After Tooth Extraction

Post-Extraction Instructions

Immediately Following Surgery:
The gauze pad placed over the surgical area should be kept in place for 45 minutes-1 hour. After this time, the gauze pad should be removed and discarded.
Vigorous mouth rinsing, spitting, and drinking through a straw should be avoided for 3 – 4 days. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
You may brush your teeth the day of surgery while being mindful of the surgical area.
You will continue with all other prescriptions such as antibiotic and pain medication if needed.
Restrict your activities the day of surgery and resume normal activity as you feel comfortable. No strenuous activity for 1 week, (this can increase chance of break-through bleeding.)
Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
Sleeping in an elevated position will reduce bruising and swelling.

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 placing a gauze pad over the area and biting firmly for 45 minutes-1 hour. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, minimize talking, no exercise, and eat cold foods as warm foods can increase bleeding. 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. However, the swelling may be minimized by the immediate use of ice packs. Place ice packs on the cheek and alternate on and off in 20-minute intervals for the first 36 hours. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. 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. It is not uncommon for one side of the face to be more swollen than the other.

Pain:
You should begin taking pain medication before the local anesthetic wears off. For moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 4-6 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen 800mg may be taken every 6-8 hours as needed for pain. For severe pain, take prescription pain medication as directed. The prescribed pain medicine could make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages and other illegal drugs. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.
Do not take any of the medication mentioned above if you are allergic or if your doctor has advised otherwise.

Sore throat 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 (Trismus) 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.
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 my office for instructions.

Diet:
Do not use straws. The sucking motion can cause more bleeding by dislodging the blood clot which would result in a dry socket. You may eat anything soft by chewing away from the surgical sites. Advance your diet as you feel comfortable. If bone grafting is performed avoid chewing directly over the area. Also, avoid hard and crunchy foods like chips, popcorn and nuts.

Keep the mouth clean:
You may brush your teeth while being mindful of the surgical area and possible sutures. You can rinse your mouth with a salt water rinse or provided mouthwash 1-3 times a day until healed. Avoid prolonged use of Peridex mouthwash as it can cause tooth discoloration.
If dissolvable sutures are placed they will dissolve 4-5 days after the procedure. When this happens, the food you eat (even soft food) will get down into the extraction site. You will be provided a plastic curved tip syringe. Draw the syringe up with water, stick the tip of the syringe past the gumline INTO the hole, use force to flush and churn out food from the holes. If this is not done, the food will sit in the holes and spoil which will later cause an infection. The extraction site will eventually fill in with bone and gum tissue within 1-2 weeks. If a bone grafting is performed you may need to return for suture removal. Keep the area clean with a salt water rinse and clean the sutures with a wet cotton swab.

Discoloration:
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood 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 will be given to help 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:
Prescription medications such as antibiotic and pain medication may cause nausea and vomiting. Be sure to take medication with food. If nausea and vomiting persist, call the office for further instructions or for prescription adjustments.

Other Complications:

•  If numbness of the lip, chin, or tongue occurs beyond 10 hours please call Dr. Maharaj or Dr. Pham.
• 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.
• Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls which supported the tooth. These projections usually smooth out over time. If not, they can be removed by Drs. Maharaj and Pham.
• 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.
• 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 get light headed, stop exercising.

If you have any questions, please call us our Lansdowne office at Lansdowne Office Phone Number703-Lansdowne Office Phone Number 703-723-7858 or our Chantilly office at Chantilly Office Phone Number703-Chantilly Office Phone Number 703-668-9494

Excuses for school and work are written on a case-by-case request. Each patient heals at a different rate after surgery. Discuss any concerns with the doctor at the time of surgery and we will gladly issue a school or work excuse based on your individual case.