After Oral Surgery

Even for the most simple-seeming procedures, post-operative care is very important. Unnecessary pain and complications can be minimized if these instructions are followed carefully. Your case is individual, no two mouths are alike. Do not accept well-intended advice from people who may have had the same procedure. Please discuss any questions or problems with the persons who are able to effectively help you: Dr. Molen and his staff.

Immediately Following Surgery:

  • The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
  • You should not drive a car, operate machinery, or perform any other tasks which require concentration while you are taking narcotic pain medications or for 6 hours thereafter.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for detailed instructions.

Keep the Mouth Clean

Mouth cleanliness is essential to good healing. Clean your mouth thoroughly after each meal beginning the day after surgery. Brush your teeth as best you can and rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete. REMEMBER: A clean wound heals better and faster.

You should also avoid rinsing with alcohol-containing mouthwash (Scope, Listerine, etc.) during this time, as it will be very uncomfortable for the healing tissues.

Controlling Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first gently rinsing or wiping any old clots from your mouth, then placing a moist gauze pad over the area and biting firmly for thirty minutes. 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. Ice to the face for 20 minutes on the side of the bleeding can also help constrict blood vessels. To minimize further bleeding, sit upright and do not exert yourself. If bleeding does not subside after implementing these measures, please call us for further instructions.

Controlling Swelling

The swelling that is expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. 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. Bags of frozen vegetables such as peas are also very effective. The ice packs may be left on continuously as tolerated while you are awake. After 36 hours, ice has no effect on swelling.

Sitting upright while awake and sleeping in a semi-elevated position will also help minimize and reduce swelling. If swelling or jaw stiffness persists for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face can help in reducing stiffness.

Controlling Pain

For moderate pain for teen and adult patients, we recommend 400-600 mg ibuprofen (Motrin or Advil) every 6 hours as needed. If you cannot take ibuprofen, 500-1,000 mg acetaminophen (Tylenol) can be taken every 6 hours instead. Do not take aspirin-containing products for pain. Please note that most narcotic-containing prescription pain medications, such as Vicodin, contain acetaminophen and you should not take more than 4,000 mg of acetaminophen in a 24-hour period.

For severe pain, we prescribe narcotic-containing medications. These medications will make you groggy and will slow down your reflexes. You should not drive a car, operate machinery, or perform any other tasks which require concentration while you are taking narcotic pain medications or for 6 hours thereafter.

Pain or discomfort following surgery should subside more and more every day. If pain worsens or does not improve after several days, it may require attention and you should call the office.

Diet

After any oral surgery procedure, liquids should be initially taken to avoid stomach upset. Do not use straws for 24 hours; drink from a glass instead. The sucking motion can cause more bleeding or "dry sockets" by dislodging the blood clot. After 24 hours, you may then advance to soft foods, chewing away from the surgical sites. Avoid hard, crunchy foods such as chips, nuts and popcorn for 7-10 days.

High calorie, high protein intake is very important. Nourishment should be taken regularly. 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 5-6 glasses of liquid should be taken daily. 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 while on a limited diet, you may become dizzy. If you are lying down, make sure you sit for one minute before standing.

“Dry Sockets”

Dry sockets (alveolitis) occur almost exclusively with the removal of impacted wisdom teeth from the lower jaw. They are very uncommon and are caused by dislodgement of the blood clot from the extraction site. Activities such as smoking or sucking through straws can increase the risk of developing a dry socket. Symptoms of new, severe pain at the surgical site and even pain to the ear 2-3 days following surgery are the usual signs of a dry socket. Call us if this occurs, so that we can evaluate you.

Sutures

Sutures (stitches) are sometimes placed in the area of surgery to minimize post-operative bleeding and to help healing. The materials Dr. Molen uses are almost always dissolvable, and will eventually fall out or unravel. This is no cause for alarm. Just remove the thread from your mouth and discard it. If you have non-dissolving sutures, we will arrange to have you return to the office for removal. The removal of sutures is very simple, and does not require any shots.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration on the face and neck is due to fluid spreading beneath the tissues, and then draining through the lymphatic system via gravity. This is a normal occurrence after surgery, which may occur several days after surgery as swelling begins to decline. Moist heat applied to the area may speed up resolution of this process.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help treat or prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if this occurs.

Nausea

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including prescribed medications. You should then slowly resume oral intake with sips of clear liquids such as water, soft drinks, sports drinks or herbal tea. You should sip slowly, taking in approximately 8 ounces over a fifteen-minute period. When the nausea subsides you can begin taking more fluids, solid foods and resume prescribed medications.

Other Common Issues

  • Fever: Slight elevation of temperature immediately following surgery is not uncommon. If a temperature above 101.5º persists, please notify our office. Acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can be taken to reduce elevated temperatures.
  • Dizziness: You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery, and may be slightly dehydrated. You could get light headed when you stand up suddenly. Taking certain pain medications can make you dizzy. Before standing up, you should sit for one minute then slowly get up.
  • Cracked lips: If the corners of your mouth were stretched, they may dry out and crack. Your lips may be kept slightly moist with an ointment such as Vaseline to promote healing.
  • Weakness: For the first few days after surgery, be aware that your normal nourishment intake may be reduced. You may not have the energy reserves to participate in your normal activities. If you get light headed during exercise or physical exertion, stop, take a break, and then slowly increase your activity as tolerated.