Post Operative Surgical Instructions

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POST-OPERATIVE INSTRUCTIONS

***PLEASE READ ALL OF THESE INSTRUCTIONS CAREFULLY*** Sometimes the after-effects of oral surgery are quite minimal, so not all of the instructions may apply. Common sense will often dictate what you should do. However, when in doubt follow these guidelines or call our office for clarification. Our number is (865) 291-1520.

FIRST HOUR: Bite down gently but firmly on the gauze packs that have been placed over the surgical areas, making sure they remain in place. Do not change them for the first hour unless the bleeding is not controlled. The packs may be gently removed after one hour. If active bleeding persists, place enough new gauze to obtain pressure over the surgical site for another 30 minutes. The gauze may then be changed as necessary (typically every 30 to 45 minutes). It is best to moisten the gauze with tap water and loosely fluff for more comfortable positioning.

EXERCISE CARE: Do not disturb the surgical area today. Do NOT rinse vigorously or probe the area with any objects. You may brush your teeth gently. PLEASE DO NOT SMOKEfor at least 48 hours, since this is very detrimental to healing and may cause a dry socket.

OOZING: Intermittent bleeding or oozing overnight is normal. Bleeding may be controlled by placing fresh gauze over the areas and biting on the gauze for 30-45 minutes at a time.

PERSISTENT BLEEDING: Bleeding should never be severe. If so, it usually means that the packs are being clenched between teeth only and are not exerting pressure on the surgical areas. Try repositioning the packs. If bleeding persists or becomes heavy you may substitute a tea bag (soaked in very hot water, squeezed damp-dry and wrapped in a moist gauze) for 20 or 30 minutes. If bleeding remains uncontrolled, please call our office.

SWELLING: Swelling is often associated with oral surgery. It can be minimized by using a cold pack, ice bag or a bag of frozen peas wrapped in a towel and applied firmly to the cheek adjacent to the surgical area. This should be applied twenty minutes on and twenty minutes off during the first 24-72 hours after surgery. If you have been prescribed medicine for the control of swelling, be sure to take it as directed.

PAIN: Unfortunately most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first pill before the anesthetic has worn off, you should be able to manage any discomfort better. Some patients find that stronger pain medicine causes nausea, but if you precede each pain pill with a small amount of food, chances for nausea will be reduced. The effects of pain medications vary widely among individuals. If you do not achieve adequate relief at first, you may supplement each pain pill with over the counter analgesics such as aspirin, acetaminophen ( Tylenol), or NSAIDS (Motrin, Advil etc…) as directed on the bottle. Remember that the most severe pain is usually within six hours after the local anesthetic wears off; after that your need for medicine should lessen. If you find you are taking large amounts of pain medicine at frequent intervals, please call our office. If you anticipate needing more prescription medication for the weekend, you must call for a refill during weekday business hours.

NAUSEA: Nausea is not uncommon after surgery. Sometimes pain medications are the cause. Nausea can be reduced by preceding each pain pill with a small amount of soft food, and taking the pill with a large volume of water. Try to keep taking clear fluids and minimize dosing of pain medications, but call us if you do not feel better. Classic Coca Cola may help with nausea.

DIET: Eat any nourishing food that can be taken with comfort. Avoid extremely hot foods. Do not use a straw for the first few days after surgery. It is sometimes advisable, but not absolutely required, to confine the first day’s intake to liquids or pureed foods (soups, puddings, yogurt, milk shakes, etc.) It is best to avoid foods like nuts, sunflower seeds, popcorn, etc., which may get lodged in the socket areas. Over the next several days you may gradually progress to solid foods. It is important not to skip meals! If you take nourishment regularly you will feel better, gain strength, have less discomfort and heal faster. If you are a diabetic, maintain your normal eating habits or follow instructions given by your doctor.

SHARP EDGES: If you feel something hard or sharp edges in the surgical areas, it is likely you are feeling the bony walls which once supported the extracted teeth. Occasionally small slivers of bone may work themselves out during the following week or so.

MOUTH RINSES: Keeping your mouth clean after surgery is essential. If you wish to use a mouth rinse, salt water rinses consisting of 1/4 teaspoon of salt dissolved in an 8 ounce glass of warm water two to three times a day is recommended.

BRUSHING: Begin your normal oral hygiene routine as soon as possible after surgery. Soreness and swelling may not permit vigorous brushing, but please make every effort to clean your teeth within the bounds of comfort.

HOT APPLICATIONS: After 72 hours, you may apply warm compresses to the skin over the areas of swelling (hot water bottle, hot moist towels, heating pad) for 20 minutes on and 20 minutes off to help soothe tender areas . This will also help decrease swelling and stiffness.

HEALING: Normal healing after tooth extraction should be as follows: The first day is usually easier than then second or the third, and it is not uncommon for the fourth or fifth days to be the most uncomfortable as this is usually when any swelling peaks, or any bruising occurs. By the fifth day you should be more comfortable and, although possibly still the most swollen, and you can usually begin a more substantial diet. The remainder of the post-operative course should be gradual, steady improvement, but it does take 7-10 days for the swelling to resolve, and 14-21 days for any bruising to fade. It also takes 4-6 weeks for dental sockets to completely fill in. If you don’t see continued improvement, please call our office because it is most likely that you have a dry socket, which is similar to a scab coming off to early, and is best treated by a medicated dressing. If you are given a plastic irrigating syringe, DO NOT use it for the first five days. Then use it daily according to the instructions until you are certain the tooth socket has closed completely and that there is no chance of any food particles lodging in the socket.

BONE GRAFT PROCEDURE: It is not uncommon for bone graft procedures to become more uncomfortable after 3-5 days, and then start to feel better in 10-21 days.   The reason for this is that you have essentially gotten a dry socket underneath your graft.  Normally a medicated dressing would be placed for a dry socked, but because a graft has been placed there is no way to place the dressing and oral pain meds are the only option for pain relief.  If a Non Resorbable membrane has been placed with the graft, which is normally the case, it will usually become more visible  as the graft heals and will require removal in 4-6 weeks

SINUS PRECAUTIONS: Because of a very close relationship to the maxillary sinus, many times when a tooth is extracted it may leave a communication between the mouth and the sinus. We will inform you if this is the case. If you are informed of a sinus communication, it is important to follow these instructions: Take your prescriptions as directed, refrain from blowing your nose for two weeks, try to stifle all sneezes, do not use a straw, do not smoke, eat soft foods for several days chewing on the opposite side if possible, do not rinse the mouth too vigorously for several days. In most cases, small mouth-sinus communications heal uneventfully and cause no problems. We will check this area carefully at you post-operative visit.

BREAST FEEDING INSTRUCTIONS : You will need to use either breast milk which you have pumped and stored prior to your surgery or a formula recommended by your pediatrician until 24 hours past you last IV anesthestic or prescribed medication. During this time, you will still need to pump your breasts and discard the milk in order to maintain proper let down. We recommend discussing your surgery with you pediatrician prior to your appointment in order to have ay specific questions regarding your infant’s nutritional needs answered.

PLEASE NOTE: Telephone calls for narcotic (pain killer) prescription renewal are ONLY accepted during office hours.