Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon for up to 24 hours following surgery.

  • If given gauze, change it as directed every 30 minutes until the active bleeding has subsided (usually 2-3 hours).
  • Make sure you apply good pressure to the gauze.
  • You may remove the gauze to begin drinking, but return fresh gauze to the extraction site(s) if bleeding is still present
  • If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. Be sure to apply constant pressure. Remain quiet in a seated position for 20 to 30 minutes. Repeat until bleeding is controlled.
  • To minimize further bleeding, do not become excited, sit upright, and avoid exercise.
  • After these directions have been followed in detail and bleeding does not subside, call for further instructions.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. The swelling will not become apparent until the day following surgery and will not reach its maximum until two to three days post-operatively.

  • The swelling may be minimized by the immediate use of ice packs. The ice packs should be left on continuously while you are awake. Ice can be used for the first 48 – 72 hours to help minimize swelling
  • If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Twenty-four hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

Post-operative discomfort is normal after oral surgery procedures. Start taking the pain medication before the local anesthesia or numbness wears off. We also offer a long-term injectable therapeutic called Exparel that numbs the surgical site for 2-3 days. Please use the following instructions to help control the amount of discomfort that you may have:

  • For the first 24 – 72 hours, we recommend taking the prescription strength ibuprofen 600 – 800 mg as scheduled to help limit the inflammation and resulting pain. Please make sure you do not take this medication on an empty stomach. If you have stomach disturbances, you may benefit from taking an acid reducer such as famotidine (Pepcid), which can be obtained without a prescription.
  • If your pain is moderate to severe and/or not resolved with ibuprofen, then you can work in another medication such as acetaminophen or narcotic pain medication (Norco, Tylenol #3) and alternate the two in a staggered fashion. The narcotic pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Be sure to eat something prior to taking pain medication to reduce nausea.
  • If your pain is uncontrolled with medication and/or your pain is not improving over time, it may require attention and you should call the office.

Limited mouth opening

  • Due to swelling and inflammation of the jaw muscles, it is normal to be limited in mouth opening for up to 2 weeks after surgery.
  • Jaw opening exercises can be initiated after 1 week

Bruising

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 postoperative occurrence, which may occur two to three days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Diet

  • Swelling inside the cheeks and limitations in opening will limit diet for the first 1-2 weeks
  • Start with liquids immediately afterwards. Do not use straws when drinking from a glass for one week. The sucking motion can cause more bleeding by dislodging the blood clot.
  • You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least five to six glasses of liquid should be taken daily.
  • You can progress to foods of softer consistency as tolerated
  • Avoid hot liquids or food, spicy foods, and foods with seeds.
  • You are probably dehydrated since your diet was limited before and after surgery. As a result, be careful going from the lying down position to standing. You could get light headed when you suddenly stand up. Before standing up, you should sit for one minute and then get up.

Vegetables

  • Soups (smooth rather than chunky) – virtually any combination of vegetables can be made into a soup, or buy readymade ones!
  • Mashed avocado/guacamole
  • Fresh spinach, kale or other greens, cooked very soft
  • Sweet potatoes, baked until very soft
  • Soft-cooked carrots, soft cooked squash (mashed if necessary)
  • Vegetable juice (such as tomato juice

Fruits

  • Fruit juice, Fruit smoothies, Mashed bananas, Baked apples, Baked bananas
  • Applesauce

Protein foods

  • Soup with soft meats
  • Moist, tender meat or poultry that is ground, shredded, finely chopped or blended with vegetables or potatoes, using a food processor
  • Soft-cooked fish, Crab cakes, Scrambled egg or poached egg, Baked Beans
  • Tofu
  • Bread, rice, potatoes, pasta:
  • Mashed potatoes, Pasta or noodles (not firm), Cooked cereal/oatmeal (with or without mashed fruit)
  • Cold cereal which has been left to soak in milk until soft
  • Bread that has been softened in soup, Soft bread rolls
  • Muffins, pancakes, waffles

Dairy products

  • Milkshakes, milk drinks
  • Yogurt
  • Yogurt drinks
  • Yogurt with soft fruits
  • Ice cream!! (without crunchy bits)
  • Cottage cheese, ricotta cheese
  • Cheese in sauces or melted in other dishes

Deserts

  • Custard/Pudding
  • Ice cream
  • Soft moist cake or pie – moisten in milk, coffee or other liquid if necessary

Foods to avoid

  • Tortilla Chips
  • Taco Shells
  • Peanuts
  • Fruit with seeds
  • Popcorn

Hygiene

  • No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the day after surgery but rinse gently.
  • The day after surgery you should begin rinsing with the chlorhexidine (peridex) mouthrinse twice a day and several times a day with a cup of warm water mixed with a teaspoon of salt, especially after meals.
  • There will be a cavity or empty hole where the tooth was removed. The size of this opening depends on the nature of the tooth impaction. Even if sutures were used, often a small opening will be present. The cavity will gradually fill in with new tissue over time and will take 4 – 6 weeks for it to be completely closed. During this time, these areas will be come a trap for food and debris accumulation and must be irrigated regularly.
  • After 3 days, we recommend irrigating the extraction socket or cavity directly with the syringe we provided using chlorhexidine (peridex) or salt water. Be sure to get the tip of the syringe into the socket and do not be afraid to be aggressive in irrigation. Over time, food and debris can accumulate in the lower extraction sockets and can lead to healing problems.
  • Do not irrigate the sockets before 3 days to avoid dry socket formation (see below)

REMEMBER: A clean wound heals better and faster.

Activity

Keep physical activities to a minimum for one week following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

Smoking

You should avoid smoking for a week following surgery. Smoking before and after surgery my increase your chance of post operative complications such as a dry socket. You may consider asking your primary care physician for a nicotine patch or medication to assist you to stop smoking.

Dry Socket

  • If you have excess or new pain about 4 – 5 days after surgery that is not relieved with medication, you may have developed a dry socket. This occurs when the blood clot dislodges or dissolves causing throbbing pain and a bad taste.
  • Please call the office and we will see you to place a medicated dressing into the offending socket that will provide relief.
  • To avoid dry sockets, do not use straws, do not irrigate the sockets until after 3 days following surgery, and avoid smoking. Oral contraceptives have also been shown to be a risk factor for developing dry sockets.

Numbness

  • Numbness of the lip, chin, or tongue can persist up to 6 hours after the surgery from the local anesthetic injections used.
  • If numbness persists the following day after surgery, please notify the office. Often, the numbness is temporary in nature and will resolve over time.
  • 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 your doctor.
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.
  • Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in two to three days.

Sutures

  • Sutures may or may not be used for each site depending on the nature of the extraction
  • If sutures are used, they are resorbable and will dislodge on their own after about 5 – 7 days