Immediately Following Surgery:

• The gauze pad placed over the surgical area should be kept in place for a half hour. 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.
• You may begin taking the pain medication prescribed by the doctor 1-2 hours following your surgery, after getting something to eat and prior to the “numbness” of the local anesthetic wearing off.
• 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.

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 directly over the area and biting firmly for thirty minutes. Repeat as necessary. If bleeding continues, instead of using gauze pads, try biting on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. If a complete or partial denture was placed at the time of your extractions, do not take it out unless it is painful to wear. To minimize further bleeding, remain calm, sit upright, and avoid strenuous exertion. 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 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 2-3 days post-operatively. Swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, a bag of frozen corn or peas, or commercially available 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 24-36 hours, ice has no beneficial effect. Thirty-six hours following surgery the application of heat to the sides of the face is beneficial in reducing jaw stiffness and residual swelling. After reaching a peak 2-3 days after surgery, facial swelling should begin to decrease.

Pain

For the first 24 hours following your surgery, take your prescription pain medication as prescribed. You may begin taking your prescription pain medication 1-2 hours following your surgery, after you have gotten something to eat. Your pain medication will be more effective if it is taken before the local anesthetic “numbness” wears off. If additional pain relief is needed, you may supplement your prescription by taking 400-600mg. of ibuprofen* (Advil, Motrin) every 4 hours. The additive effect will work best if you stagger your prescription medication with the ibuprofen, such that you are taking one or the other (not both) every 2 hours. 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 each day.
*Do not take ibuprofen or similar compounds if allergic to aspirin.

Diet

Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. Start with liquids, such as, milk shakes, Instant Breakfast, fruit juices, and Ensure. High calorie, high protein intake is very important. Your food intake will be limited for the first few days, however you may eat whatever you can comfortably tolerate. You should compensate for this and prevent dehydration though by increasing your fluid intake. Drink at least 4-5 glasses of liquid daily. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.

Oral Hygiene

You can brush your teeth and/or denture prosthesis the night of surgery. After cleaning your denture place it back into your mouth and, if tolerable, leave it in place until you are seen by your dentist. The day after surgery you should begin rinsing at least 4-5 times a day with a half teaspoon of salt in a glass of lukewarm water. If you have an immediate partial or complete denture, remove it for cleaning after every meal.

Sutures

Absorbable 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. If non-absorbable sutures were used they will be removed approximately one week after surgery. The removal of sutures takes only a minute or so, and there is no discomfort associated with this procedure.

Denture Adjustments

If an immediate partial or complete denture was placed at the time of your extractions, you will need to see your general dentist within the first 24-48 hours for an initial denture adjustment. This is absolutely mandatory in order to prevent painful denture sores. For the first few weeks following surgery, frequent denture adjustments are needed as the gums shrink and the denture “settles” into place.

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, cause increased fatigue, and further limit your ability to exercise.

Discoloration/Bruising

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood pigments spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics take the tablets or liquid as directed. Antibiotics are sometimes given to treat or prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

Nausea and Vomiting

Although uncommon, nausea is an occasional side effect of prescription medication or intravenous anesthetics. Nausea may also be caused by swallowing a small amount of blood. Although unpleasant, it is usually transient and is not harmful. In the event of nausea and/or vomiting, stop taking all oral medication, lay down, apply a cool compress to your head, and remain inactive. Wait at least one hour before you resume eating. Begin with clear liquids (broth, 7-Up, Sprite, apple juice) and dry carbohydrates (toast, crackers). Avoid caffeine and dairy products until the nausea subsides. If nausea persists, please call for assistance. It may be necessary to change your prescription medication and/or prescribe an anti-nausea medication.

Jaw Stiffness

Stiffness (Trimus) 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. Taking 400-600mg. of ibuprofen* every 4 hours and applying heat to the jaw muscles using an electric heating pad on a low setting will help to resolve jaw stiffness.
* Do not take ibuprofen or similar compounds if allergic to aspirin.

Special Concerns & Considerations

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:

• Occasionally, patients may feel hard projections in the mouth with their tongue. These are not roots, they are the bony walls that supported the teeth. These projections usually smooth out within a few weeks. If not, they can be removed by the doctor.
• 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 sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.
• Reduced nutritional intake, prescription pain medication, and intravenous anesthetics can cause dizziness, lightheadedness, and loss of balance when changing position suddenly. Move slowly when going from the lying down position to sitting or standing. After lying down, always sit for one minute before standing up. If upon standing, you begin to feel lightheaded or dizzy, lay back down, wait 5 minutes, and then try again.
• 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. This is normal and is usually due to slight dehydration. Increasing your fluid intake should resolve this problem. If an elevated temperature persists more than 24-48 hours, notify the office.