Mouth Care Instructions
Mouth care and management of pain after tooth extraction may differ slightly depending upon which teeth were extracted, number of teeth extracted, level of impaction (wisdom teeth) and relative ease/difficulty of surgery, age, and individual pain tolerance. The following are only guidelines and may be altered to tailor to your specific needs. Your doctor may have told you slightly different instructions than listed here. Our primary goal is your comfort. Please do not hesitate to call if you have questions.
*If you had IV sedation for your procedure, or are taking narcotic pain medication, do not operate a motor vehicle or heavy machinery for 24 hours
IMMEDIATELY AFTER YOUR SURGERY:
1. Remove gauze when you get home. Replace only if there is active bleeding. Small amounts of pink/red/orange on the gauze or in saliva is normal for the first 24-48 hours. Thick, dark red clots require gauze to be replaced. Properly placed gauze should be placed over the extraction sockets (behind the last tooth for wisdom teeth), in the cheek. Bite down where it hurts for 30 minutes. Biting down hard is imperative, as it is not the gauze that stops the bleeding, it is the pressure. If you run out of gauze, bite on a black tea bag. If you feel that you cannot stop active bleeding, please call.
2. Take ibuprofen (Motrin, Advil) 600mg by mouth. This will help with both pain and swelling. This can be continued every 6 hours up to 7 days, or until pain is improved. Acetaminophen (Tylenol) 325-500mg can be taken if you cannot take ibuprofen.
3. A narcotic pain medication may have been prescribed. It is normal to need narcotic pain medication for adequate pain control during the first 3-4 days, and may be needed up to a week. It can be taken alternating with or at the same time as ibuprofen. Pain will likely be more intense on the 3rd and even 4th days after surgery, bottom teeth generally hurt more than top ones, and pain may not be symmetrical (one side may hurt more or longer than the other). Take with food, as pain medication can cause stomach upset. Narcotics can also cause constipation. Drink fluids and use an over-the-counter stool softener if this occurs.
4. Apply ice packs to the outside of your cheeks, on and off for 30 minutes for 24-48 hours. Overnight icing is not necessary. Swelling will likely increase until the 3rd or 4thd day (especially wisdom teeth).
5. Eat something soft, cool, and mushy. This will help prevent stomach upset, especially with medications.
6. Antibiotics, if prescribed, may be started this evening. If you are nauseated, wait until morning. Take with food and/or probiotic, as antibiotics can cause stomach upset.
7. Numbness will likely last 2-3 hours. On occasion, but not in all cases, a longer lasting anesthetic may have been used that lasts up to 12 hours. If numbness persists into the next day, please call.
8. You may brush your teeth and begin rinses (see below) tonight. It is okay to wait until tomorrow if you are not feeling up to it.
THE FOLLOWING DAYS:
1. Take pain medication as needed, as described above. If more narcotic pain medication is needed, we will need to see you in the office. We cannot prescribe narcotic pain medications over the phone. Take pain medication with food, as it can cause stomach upset.
2. Soft diet should continue until the initial intense pain period is over, and you are able to adequately open your mouth. You may not be able to open your mouth all the way for up to a week (especially wisdom tooth extractions). Resume normal diet when your mouth is comfortable enough to do so, but avoid foods that can get lodged in extraction sockets (popcorn, peanuts, chips, etc.)
3. Drink plenty of fluids and get adequate rest.
4. Irrigation syringe may be used after 3-4 days to gently remove debris from extraction sockets. Fill with water, salt water, or prescription rinse. Irrigate as necessary so the sockets remain free of debris. It may be difficult to remove all food particles, and this is okay. The sockets will heal in 4-6 weeks from the bottom-up, however the gum tissue may close sooner.
5. Avoid rigorous, strenuous exercises and heavy lifting for 1 week.
6. Avoid smoking, spitting, drinking through a straw, or vigorous rinsing for 1 week.
7. Salt water rinses (1/4 tsp salt dissolved in a glass of warm water) may be used as many times per day as needed to remove food debris; generally 4x/day is adequate (after meals, before bed). Avoid use of “minty” over-the-counter mouthwashes for 1 week.
8. Stitches, if placed, are dissolvable. They usually last 5-7 days, but may become loose, unravel, or fall out after only 1-2 days. This is normal. The stitches do not need to remain in place for more than 1-2 days. If the stitches become unraveled or fall out on the evening of surgery, they do not need to be replaced. Due to the location of the incision for lower wisdom teeth, it may feel like the stitch is in your cheek.
9. It is normal for the inside of the extraction socket to have whitish/yellowish/greenish appearance. Yellow liquid that is draining continuously from a socket may indicate infection. Please see below regarding infections.
10. Low-grade fever is likely for 1-2 days. If questionable, please call.
A note on dry sockets: Although uncommon, they may occur. A true “dry socket” is when the matured blood clot becomes dislodged from within the extraction socket, leaving exposed bone which is very painful. This can occur from heavy lifting, straining, sucking through a straw, smoking, or can happen spontaneously without known cause. This is unlikely to happen prior to the 4th or 5th day after extraction. This is not an infection. The primary goal of treating dry socket is pain control. If pain medication is controlling the pain, no treatment is needed. If pain medication is NOT controlling the pain, we will have you come in to the office for placement of a “dry socket dressing”, which is a small gauze with medication on it, placed into the socket; it will need to be changed every 1-2 days. Dry socket dressings can also be placed into sockets that may not have “dry socket”, but are simply very painful. If you have concerns of dry socket, please call.
A note on infections: Infections may occur after (most commonly wisdom tooth) extractions, even if a course of antibiotics has been taken post-operatively. Infections rarely occur within the first two weeks. They more commonly occur 2-4 weeks (and as much as 12 weeks) after surgery, manifesting as an area of swelling and/or pain in the cheek, after everything has almost completely healed. If you have concerns of infection, please call.
Emergencies: Our offices are open weekdays from 7:30am to 4pm. If you have an emergency, please call to speak with a nurse or doctor. If during business hours, we will likely be able to have you come in if needed. If you have an emergency during non-business hours, please call our office (952) 841-9676, and the answering service will contact the doctor on-call.
WE DO NOT REFILL PRESCRIPTIONS FOR NARCOTIC PAIN MEDICATION DURING NON-BUSINESS HOURS
Located in the upper jaw are two large cavities, one on each side. These are called sinuses (maxillary sinuses). The upper back teeth extend their roots next to, and sometimes into, these sinuses.
These sinuses normally open only into the nose. However, in the course of removing teeth or performing other surgery in the area, an opening may develop into the mouth as well. The size of the opening, and the complications that may follow, depend upon the circumstances in a particular case. In only a very small number of such instances, it may be necessary to perform additional surgery to close the resulting defect.
If the opening is large enough to be detected at the time of surgery, the oral surgeon may attempt to close over the defect right away. Signs of an opening that you might notice would include:
- Bleeding from the nose
- Appearance of fluids in the nose on drinking.
- Escape of air into the mouth on blowing the nose.
In order to minimize the possible need for corrective surgery, you are asked to observe certain precautions.
- Avoid blowing the nose, coughing, sneezing or exhaling vigorously through the nose.
- Take decongestants and antibiotic in accordance with instructions. Antibiotic drugs may be prescribed as a preventive measure or to combat an infection.
- Follow instructions for mouth rinses and oral hygiene.
- Eat a well-balanced diet.
- Get adequate rest.
- Be patient, as the opening may persist for some time.
Dental Implants Care
- Swelling and bruising can and often occur in varying degrees from patient to patient. Use cold packs at 30-minute intervals the first day after surgery. Start immediately following your procedure. Using the ice prior to swelling increases its effectiveness and minimizes the severity. Don’t wait…use the cold pack even if no swelling is noticeable.
- Blood in your saliva is normal for the first day or so, however, if you should have excessive bleeding, place pressure on the area with gauze we have provided for you, or a moist tea bag. The pressure should be applied for approximately 25-40 minutes. If the bleeding continues or is alarmingly heavy, contact our office. Keeping your head elevated while sleeping or when lying down also helps.
- You will be given a prescription for an antibiotic. Start the day of surgery and take as directed.
- Should you feel discomfort, you can use Ibuprofen (if not allergic) 600-800mg, three times a day with food. (Do not exceed 2400mg a day.) You may be given a prescription for a stronger pain medication. Take as directed if needed.
- You will be given a prescription for an antibacterial mouthwash. Start the evening of surgery and use as directed. Begin warm salt water rinses the day following surgery. Rinse 4-6 times daily for one week.
- Brush and floss your remaining teeth as usual, but use caution around sutured area. Do not use a Water-Pik or any type of electric toothbrush until instructed by your doctor.
- Leave your partial(s) or denture(s) out (when applicable) unless otherwise instructed.
- If you are having upper jaw implants placed, it is not unusual to have a minor nosebleed within the first few days following the procedure. If this continues, call the office.
- Limit strenuous activities, such as jogging, for approximately two to three days following your procedure. You may resume normal daily activities, such as work, the day following your procedure unless otherwise instructed.
- Smoking and alcohol should be avoided for three weeks following your procedure, as these severely affect the healing process.
- Diet following implant placement should be soft foods, chewing only in the areas where you have natural teeth remaining. Do not chew in the area(s) of the sutures. Also avoid things such as popcorn and food with small seeds, as these tend to get lodged in the sutures. Continue with this diet until the sutures are removed or otherwise instructed.
- Full-mouth replacement: You should stay on a soft diet for the first week following your procedure. You may increase the texture of your food after the first week. You will receive specific instructions about this from your doctor.
- If you have any questions or problems, please contact our office 24 hours a day at (952) 841-9676.