post-operative (After) Tooth Extraction surgery instructions:

***All patients are different.  You may be provided different instructions than what appear on this website.  Please contact our office for your individual instructions***

The removal of teeth should be treated as a  surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.

Immediately Following Surgery

• The gauze pad placed over the surgical area should be kept in place for a half hour. Make sure to keep pressure on the site to help stop any additional bleeding.  After this time, the gauze pad should be checked and changed. Do not rinse your mouth or brush your teeth. This may initiate bleeding by causing the blood clot that has formed to become dislodged. 
• Eating and Drinking are critical to a nice post-operative outcome.  You need hydration and proper nourishment for healing to occur.  Please eat and drink right away after leaving our office to make sure you have a well coated stomach for medications that may be prescribed for pain.  Make sure to eat soft foods that contain starch/dairy for stomach coating purposes. (Mashed potatoes/gravy, mac & cheese, ice cream, pudding, yogurt, oatmeal, cream of wheat, milk, soft eggs, pancakes, etc are good).  Please take your prescribed medications after eating.   This will usually coincide with the local anesthetic becoming diminished.  Be sure to eat before taking medication each time to avoid nausea.  Please drink plenty of fluids. Water, juice, milk, Gatorade/Powerage, are the best.  Do not drink any carbonated beverages for at least 4 days following surgery. 
• Please do not smoke cigarettes, use straws, or do any forcible spitting or rinsing for 72 hours after surgery.  This can sometimes cause the blood clots that form to dislodge.
• Please rest and restrict exercise, work or any other activities.  Place ice packs to the sides of your face where surgery was performed in increments of 20 minutes on/20 minutes off.  Please only use ice the day of surgery and only for the first 24 hours following surgery.  After that, even with swelling–DO NOT USE ICE! DO NOT PUT HEAT ON THE FACE AT ANY TIME AFTER SURGERY! Refer to the section on swelling for explanation.
• If you had general anesthesia or IV sedation, please do not drive a car, operate machinery or sign any legal documents at least 24 hours after surgery.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Place a moist (not wet) gauze pad over the surgical site.  Bite down on the gauze creating a pressure enough to hold the gauze pad firmly over the site.  Keep firmly in place for 30 minutes.  Be careful to keep continuous pressure. Remove the gauze and replace with a new gauze pad.  Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise or activity. It is not uncommon for this to continue several hours post-surgery.  If bleeding does not subside or increases, please call our office.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved.  However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed on for 20 minutes, off for 20 minutes. After 24 hours, ice has no beneficial effect. **Do not use ice after 24 hours following surgery!***If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Do not apply heat to the face!  If you experience redness or unusual painful swelling, please call our office.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. Please start with foods that have starch and dairy components such as: mashed potatoes & gravy, mac & cheese, ice cream, yogurt, pudding, oatmeal, cream of wheat, milk, etc.  You should prevent dehydration by taking fluids regularly.  You should compensate for this by increasing your fluid intake. At least 8 glasses of liquid should be taken daily. Do not drink carbonated beverages! Water, gatorade/powerade and clear juices are best. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. 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.

Rinses/Brushing

No brushing or rinsing of any kind should be performed until the day following surgery. You can brush your teeth the following day, but avoid getting too close to the surgical site.  The day after surgery you should begin rinsing at least 4 times a day after eating with 1) Hydrogen Peroxide 3%.  Make sure to keep it in the mouth (without heavy swishing) and allow that to stay in and around the surgical site for 30 seconds.  2) Follow with a rinse of warm water (about a cup) mixed with a 1/2 teaspoon of salt. Again allow the rinse to stay in for 30 seconds and let that go gently.  Do these two rinses back to back 4 times a day,  (after breakfast, lunch, dinner and before bed) each day for one week or until seen post-operatively by the doctor.

***IF YOU HAVE SOCKET OR BONEGRAFTS IN ADDITION TO YOUR EXTRACTIONS, ONLY RINSE WITH WARM SALT WATER. DO NOT USE PEROXIDE!!***

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood pigments breaking down beneath the skin. This is a normal post-operative occurrence with certain individuals and will go away eventually.

Medications

If you have been placed on antibiotics, take the tablets or liquid as directed. Take the medication until all of it is gone! Antibiotics will be given to help prevent infection.  Please discontinue medication use and call our office in the event of a rash or other unfavorable reaction. Some allergies to medication can be dangerous. If needed take emergency pre-cautions if severe reactions occur.

Pain medications may be prescribed.  It is important to always have a well-coated stomach (starch and dairy products are best) when taking strong pain medications.  Please only take as directed, and only take what has been prescribed to YOU!  It is important not to mix certain medications, as that can have dangerous side effects.  Discuss all medications with Dr. Krause before leaving our office.  Take only prescribed amounts.  Do not use alcoholic beverages when taking medications!

In the event of nausea and/or vomiting, or any unusual side effects following surgery, stop taking all medication and contact our office.  Further instructions will be given.  

Other Complications

• If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call our office if you have any questions.
• Slight elevation of temperature immediately following surgery is usually due to dehydration.  Please drink plenty of fluids.   If the temperature persists, notify the office.
• You should be careful going from the lying down position to standing.  Before standing up, you should sit for one minute then get up.
• 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 irritation occurs, please contact our office.
• 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 2-3 days.

Finally

Dissolvable sutures are placed the area of surgery to minimize post-operative bleeding and to help healing.  The sutures will dissolve and will eliminate when the body is ready.

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call my office for instructions.

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 salt water rinses. If you experience any issues, please contact our office.

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. Krause or your family dentist.

Brushing your teeth is okay – avoid the surgical sites for 4-5 days and once you do brush, just be gentle at the surgical sites.