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After Tooth Extractions

Medications

All medications should be taken as directed on the bottle. If you were given ibuprofen for pain, take your first dose as soon as you get home, before the numbness wears off. Continue to take the ibuprofen every 6 hours for 3 days following surgery. If that does not satisfactorily relieve the pain in 1 hour, then take two Tylenol up to every 6 hours. If the ibuprofen + Tylenol combination is not effective, then take the narcotic as prescribed. Do not take any pain medication on an empty stomach, as this can cause nausea. After taking medication, drink 8 oz of water and sit up for at least 20 minutes. Do not drive while taking the narcotic pain medication. If you were prescribed an antibiotic, take the medication exactly as described on the bottle until the prescription is gone.

NOTE: IF YOU EXPERIENCE ANY OF THE FOLLOWING, STOP TAKING ALL MEDICATIONS IMMEDIATELY AND CALL THE OFFICE OR GO TO THE NEAREST EMERGENCY DEPARTMENT: rash, itching, breathing difficulties, wheezing, multiple episodes of vomiting, diarrhea, or swelling of the lips throat, eyes, hands, or feet. If you are a female taking birth control pills, antibiotics can interact and significantly decrease the effectiveness of birth control pills.

Do not take any ibuprofen if you are allergic to aspirin, ibuprofen, or NSAIDS (non-steroidal anti-inflammatory drugs); in this case, just take Tylenol or the prescribed narcotic as directed on the label.

Bleeding

A small amount of bleeding is expected and normally is not a cause for concern. A fresh gauze will be placed in the area of the surgery prior to leaving the office. Keep the jaws tightly closed to provide pressure on the surgical sites. Remove this gauze in approximately one hour and replace it with a fresh, tightly-folded gauze. Again apply pressure and leave it in place for 60 minutes. This should stop most bleeding. Do not replace the gauze more often than every 60 minutes. When the gauze is removed, it is normal for the surgical site(s) to slightly ooze for up to 24 hours. It is not normal if the oozing causes large, thick clots to form in your mouth. If bleeding continues, run a tea bag under warm water, wrap it in gauze, and bite on it for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. If the oozing continues at a brisk pace, call Dr. Engel or report to the local hospital Emergency Department after hours for instructions.  

Swelling

Some mild swelling may be expected and may persist for several days. Peak swelling and discomfort usually occur 2-3 days after surgery. It may be minimized by the application of ice packs. Cold therapy can be helpful if swelling is expected. If you were given a Cool Jaw, place the ice packs on for 20 minutes on then 10 minutes off during the first 24 hours, except for eating and hygiene. When you lie down, elevate your head using a pillow. This allows gravity to work for you and helps reduce swelling.  

Oral Hygiene

Avoid toothbrushing or rinsing until the next day after surgery. You should also begin gentle warm salt water rinses the day after surgery. To do this, add 1/2 teaspoon salt to an 8 oz glass of warm (not hot) water. Gently rinse for about 30 seconds and then let the water fall out of your mouth without spitting. The day after surgery, brush and floss but avoid the surgical sites. Remember to rinse after every meal and maintain excellent oral hygiene to promote healing. If a mouthwash was prescribed, use it as directed. Avoid ALL tobacco products INDEFINITELY.  If you have an irrigating syringe or a Water Pic, do not start using it any sooner than 1 week after surgery.

Eating

Fluids should be taken as soon as possible after surgery. Avoid using a straw for the first few days. Do not drink carbonated drinks or alcoholic beverages. You may have beverages such as: water, apple juice, broth, milkshakes, etc. High fluid intake is recommend for the first 48 hours to help prevent nausea and insure adequate hydration. Only eat soft foods (pasta, eggs, yogurt, soups, instant breakfast drinks, puddings, etc.). Do not consume any hard, chewy, or crunchy foods . Your food intake may be limited for the first few days. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.

Activity

If you you had intravenous (IV) sedation, then a responsible adult needs to accompany you home on the day of your surgery. You are to go directly home and rest quietly with your head elevated the remainder of the day. The residual effects of the IV medication used during your procedure may alter your judgment and physical abilities. Do not attempt to drive or operate dangerous equipment (e.g. power tools, motor boats, etc.), for 24 hours or while taking the narcotic pain medication, and do not exercise strenuously (jogging, sports, weight lifting) for one week. Restrict your activities the day of surgery and resume normal activity when you feel comfortable. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

Sutures

You probably had sutures placed. If you have sutures, they will be absorbed in 7-10 days. If the sutures are bothersome or persist after a few weeks, we can remove them for you. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it.

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.  

Intravenous Catheter

If you had intravenous sedation, you may notice a bruise and some soreness at the previous location of your IV. The day after surgery you may apply moist heat to the area to relieve discomfort. If pain increases or does not improve within a few days please call Dr. Engel .

Stiffness in the Jaw

Stiffness (trismus) and soreness around the jaw area can be anticipated for several days. After 24 hours, you may start to apply moist heat packs (applied to the stiff areas for 20 minutes 4-5 times a day) to speed recovery.  

For Patients Taking Birth Control Pills

Antibiotics can sometimes render birth control pills less effective. It is advisable to use an alternative method of contraception for the remainder of that cycle’s package of pills when an antibiotic is taken.

Special Precautions

You may feel light-headed or dizzy due to the combined effects of the IV and pain medications. Be careful when you get up and ask for assistance when needed. Please feel free to contact us if any doubt arises as to your progress or recovery, especially if any of the following occur:

  •  Increasing or persistent pain after the first 3-4 days

  •  Continued increase in facial swelling after the first 72 hours

  •  Persistent bleeding, despite following the above instructions

  •  The presence of persistent nausea or vomiting

Finally

There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with warm salt water rinses.

Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Dr. Engel  or his staff.

Refrain from exercise for one week. Be aware that your normal nourishment intake is reduced and exercise may weaken you. If you get light headed, stop exercising.

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 spontaneously. If not, they can be removed by Dr. Engel .

We will tell you at the time of discharge when your appointment is scheduled. If there is a problem keeping this appointment, please call as soon as possible to reschedule. Do not hesitate to call us at (860) 739-3133if you have ANY questions!

  Informed Consent video for extractions