain pill with a small amount of soft food, and taking the pill with a large volume of water. Try to continue drinking clear fluids and minimize the dosage of pain medications over a period of time. Classic Coca Cola, tea, or ginger ale may help with nausea.
Diet: Eat any nourishing food that can be taken with comfort. Avoid extremely hot foods. Do not use a straw for the first few days after surgery. A straw creates suction that could break down the blood clot at the surgery site (i.e. dry socket), prolong bleeding, and possibly delay healing. It is sometimes advisable, but not absolutely required, to confine the first day’s intake to cool liquids or pureed foods (soups, puddings, yogurt, milk shakes, etc.) It is best to avoid foods like nuts, rice, ground beef, sunflower seeds, popcorn, etc., which may get lodged in the socket areas. Over the next several days you may gradually progress to solid foods. It is important to not skip meals and to drink plenty of water! If you take nourishment regularly, you will feel better, gain strength, have less discomfort, and heal faster. If you are a diabetic, maintain your normal eating habits or follow instructions given by your doctor.
Sharp Edges: If you feel something hard or sharp edges in the surgical areas, it is likely you are feeling the bony walls which once supported the extracted teeth. Occasionally small slivers of bone may work themselves out of the extraction site during the following week or so. If this causes concern or discomfort, please call the office.
Medication: If you have undergone IV sedation or General Anesthesia and/or have been prescribed a stronger medication for pain, do not drive an automobile or work around machinery for at least 24 hours after your procedure. An additional sheet included in your bag contains all of the information you need regarding the interval of medication.
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.
Mouth Rinses: Keeping your mouth clean after surgery is essential. If desired, dissolve 1/4 teaspoon of salt 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 two or three times daily. Warm salt-water rinses help to keep the mouth clean and aid with discomfort of the extraction site.
Brushing: Begin your normal oral 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.
Hot Applications: You may apply warm compresses to the skin over the areas of swelling (hot water bottle, hot moist towels, and heating pad) for 20 minutes on and 20 minutes off to help soothe tender areas. This will also help decrease swelling and stiffness.
Discoloration: In some cases, especially for IV sedated and General Anesthesia patients, 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 post operative occurrence, which may occur 2-3 days after surgery.
Activity: You may carefully resume exercise and physical activity 2-3 days after surgery.
Pain: Most significant pain should be resolved, although local discomfort may persist for 2-3 weeks. It is usually resolved with Tylenol or Ibuprofen. Contact our office for persistent pain, which can be due to dry socket, infection, or bone spur.
Swelling: Most, if not all swelling should be resolved within 7-10 days after surgery. Facial bruising may persist for up to 10-14 days. Local heat will help things return to normal more quickly.
Jaw Stiffness: This is normal and should be expected following surgery. You must make a conscious effort several times a day to stretch your jaws open wide. Local heat and ibuprofen can help the associated discomfort and inflammation.
Oral Hygiene: By a week after surgery, you should be back to brushing your teeth as normal, hopefully several times per day. Thorough rinsing with tap water or salt water helps maintain cleanliness at the surgical sites. There is no need for excessive use of mouthwashes; in fact it may be harmful. Extra attention at the extraction sites may be necessary for up to 3-4 weeks after teeth are removed until tissue healing has filled the defect.
Diet: Approximately 1 week after surgery your diet should be returning to normal. You may require an additional week to be able to consume hot, spicy, or harder foods without difficulty.
Activity: By approximately 1 week after surgery, most routine activities may be resumed. It is usually advisable to avoid swimming or diving for 10-14 days.
Bite: It is not uncommon for the bite to feel “different”, or that the lower teeth have “shifted” following third molar surgery. This is usually due to stiffness in the muscles resulting in a slight repositioning of the lower jaw or release of pressure on the adjacent molar teeth and thus a change in the way the teeth meet. This situation generally returns to normal in 1-2 weeks. If you feel uncertainty after this allotted time, please do not hesitate to call us.
Sutures: Dissolvable sutures are often placed over the extraction sites, and will dissolve on their own in 7-10 days. Sutures may become loose, irritating or may come out either earlier or later than expected.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions should provide you with the information you need, but if you have questions about your progress or fail to see continued improvement, please call the office and speak to one of our dedicated staff members. A 24-hour answering service is available to contact the doctor after hours. Calling during office hours will afford a faster response to your question or concern.