Oral Surgery Postoperative Instructions

The removal of a tooth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and complications such as infection and swelling can be minimized if these instructions are followed carefully. 

What to Expect After Surgery

  • Bleeding, oozing, or redness in the saliva
  • Swelling
  • Discoloration of skin 
  • Slight elevation of temperature for 24-48 hours
  • Numbness of the lip, chin, or tongue
  • Discomfort, earache, or sore throat
  • Trismus (tightness) of the muscles may cause difficulty in opening of the mouth
  • Sharp edges in the surgical areas 

Please Follow the Instructions

  • Bite down firmly on the gauze that has been placed over the surgical areas for a half hour. If active bleeding persists after one hour, place new gauze to obtain pressure over the surgical site for another 30-60 minutes. Repeat if necessary. If bleeding continues, bite on a moistened black tea bag for 30 minutes. 
  • Do not use a straw or spit the saliva for 24 hours. The sucking motion can cause more bleeding by dislodging the blood clot. Drink from a glass and do not use straws.
  • Do not disturb the surgical area. You may gently wipe/brush your teeth but do not rinse vigorously or probe the area with any objects or your fingers. This may cause dislodging of a blood clot and initiate bleeding. 
  • Apply an ice pack to the sides of the face where surgery was performed – 20 minutes on and 20 minutes off during the first 24 hours after surgery. After 24 hours, it is usually best to switch from ice to moist heat to help soothe tender areas.
  • Do not smoke for at least 5 to 7 days after the surgery. 
  • Stay hydrated and drink plenty of liquids.
  • Confine the first day’s food intake to bland soft foods
  • Avoid hot, spicy, salty, citric, or crunchy foods
  • Take the prescribed pain medications and antibiotics with soft foods. Do not drive or drink alcohol after taking a narcotic. 
  • Restrict your activities on the day of surgery. This helps reduce bleeding. 
  • If you develop nausea, sip on a carbonated beverage slowly over a 15-minute period. Try to keep taking clear fluids and minimize the pain medication.  

  • After 24 hours of surgery, gently rinse your mouth with warm saltwater or Peridex for the next five days. 

Bleeding

Intermittent bleeding, oozing, or redness in the saliva is not uncommon. This may be controlled by placing new gauze over and biting down firmly for 30-60 minutes. Bleeding should never be severe. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a new gauze pad over the area and biting firmly for 30 minutes. The gauze must contact the gum tissue over the extraction site so that the pressure is applied where the bleeding occurs. Repeat if necessary. If bleeding continues, bite on a moistened black tea bag for 30 minutes. The tannic acid in the black tea helps to form a clot by contracting bleeding vessels. If bleeding does not subside, call our office for further instructions.

Swelling

Swelling is normally expected and 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 should be applied to the sides of the face where surgery was performed – 20 minutes on and 20 minutes off during the first 24 hours after surgery. After 24 hours, it is usually best to switch from ice to moist heat to help soothe tender areas. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed. 

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.

Pain

Unfortunately, most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication, and if you take the first pill before the anesthetic has worn off, you will be able to manage any discomfort better. After the first day of surgery, you will be most uncomfortable and there is some degree of swelling and stiffness. From the third day on gradual and steady improvement should mark the remainder of your post-operative course. 

Moderate Pain – Take 1 or 2 tablets of Tylenol every 4-6 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Do not exceed 3200 mg daily for an adult. Consult our practice for individuals under 18. 

Severe Pain – Take the prescribed medication as directed. Do not take any of the above medications if you are allergic to them, or have been instructed by your doctor not to take them. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. 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.

Discoloration

Skin discoloration may be expected and is usually limited to the neck or cheek area near the surgical site. This is caused by bleeding through the mucous membranes of the mouth beneath the skin and appears as a bruise. If discoloration occurs, it often takes a week for this to completely disappear. Occasionally, the arm or hand near the site where the needle was placed to administer IV drugs may remain inflamed and tender. This is caused by chemical irritation in the vein. Aspirin and the application of heat on the area will usually correct these symptoms. 

Nausea and Vomiting

Nausea is not uncommon even after surgery, and it is sometimes caused by stronger pain medicines. Nausea may be reduced by preceding each pill with a small amount of soft food, then taking the pill with a large volume of water.  You should then sip on the carbonated beverage slowly over a 15-minute period. Try to keep taking clear fluids and minimize the pain medication, but call us if you do not feel better or if repeated vomiting is a problem. 

Numbness

Loss of sensation of the lip and chin may occur, usually following lower wisdom teeth removal. This is usually temporary and disappears within a few days and weeks. Occasionally, some numbness may persist for months, due to the close association of the roots of the teeth to the nerve that supplies sensation to these areas described. 

Diet

Eat any nourishing soft food that can be taken with comfort by chewing away from the surgical sites. You should prevent dehydration by taking at least 5-6 glasses of fluids daily. You will feel better and heal faster if you continue to nourish and hydrate yourself. It is important not to skip meals! 

  • Confine the first day’s intake to bland liquids or pureed foods like creamed soups, puddings, yogurt, milkshakes, or mashed potatoes. 
  • Avoid foods like nuts, sunflower seeds, or popcorns that may get lodged in the surgical areas. 
  • Avoid extremely hot or spicy foods. 
  • Over the next several days, you can progress to solid foods at your own pace. 
  • If you are diabetic, maintain your normal eating habits as much as possible and follow instructions from your physician regarding your insulin schedule. 

Sharp Edges

If you feel sharp edges in the surgical areas with your tongue, it is probably the bony walls that originally supported the teeth. Occasionally small slivers of bone may work themselves out during the first week or two after surgery. If necessary, it will be removed at your follow-up visit. 

Oral Hygiene 

Keeping your mouth clean after surgery is essential but no rinsing of any kind should be performed until the day following surgery. Begin your normal oral hygiene routine as soon as possible after surgery. After 24 hours of surgery, you may rinse your mouth with warm saltwater. Repeat as often as you like, but at least 2-3 times daily for the next five days. Please make every effort to clean your teeth within the bounds of comfort. 

If you were given an irrigating syringe, start using it the third day after surgery to keep sockets clean. Fill it with warm salt water and irrigate any open sockets gently, especially after eating. 

Dry Sockets

If a dry socket occurs (loss of blood clot from the socket, usually on the 3rd to 5th day), there is a noticeable, distinct, persistent throbbing pain in the jaw, often radiating toward the ear and forward along the jaw to cause other teeth to ache. If you do not see steady improvement during the first few days after surgery, don’t suffer needlessly. Call the office and report symptoms so you can be seen as soon as possible. 

Antibiotics

If you have been placed on antibiotics, take the medication as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. Call the office if you have any questions.

For patients who are taking oral contraceptives (“birth control pills”): Please note that antibiotics and other medications may interfere with the effectiveness of oral contraceptives. Therefore, you will need to use some additional form of birth control for one complete cycle of birth control pills after the course of antibiotics or other medication is completed. 

Sutures

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help to heal. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is usually no discomfort associated with this procedure.

Call Your Doctor If:

  • You experience prolonged severe bleeding
  • Your pain increases and you have signs of infection, sudden swelling, or fever
  • You have a reaction to any of the prescribed medications.

It is our desire that your recovery is as smooth and pleasant as possible. If you have any questions about your progress or any symptoms you are experiencing, please call our office at (301) 652-8555 or (202) 466-7555. After office hours, you may call our 24-hour answering service and our doctor will contact you as soon as possible.