Post Op Instruction for Tooth Extractions and Oral Surgery

THINGS TO EXPECT RIGHT AFTER SURGERY: After surgery, the patient’s post-operative ride will be shown how to change the gauze and will be given post-operative irrigation instructions. Extra gauze will also be provided for the patient to take home. Most patients will only need to keep the new gauze in place for 1-1.5 hours. It is recommended that the patient firmly bite down, putting pressure on the gauze, while NOT TALKING. Ultimately, the longer a patient firmly bites down, with pressure on the gauze, waiting for the clot to establish before eating or drinking, the less chance they will have of swallowing blood. Swallowing blood can cause nausea and vomiting. The sooner a patient eats or drinks right after a surgery, the more a surgery site will bleed. Patient may have cold and creamy food typically between 1-1.5 hours after surgery. Contact 911 or Emergency Medical Services (EMS) if patient loses or has lost consciousness.

DO’s

1. DO eat only cold and creamy foods the day of surgery until the numbness wears off, which can take several hours (in some cases up to 18 hours). Eating hot foods or soups while patient is still numb can dislodge blood clots and can burn the mouth.

2. DO eat liquid/mushy foods for 14 days. Liquid/mushy foods are foods you can swallow without chewing, such as: smoothies, mashed potatoes, pudding, yogurt, Ensure, protein drinks, milkshakes, and applesauce.

3. DO use a spoon for eating; no straws/no spitting.

4. DO have the patient read these instructions after surgery, as well as on the day after surgery. The patient will likely forget much of what happens on the day of surgery (including what is read) until after they awaken from a post-surgery nap later in the day.

5. DO eat 20 minutes prior to taking any pain medication or antibiotics in order to help prevent nausea.

6. DO rest for the first 24-48 hours after surgery. Patients who have sedation should refrain from driving an automobile or from engaging in any task that requires alertness for the first 24 hours after surgery.

7. DO take antibiotics, if prescribed. Be sure to take all pills in prescription, as directed.

8. DO expect swelling, pain, and discomfort to peak on days 3, 4, and 5. After day 5, the extraction site(s) should slowly decrease in discomfort every 2 days. For example, day 7 should feel a little better than day 5, and day 8 should feel a little better than day 6, etc.

9. DO return to your general dentist's office in five-to-seven days for your post-op appointment.

10. DO contact us if swelling is excessive, spreading, or continuing to increase after 60 hours; if allergic reactions to medications occur that are causing a generalized rash or excessive itching; or, if things are not improving week by week.

11. DO begin using the irrigation syringe starting on day 5 after surgery. If you were prescribed Peridex, you will start gently swishing with it the day after the surgery, but you will also use it for irrigating with the syringe (you may dilute the Peridex with water when using it as an irrigation solution). When you run out of Peridex, start using warm salt water. To make the salt water solution, dissolve 1⁄2 a teaspoon of salt in a small glass of warm tap water. We do not recommend a refill for Peridex because it may start to stain the patient’s teeth. BLEEDING AFTER IRRIGATION IS NORMAL for the next several days, when you begin irrigation on day 5 after surgery. Irrigation Instructions: Begin irrigation 5 days after surgery. Curved tip of syringe MUST be positioned directly above and very close to the hole left behind where the tooth was once positioned. For wisdom tooth patients, the incision or hole will be located behind the back remaining tooth in each arch between the tooth and the cheek. Solution from irrigation syringe should be pushed with enough force to empty it into the hole. It may help to take Ibuprofen (Advil) 30-40 minutes before patient starts the irrigation.

12. DO USE IRRIGATION SYRINGE STARTING DAY 4 OR 5 AFTER SURGERY, COMPLETING 2 SESSIONS PER DAY (one session in the afternoon/one session in the evening before bed). Express 7-8 syringes full of warm salt water in each site for next several weeks until incisions or holes close. Important: Pain will peak 3-5 days after surgery, plateauing around day 5. If patient feels that pain has been tolerable but then suddenly begins to worsen, in an overwhelming majority of cases, this means that there is impacted food in the extraction site(s). In this case, patient should start to irrigate the holes as soon as the 4th day after surgery. NOTE: Each extraction site is its own, individual surgery site. For example, if you have had 4 wisdom teeth removed, it is common for one site (typically a lower site) to hurt more than the other 3 sites during the healing process.

DON’TS

1. DON’T hesitate to call us if things aren’t improving week-by-week or if surgery site PAIN doesn’t slowly start to return to normal within 2 weeks.

2. DON’T change-out gauze frequently. Bite on gauze one hour at a time.

3. DON’T sleep, eat, or drink with gauze in your mouth. THIS IS A CHOKING HAZARD!

4. DON’T leave the patient alone for the first 24 hours―especially with gauze in his/her mouth.

5. DON’T allow patient to drive on the day of surgery.

6. DON’T chew while eating for 14 days.

7. DON’T smoke, vape, or drink alcohol for two weeks, and do not use smokeless tobacco (dip) for at least one month.

8. DON’T exercise hard for 4 full days.

9. DON’T blow your nose or hold in a sneeze for 7 full days.

10. DON’T miss or skip your post-op appointment 5-7 days after surgery.

**Science has proven that staggering between Ibuprofen (Advil) and Acetaminophen (Tylenol)** provides the greatest pain management for post-operative pain after tooth extractions. Helpful How-to's for Taking Medications: Stagger between Advil and Tylenol every 6 hours. Take 3 Advil tablets, and wait 3 hours...then, take 1 extra-strength Tylenol... then, wait 3 hours and switch back to Advil...then, wait 3 more hours, and switch back to Tylenol. Advil (Ibuprofen) 600 mg = 3 over-the-counter pills􏰃Do NOT take more than 3200mg of Advil/lbuprofen per day PLUS Tylenol (Acetaminophen) 500 mg = 1 extra strength pill􏰃Do NOT take more than 3000 mg of Tylenol/Acetaminophen per day