Post Surgical Instructions

Each patient will receive “after surgery information” pertaining to his or her specific procedure.

After Wisdom Teeth Removal

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.

Immediately Following Surgery

  • The gauze pad placed over the surgical area should be kept in place for 30 minutes. After this time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.

Bleeding

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 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 alarmed. Sit upright and avoid exercise. If bleeding does not subside call for further instructions.

Swelling

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 common. 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.

Pain

For moderate pain, one or two tablets of Tylenol® or Extra Strength Tylenol® may be taken every three to four hours or Ibuprofen (Motrin® or Advil®) two to four 200 mg tablets may be taken every three to four hours.

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 a motor vehicle 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. You should call the office.

Diet

Drink liquids after general anesthesia or IV sedation. You may eat anything soft by chewing away from the surgical site(s). High calorie, high protein intake is very important. Try to maintain a normal diet. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least five to six glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.

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.

Keep the Mouth Clean

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least five to six times a day with a cup of warm water mixed with a teaspoon of salt especially after eating.

Discoloration

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. The discoloration will migrate down the neck towards the chest.  This is a normal pattern.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will 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.

Nausea & Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least one hour including the prescribed medicine. You should then sip on Coke®, tea or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin ingesting solid foods and the prescribed medicine. Narcotic pain medicine is the most common cause of nausea and vomiting. If this occur, substitute  Motrin® or Tylenol®; lie down and try to rest. Nausea from narcotics is like motion sickness and may last for several hours after your last dose.

Other Complications

  • If numbness of the lip, chin or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. Be careful. Call Dr. Hecht if you have any questions.
  • A slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol® or Ibuprofen should be taken to reduce the fever.
  • You should be careful going from the lying down position to standing. Before standing up, you should remain seated for one minute, then get up. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light-headed if you suddenly stand up.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls, which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Hecht.
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline®.
  • Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in two to three days.
  • Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event that will resolve in time.  It occurs from muscle trauma during surgery.

Finally

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.  Most sutures will dissolve on their own, others 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.

There will be a cavity where the tooth was removed. The cavity will gradually fill in with new tissue during the next month. In that time, the area should be kept clean especially after meals using a salt-water rinse or a toothbrush.

Your case is unique to you. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with those best able to effectively help you: Dr. Hecht or your family dentist.

Brushing your teeth is okay – just be gentle at the surgical sites. The cleaner the mouth the quicker the healing  process.

A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur two to three days following surgery. The pain can be treated effectively with medicated dressings that need to be changed frequently at your convenience. Call the office if this occurs.

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. Exercising too soon will cause pain and swelling leading to a prolonged post operative course.

After Dental Implant Surgery

Do not disturb the wound. Avoid rinsing, spitting or touching the wound on the day of surgery. There will be a metal healing abutment protruding through the gingival (gum) tissue.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues, please call Hecht Oral Surgery for further instructions.

Swelling

Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, plastic bag or towel filled with ice on the cheek in the area of surgery. Apply the ice continuously, as often as possible, for the first 36 hours.

Diet

Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

Pain

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one to two Tylenol® or Extra Strength Tylenol ® may be taken every three to four hours. Ibuprofen (Advil® or Motrin®) may be taken instead of Tylenol®. Ibuprofen, bought over the counter comes in 200 mg tablets. Two to three tablets may be taken every three to four hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic or have been instructed by your doctor not to take it.

Antibiotics

Be sure to take the prescribed antibiotics as directed to help prevent infection.

Oral Hygiene

Good oral hygiene is essential to good healing. The night of surgery, use the prescribed Peridex Oral Rinse® before bed. Five days after surgery, the Peridex® should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt-water rinses (one teaspoon of salt in a cup of warm water) should be used at least four to five times a day, as well, especially after meals. Brushing your teeth with the healing abutments is not a problem. Be gentle initially when brushing the surgical areas. Refrain from the use of mouthwashes and antimicrobial rinses for at least five to seven days post-op.

Activity

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.

Wearing Your Prosthesis

Partial dentures, flippers, or full dentures should not be used immediately after surgery and for at least 10 days. This was discussed in the preoperative consultation.

Aftrer Multiple Extractions

A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding continues, a moist tea bag can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.

Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 36 hours only. Apply ice continuously while you are awake.

For mild discomfort use aspirin, Tylenol® or any similar medication; two tablets every three to four hours. Ibuprofen (Advil®, Motrin®) 200mg can be taken two to three tablets every three to four hours.

For severe pain, use the prescription given to you. If the pain does not begin to subside in two days, or increases after two days, please call the office. If an antibiotic has been prescribed, finish your prescription regardless of your symptoms. In addition, take a probiotic during your antibiotic therapy.

Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day.

Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt-water rinse every four hours and following meals to flush out particles of food and debris that may lodge in the operated area, (one teaspoon of salt in a glass of lukewarm water.). After you have seen your dentist for denture adjustment, take out denture and rinse three to four times a day.

Restrict your diet to liquids and soft foods that are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.

The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur (all of which are considered normal):

  • The area operated on will swell, reaching a maximum in two to three days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration. The towel should be applied continuously for as long as tolerable beginning 36 hours after surgery (remember ice packs are used for the first 36 hours only).
  • A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in two to three days.
  • If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline. There may be a slight elevation of temperature for 24-48 hours. If temperature continues or is greater than 100, notify the office.

If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores prolonging the healing process. As healing progresses, it is common to develop sore spots as a result of uneven bone healing. The rough areas may need to be smoothed.

After Exposure of an Impacted Tooth

If surgical packing was placed, do not disturb the wound.. The pack helps to keep the tooth exposed. If it gets dislodged or falls out, do not get alarmed. It does not need to be replaced. The area will heal normally.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding which results in your mouth filling rapidly with blood can frequently be controlled by biting with pressure on a gauze pad placed directly on the bleeding wound for 30 minutes. If this does not control the bleeding rinse your mouth with ice water gently then bite on a tea bag at the bleeding site for 30 minutes.  If bleeding continues, please call for further instructions.

Swelling

Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag or a plastic bag or towel filled with ice cubes on the cheek in the area of surgery. Apply the ice continuously as much as possible for the first 36 hours. Maximum swelling occurs after three days.

Diet

Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

Pain

You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one or two Tylenol® or Extra Strength Tylenol® may be taken. Tylenol® may be taken every three to four hours. Ibuprofen (Advil®, Motrin®) may be taken instead of Tylenol®. Ibuprofen bought over the counter comes in 200 mg tablets: Two to three tablets may be taken every three to four hours as needed for pain. For severe pain, the prescribed medication should be taken as directed.

Oral Hygiene

Mouth cleanliness is essential for good healing. Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can. Rinse with warm salt water (one teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete.

REMEMBER: A clean wound heals better and faster.

Activity

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing, swelling or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light-headed, stop exercising

After Extractions

After tooth extraction, it is important for a blood clot to form to stop the bleeding and begin the healing process. That’s why we ask you to bite on a gauze pad for 30-45 minutes after the appointment. If the bleeding or oozing persists, insert another gauze pad and bite firmly for another 30 minutes. You may have to do this several times. Do not chew on the gauze or spit as this will cause more bleeding. Slight oozing is normal and does not require pressure.

After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.

After the tooth is extracted you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen food applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours.

Use the pain medication as directed. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.

It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean.

After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for two to three days, or a reaction to the medication, call the office immediately at 717-249-7007.

Post surgical recovery area

Our nurses are stationed only steps away from patients who are in the recovery area following surgery.