Post Operative Instructions After Dental Extractions. Dr. JenniferLamphier

PLEASE READ THESE INSTRUCTIONS COMPLETELY AND CAREFULLY.  THEY ARE VERY IMPORTANT AND WILL ANSWER MOST QUESTIONS OR CONCERNS THAT MAY ARISE DURING YOUR RECOVERY


Sometimes the after-effects of oral surgery are quite minimal and sometimes they can be more extreme leading to significant post-operative discomfort and swelling.  Post operative care is very important.  Unnecessary discomfort and complications can be minimized if these instructions are followed carefully.




INSTRUCTIONS FOR THE FIRST 24 HOURS

   1.   DO NOT SPIT!
   2.   DO NOT RINSE!
   3.   DO NOT DRINK THROUGH A STRAW OR USE SUCTION TIP WATER BOTTLES!
   4.   DO NOT SMOKE!!!!  SMOKING LEADS TO DRY SOCKETS!!
   5.   NO STRENUOUS EXERCISE.  
   6.   DO NOT DRIVE IF TAKING PRESCRIPTION (NARCOTIC) PAIN MEDICATION!
   7.   KEEP HEAD SLIGHTLY ELEVATED (PROPPED UP BY PILLOWS)
   8.   BITE FIRMLY ON GAUZE UNTIL BLEEDING STOPS
   9.   DO NOT BRUSH YOUR TEETH UNTIL THE NEXT DAY
   10. STAY HYDRATED AND EAT PRIOR TO TAKING ANY MEDICATION!
   11. APPLY ICE PACKS TO OUTSIDE OF CHEEKS IN AREAS OF SURGERY!


IMMEDIATELY AFTER SURGERY: THE FIRST FEW HOURS

*  Bite down gently but firmly on the gauze packs that have been placed over the surgical areas,
    make sure they remain firmly in place.
*  Do not change them for the first 20-30 minutes unless the bleeding is very heavy.
*  Go to the pharmacy and fill any prescriptions you were given immediately.
*  Start applying ice to the outside of the cheek in the area the surgery was performed.  Ice 
    packs should be placed against the skin as close to the surgical site as possible.  If both sides 
    of the mouth had surgery then apply an ice pack on one side for 10 minutes, remove the pack 
    and place it back in the freezer.  Take a new, cold pack from the freezer and place it on the
    opposite side, near that surgical site for 10 minutes.  Continue alternating the ice packs all 
    day long as much as possible.  
*  The more ice you apply to the area the less swelling you will have over the next few
    days.
*  Again do NOT rinse, spit, smoke, drink through a straw or over exert yourself.  Anything 
    that may disrupt clot formation could lead to excessive bleeding or improper clot formation 
    and may lead to a dry socket.




PAIN MANAGEMENT
   *Unfortunately most oral surgery is accompanied by some degree of pain or discomfort.  Even though I make every effort to minimize your post operative discomfort the extent of your surgery will determine how much discomfort you will experience.  Managing pain the first day of surgery is your top priority.  You will be able to follow the rest of the instructions much easier if you are comfortable.

    *Most likely you have been given a prescription for pain medication. Most likely the pain medication contains TYLENOL and a Narcotic pain reliever.  I strongly recommend you take the first dose before the local anesthesia (Novocaine) wears off.  Generally, I use Marcaine which is a long acting anesthesia so you will have time to fill your prescriptions and still have time to eat something soft (ice cream or yogurt) and then take a pain pill before the anesthesia even starts to wear off.

     *Never take narcotic pain medication on an empty stomach or prior to driving!  If you are starting to feel discomfort before having time to eat or  while operating a motor vehicle take something without a narcotic in it as soon as possible. Such as  Ibuprofen or Aleve.  If you are planning to take the prescription soon do NOT take TYLENOL.  There is TYLENOL in the prescription pain medication and taking high amounts of TYLENOL  (Acetaminophen) can be very harmful.

     *Typically the most severe discomfort is usually within the first 6-12 hours after a surgical procedure.   After that your need for pain medicine should decrease.  Again, if prescribed a narcotic do NOT drive or operate heavy machinery.  I will have tailored the strength of the pain medication to the anticipated degree of pain you may experience.  If your pain is more severe and not being managed by the medication call the office.  Being that the most severe pain occurs the first day try to follow the pain management schedule below in order to stay as comfortable as possible.  If you cannot take Ibuprofen due to allergy or reaction with other medications or you have a medical contraindication then just take the prescription and follow the instructions on the bottle.

   * NEVER supplement the prescription pain medication with extra TYLENOL if the prescription bottle has the letters APAP printed on it.  This is the abbreviation for Acetaminophen and means there is already a significant amount of TYLENOL in the prescription medication.

    *If you had more than one area operated on you may very likely experience different levels of pain
in different areas.  This doesn't mean something is wrong with one of the sites.   Some areas of the mouth are just naturally more sensitive than others.  Pain levels are dependent on the technique that was utilized to remove the teeth.


PAIN MANAGEMENT SCHEDULE: The Day of Surgery

These are only guidelines and by no means should any of these medications be taken if you have a known allergy or have been previously instructed by your physician not to take them.  If you are unsure whether or not a medication is safe for you always check with your physician first before taking anything.  If you know you are allergic or have been told by your physician you cannot take NSAID's you cannot follow the above alternating schedules between the Ibuprofen and Narcotic pain medication.  You will only take the prescription pain medication or something over the counter that you know is safe for you to use.

* Again, as long as you don't have any medical contraindications to taking Ibuprofen you can add 400mg  (2 tablets) of Ibuprofen every 4 hours during the first day.  Ibuprofen should be taken 2 hours after each dose of the prescribed narcotic pain medication.

Example schedule: First 6-12 hours
 10am:  Prescription; Narcotic (Hydrocodone/APAP;  Oxycodone/APAP; Tramadol/APAP
 12pm:  2 tablets of Ibuprofen (200mg tabs) for a total of 400mg
 2pm:    Prescription pain medication (Narcotic)
 4pm:    2 tablets (400mg) of Ibuprofen
 Continue alternating for the first 24-48 hours as needed

After 8-12 hours this schedule can be altered according to your level of pain.
The narcotic pain medication is only to be taken for severe pain!  Once your pain lessens it is no longer necessary and should be discontinued.  I recommend that you keep the remaining tablets for a few weeks after the surgery in case any complications arise that require further surgery or you have symptoms associated with increasing pain such as dry sockets.

*  As soon as your pain starts to lessen you can change the time frame between doses.  Be sure that local anesthesia has completely worn off before lowering your dosage of pain medication.  You can start by alternating in 3 hour intervals instead of two hour intervals.

 Example schedule alternating 3 hour intervals:
 10am:  Prescription:  Narcotic (Hydrocodone/APAP;  Oxycodone/APAP; Tramadol/APAP
 1pm:  2 tablets of Ibuprofen (200mg tabs) for a total of 400mg
 4pm:  Prescription pain medication (Narcotic)
 7pm:   2 tablets (400mg) of Ibuprofen
 Continue alternating for the first 24-48 hours as needed

*  If the pain is no longer so severe that you need the narcotic you can substitute the narcotic (prescription) medication with two Tylenol and alternate the Tylenol and the Ibuprofen instead.  Once you are sure all the local anesthesia has worn off you can determine for yourself whether or not you need the narcotic pain medication any longer.

Example schedule: Alternating Ibuprofen and Tylenol
9am:   2 Ibuprofen (200mg) tabs
11am: 2 extra strength Tylenol
1pm:   2 Tylenol tabs
3pm:   2 Ibuprofen tabs
Continue throughout the next few days as needed for pain

 ANTIBIOTICS

  * If you have been placed on antibiotics, take the tablets or liquid as directed.  
  * Antibiotics are given to help treat and prevent infection.  
*   Discontinue antibiotic use in the event of a rash or other unfavorable reaction.  
*   Call the office if you have any questions or reactions to any of the prescribed medications.   

BLEEDING
*  Bleeding after surgery is NORMAL and typically lasts anywhere from 1-3 hours and you may even have some intermittent bleeding or oozing throughout the entire the first day.  As stated above it is controlled by placing fresh gauze over the surgical areas and biting down firmly in 20-30 minute intervals and continued until only a small amount of blood is showing on the gauze that is a light red/pink.
*  Once the heavy bleeding subsides and only a small amount of light red/pink blood is noted on the gauze take it out and do no place any more gauze over the site unless the bleeding were to restart heavily again. 
*  It is very important to remember; you MUST swallow your saliva and not spit or continue to let it fill up in your mouth.  This will make you think you're bleeding more heavily than you actually are and continuing to place gauze all day long can actually be detrimental to clot formation.  It is your blood it will not hurt you in any way but spitting within the first 24 hours can lead to "Dry Sockets" which are very painful and if directions are followed properly most of the time are preventable.
*  Make sure to take the gauze out to eat and drink before taking any medications.  If needed it can be replaced after eating if bleeding is still moderate and gauze pack pressure continued.
*  Never lie flat when the surgical sites are actively bleeding.  Prop your head up with a few pillows and keep it elevated.

HEAVY BLEEDING 
*  Bleeding should never be severe. If it is, it usually means that the gauze packs are being clenched between your teeth rather than exerting pressure on the surgical sites.  Try re-positioning with fresh packs making sure the gauze is directly over the surgical area.  If you are missing teeth on the opposing jaw you will need to use multiple gauze packs at once until you can feel pressure being exerted from the opposing jaw.
*  If bleeding persists for hours or becomes heavier you may substitute gauze with a "Tea bag".  Do NOT boil the tea bag just moisten it with warm water and squeeze it damp-dry.  Place the tea bag over the surgical site and bite down firmly for 30 minutes, repeat if necessary 3-4 times. Tea bags should be utilized only as a last resort when bleeding persists heavily for more than 3 hours. There is no reason for alarm if slight bleeding/oozing persists throughout the first day as long as it's not heavy.
*  If after 3-5 hours bleeding is still uncontrolled and tea bags have been tried at least 3-4 times call the office for further recommendations.
*  If at anytime bleeding is very heavy and bright red in color requiring constant gauze changes every few minutes call the office for further instructions.


BLOOD THINNERS: 

*  Only read this section if you are taking a blood thinner prescribed by your physician.
*  If you regularly take a blood thinner (Aspirin, Plavix, Coumadin etc) it is expected it will take
    longer to clot even if the blood thinner was discontinued prior to surgery.  Patients that take aspirin
    and/or Ibuprofen daily will be expected to have heavier bleeding that will persist longer.

*  If you take aspirin and/or Ibuprofen regularly and have more surgery scheduled in the future it is
    best to stop these medications 5 days before surgery.  However, you should always check with
    your physician before stopping any regularly prescribed medication.
*  There are also naturally occurring blood thinners, so if you have been using any herbal remedies
     prior to surgery you may experience prolonged bleeding as well.

SWELLING
*   Some swelling is normally associated with oral surgery.  The amount depends on the extent of the
     surgery.
*   You can minimize this by using a cold pack/ice pack wrapped in a towel and applied firmly to the
      face or cheek adjacent to the surgical area.  Ice packs should be applied "10 minutes on and 10
      minutes off" as much as possible the first 24 hours after surgery . The more diligent you are at
      applying ice the first day the less you will swell in the area.
*    Swelling however, will still occur in most instances; this is NORMAL.
*    After 24 hours applying more ice will not help reduce the swelling but if it makes you feel better
      it be applied.
*    Swelling typically peaks (most severe) 48-72 hours after surgery so there is no reason for alarm if
     you wake up 2 days after your surgery even more swollen than the previous day.  By the 3rd day it
     has usually leveled off or even started to decrease.
*   You should notice a steady decline in swelling each day from this point on, if at any time the
    swelling recurs call the office immediately.

MEDROL DOSE PACK: STEROIDS ARE USED TO MINIMIZE SWELLING
 *This ONLY applies if you were prescribed a MEDROL dose pack.  Medrol is methylprednisolone, this is a steroid used to reduce and/or prevent inflammation in the body.  If a lot of swelling is anticipated you will likely be prescribed this medication.  The package contains 21 pills each pill is 4mg's in strength and are taken over a 6 day period until finished.  Being that most swelling occurs the first few days after surgery it is very important to take all of the pills in each day and do NOT stop taking this medication abruptly because the swelling has resolved.  Stopping steroids abruptly can lead to serious side effects.  The picture below illustrates the tapering dosages of the Medrol dose pack.

* If you were prescribed a Medrol dose pack prior to the day of surgery you are to start taking
   them the morning of your appointment, regardless of what time your surgery is that day.  Take
   all of the pills as prescribed.  Starting the steroids prior to your surgery will significantly reduce
   post operative swelling and discomfort.  If you were not prescribed a Medrol pack by me at your
   consultation appointment then most likely I do not anticipate that you will have significant swelling
   after surgery.  However, this in now way means that you are guaranteed not to have swelling.
   Sometimes extractions can wind up being more complicated than originally anticipated
 
*  Prescribing steroids is only and adjunctive therapy and not necessary or by any means the standard
    protocol for everyone but if you think I may have overlooked this issue at your
    consultation appointment by all means call the office and let us know.  

*  If you did not have a consultation prior to surgery and you were given a prescription for a 
    Medrol pack at your appointment then I anticipate your swelling will be moderate to severe.  
    When you get your prescription filled take the first dose (before breakfast dose) as soon as you
    can.  Before breakfast means you don't need to eat prior to taking the pills.  Then calculate the
    hours you think you will be awake until bedtime and shorten the hours between your lunch, 
    supper and bedtime doses.

*  Example. Surgery performed at 10 am
    Prescription filled at 11;30 am: Breakfast dose taken at 12:00 pm, Noon
    Estimated time going to bed: 12am
    Using those times you will be awake for the next 12 hours
    Dividing 12 hours by 3 more doses you will need to take each dose 4 hours apart

*  Your schedule for the first day of Steroids would look like this:
    Breakfast dose at 12:00 Noon
    Lunch dose at 4:00 pm
    Supper dose at 8pm
    Bedtime dose at 12:00am

*  If your surgery is later in the evening using the same formula only plan to take 2-3 doses of
    the first day of steroids.  You don't want to take them too close together.  I would recommend
    minimum time frame of 2 1/2 hours between doses.  If you want the full effect then set an
    and get up in a few hours to take your last dose during the night.


NAUSEA AND/OR VOMITING
*  NEVER TAKE PAIN MEDICATION ON AN EMPTY STOMACH!!

*  Even though you just had surgery in your mouth it is very important to eat something prior to
    taking the narcotic paid medication and most antibiotics.  Just be cautious while eating, food must
    be soft and room temperature is best until the local anesthesia wears off.

*  Nausea is not an uncommon event after surgery, and it is most often caused by the stronger,
    narcotic pain medications but can be also be caused by certain antibiotics as well.

*  Nausea may be reduced by preceding each pill with a small amount of soft food (ice cream, yogurt,     scrambled eggs), then taking the pill with a large volume of water.  Try to keep drinking clear fluids     and eating in small increments and minimize the pain medication if nausea arises but call the office     if you do not feel better or if repeated vomiting occurs.

*  Nausea/Vomiting after surgery generally will subside within a few hours of stopping the medication
    that caused it however, it may take time for the medication to clear your system and even without
    repeated doses may continue for the first 24 hours.  Continue to try to eat and drink in small
    increments.



Tips to Control Post Operative Nausea and Vomiting "PONV"

*  If you are continuously feeling nauseous, then you should try sitting or standing in one place,
    avoid moving as much as possible.  Movement and exertion can worsen the feeling of nausea 
    which may then lead to vomiting.

*   Drink clear or ice cold drinks.  Drink slowly.
*   Eat light, bland foods (such as soft bread)
*   Avoid fried, greasy, or sweet foods.
*   Eat slowly, and eat small more frequent meals.
*   Do not mix hot and cold foods
*   Avoid brushing your teeth (which you should not do the first day of surgery anyway).
*   Avoid acidic fruits and juices and heavy cream products.  
*   Do not drink excessive amounts of carbonated beverages but small amounts of ginger ale
     may be helpful preferably on the flat side.  Excessive carbonation can lead to distention of  
     the stomach and gas pains so try to avoid too much soda unless it is flat.
*  It is important to stay hydrated.  Excessive vomiting can lead to dehydration.

*  Another possibly helpful home remedy is to sip on a mixture of; one teaspoon each of mint 
    juice, ginger juice, lemon juice and honey. 

*  Ginger tablets may also help which can be bought at a health food store.

*  Anti-nausea drugs are medications that control nausea and prevent vomiting.  Drugs that   
    stop and control PONV once it has occurred are called anti-emetics.  

*  The first drug to try if PONV occurs is one you may already have at home, Benadryl

*  Benadryl is also called Diphenhydramine, it is an antihistamine used to relieve symptoms of       allergy, hay fever, and the common cold.  Bendadryl relieves symptoms that include 
    rash, itching, watery eyes, cough, runny nose, sneezing and also relieves nausea, vomiting
    and dizziness.

*  Benadryl; Diphenhydramine can also be used to help you relax.  It will often bring on
    drowsiness and help you fall asleep.  

*  If none of the above helps to relieve the nausea and vomiting call the office.  The most
    commonly used anti-emetic for PONV is called Zofran.  It comes as an oral   
    dissolving tablet that is placed under the tongue so it isn't necessary to swallow a pill with 
    food or water leading to more vomiting. 

*  It is important to get PONV under control as soon as possible.  Unfortunately, it is a 
    very common side effect of the narcotic pain medications.  If vomiting occurs within the first
    24 hours during the period where you should not be spitting or rinsing you may see in 
    increase in bleeding from the extractions sites.  If this happens just replace the gauze and 
    apply pressure again until it stops.  Unfortunately, this will also make you more susceptible 
    to developing a dry socket.

6.  DIET: Very Important!
     
 *  As soon as you return home remove your gauze packs and eat something soft immediately (ice cream, yogurt, scrambled eggs etc.)
*  Wait 20-30 minutes and then take your first pain pill.  If necessary you can replace the gauze if the
    site is still actively bleeding.
*  Eat nourishing food that can be taken with comfort the first few days.
*  Temperature of the food doesn't really matter after the first 24 hours but try to avoid extremely hot
    foods initially.
*  It is sometimes advisable, but not required, to restrict the first day’s intake to bland liquids or
    pureed foods (creamed soups, puddings, yogurt, milk shakes, etc.).
*  Avoid foods like nuts or anything with seeds, no popcorn or rice etc.,  Foods that are small may get
    lodged in the sockets and could lead to infection.
*  Over the next several days you can progress to more solid foods at your own pace.
*  It is important not to skip meals!
*  Keep hydrated but do not use straws. 

*  If you take nourishment regularly, you will feel better, gain strength, have less discomfort and heal
    faster.
*  If you are diabetic, maintain your normal eating habits as much as possible and follow instructions
    from us or your physician regarding your insulin schedule.  If you are really struggling to get
    enough solid, nutritious meals in the first week I would recommend you buy some protein drinks
    such as Ensure.  You can mix them with ice cream in a blender to make them taste better.



8.  DISCOLORATION/BRUISING

In some cases, discoloration or bruising 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.

Instructions for the 2nd and 3rd Days after surgery
1.  MOUTH RINSES:  Keeping your mouth clean after surgery is very important.  Use 1⁄4 tsp. of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least two to three times daily until the extraction sites fill in.  This is most important after meals and before bedtime. It can take anywhere from 1- 3 weeks for the surgical sites to completely close.

2. BRUSHING:  Begin your normal oral hygiene routine 24 hours after surgery.  If you had surgery later in the afternoon you can brush gently the following morning but do not rinse or spit forcefully. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean your teeth within the bounds of comfort.

3.  HEAT APPLICATION:  Starting 72 hours after surgery you can apply warm compresses to the skin overlying areas of swelling (hot water bottle, moist hot towels, heating pad) for 20 minutes on and 20 minutes off to help soothe those tender areas. This will also help decrease swelling and stiffness of the muscles and prevent muscle spasm leading to decreased opening.  After more involved surgery it is normal not to be able to open wide and may take a week or so to return to normal.  Moist heat and mouth opening stretches and exercises will help return everything to normal.

The First Week After Surgery
1.  PAIN:  Most of the significant pain should be resolved 3-7 days after surgery.  Although, mild local (right around the extraction site) discomfort may persist for 2-3 weeks.  It is usually only necessary to need some occasional Tylenol ES or Ibuprofen at this point or nothing at all.  Pain which increases or fails to resolve may be due to a "dry socket".


WHAT IS A DRY SOCKET?    "Dry socket" also called (alveolar osteitis) is a painful dental condition that can occur after extraction of a permanent adult tooth.  Dry Sockets occur when the blood clot formed the first day at the site of the extraction has been dislodged or has dissolved before the socket has filled in with new gum tissue.  Exposure of the underlying bone and nerves to the cold air and your saliva is what results in the severe pain.

 IRRIGATION SYRINGE:  If you were given an irrigating syringe at your first office visit you can start using it 1 week after surgery to keep sockets clean. Typically the syringe is if given at your post operative follow up appointment 1-2 weeks after surgery and only if deemed necessary.  If you weren't required to return and find you keep trapping food debris in the socket feel free to call the office and ask for a syringe.  Fill it with warm salt water or mouthwash and irrigate any open sockets gently before bedtime.  You can use it more frequently if needed but typically it's only necessary once daily.  Just continue your daily rinses with warm salt water after meals for 1-3 weeks or until the holes have filled completely and use the syringe before bedtime to make sure all debris is removed. This is the best way to prevent a post operative infection. If you notice a few weeks after surgery the site is becoming tender or swollen call the office ASAP to be seen.  The sooner an infection is treated the better.

A "dry socket" usually presents the 3rd to 6th day after the extraction.  Pain will be significant and may even feel like an ear ache or a tooth ache coming from a tooth in front of the surgical site.  You will not know the blood clot was lost it won't be visible to you and the area will not bleed from this, the only way to know is by your pain increasing or not subsiding at all.  Dry sockets are most common from lower (mandibular) molar extractions.   Especially, impacted 3rd molar (wisdom teeth) extractions where it was necessary to section the tooth with a drill to remove it.  Also most common in smokers!!  So do not smoke after extractions for the first 72 hours!!   It is very rare from upper (maxillary) extractions but does happen occasionally and it can occur in any dental extraction site so don't think because you didn't have a wisdom tooth removed that it couldn't be a dry socket.   Call the office immediately and a sedative dressing material can be placed into the socket (in the office) and the pain will resolve within 10-20 minutes of this treatment.  When in doubt call the office if you think something is wrong.
Dry socket is the most common complication following tooth extractions, especially removal of impacted wisdom teeth. If a dry socket occurs, the pain usually begins one to three days after the extraction but can occur up to even 1 week after.  Over-the-counter or even narcotic prescription medications alone typically don't adequately treat dry socket pain and therefore, your dentist or oral surgeon will initiate treatment with a sedative to lessen pain and promote healing.  The sooner it is treated the faster you will heal and feel better so call the office if you notice any increase in pain or even your pain remaining constant after the 3-4th day.  By the 3rd -4th day the prescription pain medication should only be needed sparingly, if at all.  Most of the time your discomfort should be alleviated with Ibuprofen or Tylenol at this point.   If your pain is still so severe that you need the narcotic prescription pain medication every 4 hours you may have a dry socket.  Call the office for site to be checked.
2.  SWELLING:  Swelling should resolve 5-7 days after surgery but can last longer depending on the extent of the procedure performed.  Swelling increases up to 72 hours after surgery but typically peaks at 48 hours (2 days after) and levels off the 3rd day then starts decreasing Each day after that.  As stated above ice packs only help for the first 24 hours.   Local heat, a heating pad set on “low”, or hot water bottle will help things to return to normal more quickly.  Swelling which appears or increases after the first 5-7 days may indicate infection.  If you initially presented with a large facial swelling at the time of surgery do not use heat packs until 1 week after surgery, heat used to early at the site of an infection can stimulate bacterial growth and cause the infection to get worse.   If you are not sure either call the office or wait until you follow up appointment.

3. JAW STIFFNESS:  This is normal and should be expected following surgery.  You must make a conscious effort several times a day to stretch your jaws open wide but do not force them open.  If you are really sore do your stretching exercises 1 hour after taking your pain medication.  Place your thumb on your upper front teeth and your forefinger on the lower and gently stretch bouncing your lower jaw to increase opening slowly.  Chewing gum offers good exercise for the jaw muscles as well but keep gum away from the surgical sites.   Again, Local heat and Ibuprofen can help the associated discomfort and inflammation.  It often take a few weeks for mouth opening to return to normal.

4.  ORAL HYGIENE: By a week after surgery, you should be back to brushing your teeth as normal, hopefully several times per day. Thorough rinsing with tap water/salt water or mouthwash helps maintain cleanliness at the surgical sites. After one week has passed you can start using mouthwash rinses if preferred. Do NOT use mouth wash until 1 week has passed as they contain alcohol which can dry out the site and slow healing.  Listerine  is preferable due to its antibacterial effects.  There is no need for excessive use of mouthwashes; in fact it may be harmful. Extra attention at the extraction sites may be necessary for up to 3-4 weeks after teeth are removed until tissue healing has filled the defect.

5.  DIET: Approximately 1 week after surgery your diet should be returning to normal. You may require an additional week to be able to consume hot, spicy, or tough types of foods without difficulty.

6. ACTIVITY:  By approximately 1 week after surgery, most routine activities may be resumed. It is usually advisable to avoid swimming or diving for 10-14 days. Routine dental work is best postponed for 2-3 weeks.

7.  MEDICATION:  Any antibiotics (penicillin, erythromycin, etc.) should be taken until gone. Pain medication should only be taken as prescribed to relieve discomfort. Remember, narcotic-based pain relievers can cause drowsiness and decrease coordination. You should refrain from using alcohol or other sedative-type drugs while using them.

8.  BITE:  It is not uncommon for your bite to feel “different”, or that the lower teeth have “shifted” following third molar surgery. This is usually due to stiffness in the muscles resulting in a slight re-positioning of the lower jaw or release of pressure on the adjacent molar teeth and thus a change in the way the teeth meet. This situation generally returns to normal in 1-2 weeks.

9.  BRUISING:  In some cases you may develop some mild bruising of the skin adjacent to the surgical site.  This is normal & will resolve typically within 7-10 days.

10.  SHARP RIDGES/BONE SPICULES:
     If you feel a sharp edges in or around the surgical area with your tongue it is probably the bony walls which originally supported the teeth.  Occasionally small slivers of bone may work themselves out during the first week or two after the surgery. These are NOT pieces of tooth and, if necessary, we will remove them.  They often will work themselves out on their own however, if they persist or the area is very painful or becomes swollen after the first week or two please call the office and make an appointment to be seen.

Two weeks after surgery
THE NORMAL POST-OP COURSE:  Normal healing after dental extractions should be as follows: The first day of surgery is usually the most uncomfortable and there is some degree of swelling and stiffness. The second day you will usually be far more comfortable and, although still swollen, you can usually begin a more substantial diet. Slight increase in swelling on the 3rd day but pain should be less. From the third day on GRADUAL STEADY IMPROVEMENT should mark the remainder of your post-operative course. If you do not see steady improvement during the first few days after surgery, DO NOT suffer needlessly!  Call the office to have it looked at you most likely have a dry socket.  Some indicators that you may have post-operative problems which should be looked at are: persistent pain, swelling after the first 5-7 days, persistent jaw stiffness, and repeated bleeding or discharge or a bad smell from the surgical site. Call the office and report symptoms so you can be seen as soon as possible. You should return to the regular care of your general dentist for further care or routine visits as he/she directs.

IBUPROFEN INFORMATION
"Ibuprofen" class: NSAID's;  Non- steroidal anti-inflammatory drugs
1.Do NOT take ibuprofen also known as Advil or Motrin; If you have a history of allergic reactions to NSAIDs
2. Some asthma patients cannot take NSAID's.  Asthma patient's please check with your physician if you are unsure whether or not you can take it.
4. Patient's with a history of ulcers or GI bleeding should not take ibuprofen unless cleared by their physician
3. Do not exceed recommended dosages.  In high doses Ibuprofen can lead to heart, liver, kidney problems and excessive bleeding.
4.  May interact with blood thinners and cause prolonged bleeding

I hope this information was helpful and I hope you are doing well.
Sincerely,
Jennifer Lamphier DMD
SPECIALTY; Oral & Maxillofacial Surgery