We are committed to providing the same quality of care following procedures that began during your initial visit. To that end, please refer to some general postoperative guidelines below, and by all means, CALL at any hour of any day to report any continuing problem.
Faithful compliance with these instructions will add to your comfort and hasten your recovery. Be sure to follow these instructions carefully. Only in this way will you avoid the complications which lead to unnecessary discomfort and delayed recovery. Should any undue reaction or complications arise, notify the office immediately.
The Day of Surgery
- Some degree of discomfort and pain arises as numbness subsides. At the first sign of pain or discomfort, take the Motrin 800 mg as prescribed or take 2-4 Advil. If you cannot take aspirin products, then take two Tylenol. Repeat every 6-8 hours as necessary. If the Advil isn’t strong enough for the pain you are having, you may take the prescribed severe pain medicine, but only in small doses and only after eating some food. Any pain medications can cause nausea and vomiting. It is very important that you have some food in your stomach before you take them.
TO REPEAT, take Motrin 800 mg as prescribed or 2-4 Advil as the numbness wears off. Do not take the prescribed severe pain medicine unless absolutely necessary.
- DO NOT DISTURB THE AREA OF SURGERY. The first stages of healing are aided by placing tissues at rest. Avoid vigorous chewing, excessive spitting, or rinsing as initial healing may be delayed, active bleeding restarted, or infection introduced.
- Expect minor bleeding or OOZING from the operative site. This bleeding may continue throughout the first day. For the first hour, keep firm pressure on the area of surgery by biting on the gauze sponge placed in your mouth at the office. If bleeding persists, continue pressure on a fresh sponge for an additional 30 minutes to an hour. Biting on a moist tea bag wrapped in gauze may help control persistent oozing from the surgical site. Tea has an ingredient that promotes blood clotting.
If active bleeding should recur at any time, carefully rinse your mouth with cold water and apply a fresh gauze sponge to the bleeding site. Firm pressure for 15-30 minutes usually controls the problem. Should active bleeding persist, please call the office.
- LIMIT PHYSICAL ACTIVITY during the first 24-48 hours after surgery. Over exertion may lead to postoperative bleeding and discomfort. When you lie down, keep your head elevated on a pillow.
- PAIN FOLLOWING ORAL SURGERY will be most severe within the first 6-8 hours after the operation. To limit the amount of pain, you should take Motrin 800 mg or Advil before the numbness wears off. If you have to take the prescribed severe pain medication, remember to have some food intake prior to that and to start slowly. Please do not drink alcoholic beverages while taking prescription pain medication. Do not wait for the pain to become unbearable before using some form of pain medication, as then it will be more difficult to control. Moderate to severe pain usually does not last longer than 24-48 hours, and there should be no more than the slight pain or discomfort after the third day. Persistent or increasing pain 3-4 days following oral surgery may be caused by early loss of the blood clot (dry socket) or infection. If you feel that this may be happening to you, please contact us so that we can help make you more comfortable.
- SWELLING RELATED TO THE SURGICAL PROCEDURE usually develops during the first 12-24 hours following surgery, often increasing on the second day. It should begin to subside by the third day. Swelling can be minimized a great deal by wearing an ice pack on the side of your face for 30-45 minutes every hour while you are awake during the first 24 hours following the surgery, unless you receive special instructions. Anti-inflammatory medications, such as Motrin or Advil, also help decrease swelling.
- FLUID INTAKE IS IMPORTANT. I suggest you start with clear carbonated beverages, such as ginger ale, Seven-Up, or Sprite. Once your stomach has settled, you can advance to other fluids such as water, teas, soda, broth, soups, or juices. I suggest avoiding dairy products initially, such as milk, milk shakes, and egg nogs. Also avoid hot liquids until the numbness has worn off, and the bleeding has stopped. It is important to drink all the fluids you desire and to drink plenty of fluids.
- AVOID USING A STRAW FOR SEVERAL DAYS as it may cause the blood clot to dislodge and delay healing.
- FOOD SELECTION is largely a matter of your choice. Soft, cool foods that require little or no chewing are most easily tolerated at this time. A nutritious diet throughout your healing process is most important to your comfort and temperament. Hungry people become irritable and less able to deal with discomfort which can follow surgery. Since you will be taking medication, it is important to remember that eating can prevent nausea sometimes associated with certain medications. Once your stomach is settled, soups, broiled fish, stewed chicken, mashed potatoes, macaroni and cheese, and cooked vegetables can be added to your diet as your comfort indicates. Ensure, Carnation Instant Breakfast and/or yogurt supply excellent added nutrition.
- Take any special medication such as ANTIBIOTICS we have prescribed on the specified dosing schedule. Yogurt with active cultures or acidophilus should be taken while on antibiotics to prevent diarrhea. It is important to take the antibiotics to completion. If you are given antibiotics and take birth control pills, you should be aware that the birth control pill may become ineffective, therefore take appropriate precautions.
- Take any regularly scheduled medication (for diabetes, high blood pressure, etc.) on your regular schedule unless advised to do otherwise.
- TRY TO AVOID SMOKING COMPLETELY, as it tends to slow the healing process and may also contribute to development of a dry socket.
- DO NOT DRIVE AN AUTOMOBILE for 24 hours following surgery if you have had intravenous sedation, or if you are taking prescription pain medication.
14. IF YOU WERE INFORMED THAT A SINUS COMMUNICATION OCCURRED DURING SURGERY, as a result of the close relationship between the roots of your upper teeth and your sinuses, or if you have had some surgery that involved work near your sinuses or in your sinuses, please follow these instructions:
- DO NOT blow your nose.
- DO NOT sneeze through your nose. If the urge to sneeze arises, sneeze with your mouth open.
- DO NOT smoke or use a straw.
- AVOID swimming and strenuous exercise for at least one week.
- It is not uncommon to have a slight amount of bleeding from the nose for several days.
- Please remember that occasionally a second procedure may be required if there is a persistent sinus communication.
The day following surgery and thereafter.
- On the morning of the day following surgery, rinse your mouth carefully with the solution made by adding 1/2 teaspoon of salt to a large glass of warm water. Repeat three times a day until remaining soreness subsides. Resume brushing any remaining teeth and your regular oral hygiene as soon as possible. Do not avoid brushing the area as this will cause more inflammation in the area. Please do not use a syringe or Water Pik® to aggressively rinse during the first week. This can dislodge the blood clot.
- DO NOT WORRY ABOUT STITCHES. Stitches (also known as sutures) are usually placed to control bleeding, aid healing and help prevent food from collecting in the surgical site – – especially for lower teeth. The sutures we use dissolve in 3 to 5 days and DO NOT HAVE TO BE REMOVED.
- ANY SWELLING, SORENESS, OR STIFFNESS IN THE JAW MUSCLES can be relieved by applying a warm moist towel to the affected side of the face several times a day. Moist heat should be used after the first 24 hours. If swelling, tenderness, or pain should increase after the first few days, call the office.
- Sometimes a soft diet may be necessary for the first few days following surgery. Most patients are able to resume regular food intake within a short time.
- Bruising marks may appear on the skin of the face during the first few days after surgery. Moist heat application will help relieve this condition once again.
What are dry sockets?
Dry sockets continue to be the most common problem people experience following dental surgery. They arise due to premature loss of a blood clot in the empty tooth socket and affect approximately one out of five patients. This seems to occur with greater frequency in people who smoke or are taking birth control pills. While both jaws can be affected, they usually occur in the lower jaw on the third to fifth day. They cause a deep, dull, continuous aching on the affected side(s). Patients may first notice the pain starting in the ear radiating down towards the chin. It frequently begins in the middle of the night, and the Motrin medication usually doesn’t help. Treatment involves placing a medicated dressing in the “empty” tooth socket. This will help decrease the pain and protect the socket from food particles. The effectiveness in alleviating the pain lasts for 24-48 hours and usually will require dressing changes every day or two for five to seven days. Dressings usually are removed when you have been pain free for 2-3 days. The dressing doesn’t aid in healing. The only reason to place a dressing is for pain control. If Motrin is controlling the pain, the socket will heal without a dressing. An irrigation device will be given to you to help keep food particles from lodging in the extraction site following removal of the dressing.
Postoperative Instructions for Bone Grafting
In addition to the general postoperative instructions, I would like to emphasize a few points.
Your bone graft is made up of many particles. You may find some small granules in your mouth for the first several days. Do not be alarmed by these. It’s normal to have some of them come out of the graft site and into your mouth. There are some things you could do to minimize the amount of particles that become dislodged:
- Do not vigorously rinse or spit for 3-5 days.
- Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.
- Do not lift or pull on the lip to look at the sutures. This can actually cause damage to the wound site and tear the sutures.
For the first day, I would suggest letting the blood clot stabilize and not even rinse your mouth. Following the first day, gentle rinsing would be advised but not too vigorously as you can again disturb some of the bone graft granules. If a partial denture or a flipper was placed in your mouth, you will probably have to see your restorative dentist to have it adjusted and learn how to remove and replace it appropriately.
Postoperative instructions for sinus grafting.
If you had a sinus grafting procedure performed, the general postoperative instructions still apply, but I would like to emphasize a few important points about your particular procedure and remind you of some instructions:
- Do not blow your nose.
- If you must sneeze, do so with your mouth open to avoid any unnecessary pressure on the sinus area.
- 3. Do not smoke or use smokeless tobacco. Smoking greatly inhibits the healing, especially in the sinus graft.
- Do not take liquids in through a straw.
- Do not lift or pull up on your lip to look at the stitches, as this may actually create damage and tear the stitches.
- Take your antibiotics as directed and until finished.
- You may have some bleeding from the nose. This is not uncommon and should pass quickly.
- You may be aware of small granules in your mouth for the next few days. This is not unusual, as your graft is mainly made of particles and not all of them are accepted by the body.
- If you feel congested, you may need to use antihistamines or decongestants. If you do, use over-the-counter products such as Tavist-D or Dimetapp. I would also suggest that you avoid nasal sprays unless they are saline. Most of the time, patients do fine without any nasal sprays, antihistamines, or decongestants.
Postoperative instructions for endosteal implants
If you had endosteal implants placed, general postoperative instructions apply, but I’d like to emphasize a few things:
- Placement of endosteal implants usually do not create a great deal of pain. Once again, start with Advil first.
- You need to brush the area after the first 24 hours with a very soft toothbrush. Do not avoid brushing the area. Most times the sutures that are placed are dissolvable sutures which will dissolve on their own in 8-12 days.
- If a one-stage implant was placed so that you can actually see the metal part protruding from the gum tissue, it is very important for you to keep this area clean. You may start with a Q-tip dipped in Listerine or even warm salt water. Just clean the metal part protruding from the tissue. Then you can proceed to a soft toothbrush.
- Avoid chewing hard foods on the implant sites. Chewing forces during the healing phase can decrease the body’s ability to heal around the implant.
After Hours, Weekend, and Emergency Service
If you need assistance over the weekend, it is helpful if you call around 9:00 AM, so that we can arrange to see you in one of our offices. We appreciate your patience as we do our best to keep you comfortable during the healing process.
If you need to contact us after office hours, please call the office at 603-436-8222.
We make every attempt to answer the emergency pager as promptly as possible. Occasionally, your messages do not reach my pager. If you do not hear from the doctor on call within one-half hour, please call back and ask them to page the doctor again.