Post Operative Instruction

Extractions of teeth or other oral surgeries are serious procedures. Postoperative care is very important and to prevent complications and unnecessary pain, discomfort, and expense, the following instructions should be followed closely to ensure proper healing.

SUTURES

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.

KEEP THE MOUTH CLEAN

Do not do any rinsing of the mouth or brushing of teeth for 24 hours after surgery. The day after surgery use a solution of ½ teaspoon of salt in a glass of warm water as needed, not too vigorously, since this may dislodge the blood clot and possibly delay healing. Resume brushing teeth the following day. Stitches will dissolve in 5-10 days.

BLEEDING

Following oral surgery, slight bleeding or oozing for the first day is not uncommon. Place a roll of gauze over the wound and bite down firmly for at least two hours. Do not spit or rinse. This only makes the bleeding worse. Swallow normally; the fluids will not hurt you. If bleeding continues after trying the above, bite on a moistened tea bag for 20 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. Do not become excited, but rather lie down with your head elevated on three pillows. If bleeding does not subside, call for further instructions. Upon leaving our office, your first stop needs to be for a milkshake. Have the patient drink the shake with a spoon or “cup it.” Do not use a straw! You may take the gauze out to eat or drink and then replace it as needed when you are done. When only a few swallows of the shake are left, have the patient take two pain pills and one antibiotic unless otherwise instructed.

PAIN

For severe pain, take tablets prescribed for pain. For moderate pain, take 800mg of Ibuprofen 3 times a day with food or juice. IMPORTANT! Swallow tablets, they are not to dissolve in mouth. If prescription was given, please use as directed. The prescription for pain will make you a little groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Move about slowly. If you suddenly sit up or stand up from a lying position, you may become dizzy, and a few people even black out for a few seconds. Without infection or other complications, the discomfort following an extraction or other oral surgery will usually disappear in a few days. However, if pain or swelling continues, it may require attention and you should call the office. (580) 355-6000.

ANTIBIOTICS

You have been given a prescription for an antibiotic. Take the entire prescription as directed. The drugs you may have been given will minimize swelling, reduce discomfort, prevent infection, and promote healing. Discontinue only in the event of a rash or other unfavorable reaction and call our office immediately. NOTE: Antibiotics may reduce the effectiveness of birth control pills. Please use other forms of birth control until you start your next pack of pills.

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. However, the swelling may be minimized by the immediate use of ice packs. Two Baggies 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 24 hours of ice, moist heat should be applied to area until all swelling is gone. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. After 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. Some temperature rise is to be expected after surgery.

DISCOLORATION

You may develop black, blue, green, or yellow discoloration resembling a bruise in the tissue. This is due to a slight oozing of blood beneath the tissues and is of little significance. This is a perfectly normal postoperative event. It should be treated the same as swelling.

FLUIDS

For the first 24 hours, cool liquids only may be consumed. Dehydration must be guarded against when having oral surgery, since a patient’s solid food intake is limited on the first day. It is necessary to compensate for this by increasing the fluid intake (at least five to six glasses of liquid should be taken). Suggested food for the day of surgery: yogurt, pudding, Jell-O, instant breakfast milk, malts, ice cream, and applesauce. The day after surgery diet should consist of soft foods such as soups, eggs, cottage cheese, and a hamburger patty.

NAUSEA

In the event of nausea from taking pain medication, keep something light in your stomach such as broth or saltines. Do not get up and move around more than necessary. Make sure to take your anti-nausea medication if one has been prescribed. Call our office if nausea persists.

ORAL HYGIENE

Twenty-four hours after surgery, rinse mouth gently with a solution of one-half teaspoonful of salt dissolved in a glass of water. Repeat after every meal or snack for seven days. Rinsing is important because it removes food particles and debris from the socket area and thus helps prevent infection and promote healing. Also 24 hours after your surgery you can resume your regular tooth brushing but avoid disturbing the surgical site so as not to loosen or remove the blood clot. Keep your mouth very clean.

MAINTAIN A PROPER DIET

After general anesthetic or I.V. sedation, soft to liquid diet should be taken at first. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie and high protein intake is very important. Nourishment should be taken regularly. 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 5-6 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. Add solid foods to your diet as soon as they are comfortable to chew.

Caution: If you suddenly sit up or stand from a lying position you may become dizzy. Therefore, immediately following surgery, if you are lying down, make sure you sit for one minute before standing.

IMPACTED OR BURIED TEETH

The following conditions are not uncommon with removal of these teeth: difficulty in opening your mouth due to muscle spasms. If a lower impaction was removed, you may have numbness of the lower lip or tongue on the side from which the tooth was removed. This is almost always a temporary condition. It is not disfiguring but can be annoying. It may last from a few days to many months. After removal, the adjacent teeth may realign themselves, causing some discomfort or sensitivity. Sores may develop at the corner of the mouth, and these should be covered with a mild ointment (Vaseline).

SHARP BONY EDGES

Occasionally patients will place their tongue on an operation site and feel a hard substance, which they think is a part of a tooth. It is the hard, bony wall that originally supported the tooth. Leave it alone and it should heal nicely.

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 it so be careful. Call our office if you have any questions about this.

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. As you were not able to eat or drink prior to surgery, and it is difficult to take fluids, and taking pain medications can make you dizzy. You could get lightheaded when you stand up suddenly. Before standing up, you should sit for one minute then get up.

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 is not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.

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, which will resolve in time.

IN REVIEW

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions.

There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the meantime, the area should be kept clean, especially after meals with salt-water rinses.

Your case is individual; no two people are alike. Do not take seriously well-intended advice from friends. Discuss your problem with the people best able to effectively help you: The doctors and staff at Lawton Oral Surgery.

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 2-3 days following surgery. 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 are to get lightheaded, please stop exercising.

CARE OF MOUTH AFTER YOUR ORAL SURGERY

⦁ Do not rinse or spit for 24 hours after surgery.
⦁ Keep fingers and tongue away from socket or surgical area.
⦁ Use ice packs on surgical area (side of face) for first 24 hours; apply ice 20 minutes on — 10 minutes off.
⦁ For mild discomfort take Tylenol or Ibuprofen every three to four hours.
⦁ For severe pain use the medication prescribed to you.
⦁ Drink plenty of fluids. (Do not use a straw)
⦁ If the muscles of the jaw become stiff, you can massage and exercise your jaws. Chewing gum at intervals will help relax the muscles. After 24-48 hours the use of warm, moist heat to the outside of your face over these muscles will help get rid of the stiffness.
⦁ After the first post-operative day, use a warm salt-water rinse following meals for the first week to flush out particles of food and debris, which may lodge in the surgical area. (1/2 teaspoon of salt in a glass of warm water.)
⦁ Diet may consist of soft foods, which can be easily chewed and swallowed. No seeds, nuts, rice, popcorn, etc.
⦁ A certain amount of bleeding is to be expected following surgery. Applying pressure to the surgical area using small, rolled gauze for 30-60 minutes controls bleeding. After that time remove the gauze and then you may eat or drink. If bleeding persists, a moist tea bag should be placed in the area of bleeding and bite firmly for one hour straight. This will aid in clotting blood. Repeat if necessary. If the bleeding still persists, call our office.
⦁ We suggest that you do not smoke for at least 5 days after surgery. Nicotine may break down the blood clot and cause a “dry-socket”.

IF YOU ARE IN DOUBT ABOUT ANYTHING AT ANY TIME, PLEASE CONTACT OUR OFFICE.

DO’S

DO rest today and tomorrow; half speed on the third day.
Do place ice on jaws for 24 hours.
Do use pressure on gauze packs for 2 hours

DO NOT’S

DO NOT smoke, dip, or chew tobacco.
DO NOT use drinking straws.
DO NOT drink carbonated beverages.
DO NOT use alcohol or mouthwash.
DO NOT lift, bend or strain.

THE ABOVE DO NOT’S APPLY FOR 7 DAYS AFTER YOUR ORAL SURGERY!

DRY SOCKET INFORMATION

Most of us, at one time or another, have heard of the term “dry socket” and for many whom are to have a tooth or teeth removed, it creates a certain fear. Tooth extraction is the most common of all surgeries and in most cases is a relatively minor operation. Few people escape this operation at some time during their lifetime. This sheet is designed to help you understand what a dry socket is, its possible causes, how it can be prevented, treatment, and what it means to you, the patient who may have a dry socket.

HOW A NORMAL SOCKET HEALS

Experts can’t agree on what percentage of routine dental extractions result in a dry socket, but it can range anywhere from two to six percent. One thing they all agree on is that the most common area for a dry socket is the lower wisdom tooth area followed by the lower molar area in general.

Simply put, a dry socket is a defective, abnormal healing, generally in the molar extraction site. When a tooth is removed, the empty socket fills with blood. This blood becomes the forerunner to the future permanent tissue that will eventually fill the socket.

Once the blood clots, it is organized and microscopic blood vessels penetrate it, carrying in nutrients and a variety of different cells that are part of the healing process. As time passes, the blood clot is converted to fibrous scar tissue, which then becomes calcified with conversion to bone.

An x-ray of the extraction site taken several months later shows virtually no evidence of the former tooth socket because new bone has filled the area. This is the process of normal healing of an extraction site.

WHAT IS A DRY SOCKET?

When a tooth is removed, a “hole” is left in the jaw. Healing normally occurs with a blood clot forming in the hole as described. New tissue forms, which is eventually converted into bone. Sometimes, however, the clot is either lost or doesn’t form properly.This sheet is designed to help you understand what a dry socket is, its possible causes, how it can be prevented, treatment, and what it means to you, the patient who may have a dry socket.

A dry socket occurs when, in the early stages of clotting and clot organization, certain bacteria attack the clot and feed off of it. This happens somewhere between the third and fifth day following the extraction. These germs exist in all mouths and can prevent the blood clot from progressing to normal healing. As the bacteria begin to digest the clot, there is a typical odor and taste that is foul and characteristic of a dry socket.

USING YOUR MONOJECT SYRINGE

*Not everyone receives a monject syringe. If your procedure requires socket irrigation you will receive one. If you did not receive a monoject syringe you are not required to irrigate.

This is an important part of your recovery from oral surgery. Please follow these instructions as they are given.

Begin using your monoject syringe ON THE 5TH DAY AFTER SURGERY. Using your syringe prior to that day can cause complications such as dry socket.

To use your monoject syringe:

⦁ Remove the stopper from the syringe and fill the syringe with tap water.
⦁ Replace the stopper and aim the curved tip of the syringe into the extraction site of the lower jaw. Make sure the tip of the syringe goes into the extraction socket and not just the general area.
⦁ Depress the stopper letting the water irrigate down into the extraction sites. Let the water run out of your mouth into the sink.
⦁ Repeat steps 1-3, 5 times for each lower extraction site (5 syringes of water per socket). It is important to irrigate the extraction sites first thing in the morning, after eating and before going to bed (5 times per day). You will need to do this routine for the next 10 days.

Remember the “Rule of 5’s”

5 syringes of water per socket

+ 5 times per day, for

10 days!

If you had upper third molar extractions, you do not need to irrigate these extraction sites; gravity will keep them clean. If you have questions, consult your postoperative pamphlet or call our office.

PATIENT MEDICATIONS

You will not always be prescribed all medications. The doctor will only give you the prescriptions that he feels you need.

You were not prescribed any medications today.
Lortab (hydrocodone bitarate 5.0, 7.5 or 10.0mg)
This is pain medication. Take 1-2 every 4 hours for the first 24 hours after surgery. Then take 1-2 every 4-6 hours as needed.
Tylenol #3 with codeine
This is pain medication. Take 1-2 every 4-6 hours as needed for pain.
Norco (5mg, 7.5mg or 10mg)
This is a pain medication. Take as directed.
Percocet 5mg
This is a pain medication. Take as directed.
Penicillin V Potassium 500mg
This is an antibiotic. Take 1 four times a day (breakfast, lunch, dinner, and bedtime) until gone.
Amoxicillin 500mg
This is an antibiotic. Take 1 four times a day (breakfast, lunch, dinner, and bedtime) until gone.
Cephalexin (Keflex Pulvules) 250mg
This is an antibiotic. Take 1 every 6 hours until all taken.
Clindamycin 300mg
This is an antibiotic. Take 1 four times a day (breakfast, lunch, dinner, and bedtime) until gone.
Keflex 500mg
This is an antibiotic. Take 1 four times a day (breakfast, lunch, dinner, and bedtime) until gone.
Phenergan (promethazine 25mg)
This is an anti-nausea medication. Take 1 every 4 hours with your pain medication for the first 24 hours after surgery. Then take 1 every 4-6 hours as needed for nausea.
Medrol Dose pack (methylprednisolone dose pack)
This is a steroid to help reduce swelling. Take all 6 pills in the top row within 24 hours after surgery. DO NOT TAKE THEM ALL AT ONCE, 2 at a time. Spread out over 24 hours. Do the same for all remaining rows.
Peridex (chlorhexidine gluconate)
This is a mouth rinse, swish ½ ounce for 1 ½ minutes then expectorate (spit). Use after breakfast and at dinnertime.

TAKING YOUR PAIN MEDICATIONS

FIRST 24 HOURS

Minimum one pain pill every 4 hours. Should be taken around the clock. Don’t forget to set your alarm.

Minimum one pain pill every 4 hours. Should be taken around the clock. Don’t forget to set your alarm.

SECOND 24 HOURS

Minimum one pain pill every 6 hours. Followed 3 hours later with 800mg of Ibuprofen.

PAIN MEDICATION…3 HOURS… IBUPROFEN… 3 HOURS… PAIN MEDICATION

THIRD DAY

You may be able to take ibuprofen during the day and pain pill at bedtime.