Removal of Third Molars Removal of Impacted Teeth Complicated Extractions Implants, Bone Grafting
ORAL HYGIENE: After 24 hours, begin very gentle rinsing with warm salt water (1/2 tsp. salt to 6 oz. of warm water). Do not swish the water in your cheeks. Just move your head and allow the water to passively move across the stitches. Do not spit hard, let the water fall from your mouth. In most cases, brushing can be resumed the following day. Do not brush in the area of the stitches or the wound for the first 4-5 days. Carefully brush only the teeth not involved in surgery. Vigorous rinsing of your mouth may cause dry sockets and pain!
One week after your surgery, you may fill the enclosed syringe with warm salt water (1/2 tsp. salt to 6 oz. of water) and insert the tip into the lower extraction sites. Use this syringe with warm water to flush the surgical site of any food debris. This will need to be repeated twice per day until the site is closed. Please note that if you use the syringe sooner than a week after surgery it may remove the blood clot and cause a dry socket.
ORAL HYGIENE WITH BONE GRAFT, IMPLANT PROCEDURES: The bone graft and/or implant sites are delicate and can be damaged by rinsing or normal brushing. Avoid cleaning over the graft, implant site for the first 5 days. After 5 days, dip a Q-tip in mouthwash and use it to gently clean across the surgical sites. Delicately brush the teeth adjacent to the graft area with a soft manual toothbrush starting the day after surgery but avoid electric toothbrushes. You may use toothpaste on the remainder of the teeth. You may start gently rinsing your mouth with salt water or mouthwash about 3 days after surgery. Take care not to spit, just allow the water to fall out of the mouth. Do not swish vigorously for the first two weeks after bone grafting procedures.
SMOKING: Smoking delays healing and increases your chances of infection and pain. It is recommended that you do not smoke for a minimum of 5-6 days following extractions and for at least 2 weeks after bone grafting and implant procedures.
DIET: After the initial food, your diet should consist of soups, juice, and soft foods such as scrambled eggs or mashed potatoes the first day. Avoid very hot foods, but warm foods are okay. After two days, you may gradually advance your diet to regular foods as you can tolerate. Avoid alcoholic beverages the day and night of surgery. It is very important that you take nourishment; please try not to miss a meal. Avoid peanuts, crunchy foods, and popcorn until the wounds are healed.
ACTIVITY: No heavy lifting or vigorous exercise for one week following removal of wisdom teeth unless otherwise directed by a doctor. For bone graft procedures, avoid vigorous exercise until your post-op visit. The post-surgical visit for bone grafts and implants will normally be 2 weeks after surgery.
STITCHES: Dissolvable sutures usually fall out in 7-10 days. Swallowed sutures will not cause a problem. On rare occasions an absorbable suture may come out the day of the surgery. This typically does not cause any future problems, but if you are concerned, please call our office. Sutures with bone grafts are non-dissolvable and are usually removed at the 2-week follow-up appointment.
DRY SOCKETS: Dry sockets are more common after removal of lower teeth, especially the molars including wisdom teeth. A dry socket typically develops 3-5 days after surgery and consists of an area in the socket where the tooth was extracted where the blood clot breaks down and leaves some exposed bone. Common symptoms include dull, achy, throbbing sensation that can radiate to the ear and mimic an earache. A dry socket will resolve spontaneously within 9-10 days after surgery. However, we can place a dressing to relieve the pain. If you feel that you are developing a dry socket, please call our office. You will lessen your chances of developing a dry socket if you follow all of the written instructions on this sheet. Please note that patients who smoke, women who take birth control medication and the elderly have an increased risk of developing a dry socket.
SWELLING: We use medications during surgery to reduce pain and swelling. Swelling, pain, and bruising are normal following surgery and will peak on the third morning following surgery, then gradually reduce in 5-6 days.
JAW STIFFNESS: It is recommended to do jaw stretching after extraction of molars and especially after the extraction of wisdom teeth. One of the goals after wisdom teeth surgery is prevention of jaw stiffness. You should begin chewing and stretching the jaw two days after surgery. You should try to be able to open wide enough to fit three fingers vertically between your upper and lower teeth 3-5 days after surgery. Patients who begin moving and stretching their jaws after surgery recover more quickly and have less pain.
OTHER CONDITIONS: Discoloration of the face is caused by natural seepage of blood and fluid into tissues during the surgery. These yellow or blue areas will appear gradually and disappear slowly. Small bone fragments that sometimes appear will slowly work their way out of the gum tissue as the tissue heals.
Numbness of the lower lip and/or tongue will sometimes occur after the surgery. This usually resolves in a few days to a few months. There may be a slight elevation in temperature for 24-48 hours after surgery. If the fever continues, or goes higher than 101 degrees Fahrenheit, please call our office. If you do experience any type of facial muscle weakness or numbness that lasts beyond 1-2 days, please call our office to notify our staff.
ADDITIONAL PRESCRIPTIONS: Most patients do extremely well following the prescribed medications and other instructions enclosed. Each prescription we provide is designed to provide comfort and encourage healing following surgery. On some rare occasions, there may be a need to prescribe additional medications. Please note that additional pain medication prescriptions will require a re-check appointment.
EMERGENCIES/QUESTIONS: If any problems or questions arise, please call us at 540-989-5257. After hours, an answering service will forward emergency messages, and the Doctor that saw you will return your call.
DRIVING/WALKING: Patients who have received intravenous medication should not drive for 24 hours. They should also walk with assistance to avoid stumbling and injury until fully recovered from the anesthetic. Showering and bathing should be delayed until the following day after surgery.
BLEEDING: Bite on gauze for thirty (30) minutes at a time. Initially, the gauze may be blood-tinged, but this should lessen by the third or fourth change of gauze. Do not spit or use a straw for 48 hours. Talking and general activity will cause continued oozing. You should feel light, moderate pressure when biting.
If bleeding recurs or continues, place a damp caffeinated tea bag directly on the wound and bite for one hour. Positioning of the gauze or tea bag is important. For wisdom teeth, the gauze or tea bag must press directly on the gum at the surgical site. Realize that blood-tinged saliva is normal and to be expected for 24 hours.
MEDICATION: On arriving home after surgery, remove gauze and drink or eat something cool and soft. Then take the medications prescribed. We recommend taking 600-800mg of Ibuprofen every 8 hours as a baseline level of pain control. Taking this soon after surgery will allow the pain medication to take effect before the numbness wears off. After that, continue to take the Ibuprofen (Advil, Motrin) scheduled and add in the prescription pain medicine as needed. If you are not taking the prescription pain medication, you may take 1000mg of Tylenol (Acetaminophen) every 8 hours between when you take the Ibuprofen. Unless otherwise directed, take your medication with food.
If you begin having an upset stomach, it is usually due to the pain medication. If this does occur, stop the pain medication. Allow the stomach to settle. If nausea stomach continues, please call our office.
If you begin to have itching or a rash, take 25mg of Benadryl and call our office. Do not drive after taking pain medication. In addition, birth control pills may not be effective for the cycle in which you are taking antibiotics. You need to take additional contraceptive precautions for that cycle.
ICE/HEAT: Apply ice to jaws following all surgical procedures. The ice pack should be placed of the skin closest to the site of surgery and should be left in place for 30-40 minutes. After this period, please remove the ice packs and allow the skin to rest for 30-40 minutes. Repeat this procedure as often as possible for the first 48 hours after surgery. Beginning 3 days after surgery, heat to the face is helpful to reduce residual swelling, bruising, and muscle stiffness.