Post-Op Instructions Tooth Extractions

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BLEEDING:

  • After surgery, we will place gauze packs at the surgical sites.
  • Bite with continuous pressure on the gauze packs.
  • Minimize talking as this disrupts the continuous pressure needed for the gauze to work. “Talk with your mouth closed.”
  • Remove the gauze packs 30 minutes after leaving the office (approximately when you get home). Replace the gauze packs with fresh folded gauze and bite with continuous pressure for another 30 minutes. THEN TAKE THE GAUZE OUT AND LEAVE IT OUT!
  • DO NOT use more gauze. Over-doing it with the gauze (i.e. repeated replacing) PROLONGS the bleeding and prevents proper clot formation needed to prevent dry socket.
  • The site WILL ooze blood for 1-1.5 hours. That’s okay! “Let it ooze to a stop.” We want good blood clots to form to help prevent dry socket.
  • Do not spit out the blood; swallowing it is okay!
  • To help the oozing stop: rest to maintain a low heart rate, keep ice packs on, and drink small amounts of cold liquid.

PAIN:

  • You should be comfortably numb for at least 2-3 hours following surgery.
  • When the numbness begins to wear off, take ibuprofen (Advil or Motrin) OR naproxen (Aleve). You may take acetaminophen (Tylenol), although this alone is not usually sufficient to control post-op pain for most patients.
  • If you need more pain control, take the narcotic pain medication.
    • Make sure you have food in your stomach before taking the narcotic pain medication!
    • If you have been given the anti-nausea medication Zofran (ondansetron), take this 30 minutes prior to taking any narcotic pain medication.
  • When taking narcotic strength pain medication:
    • Do not drink alcohol or consume any cannabis products
    • DO NOT DRIVE!
    • Do not operate heavy machinery
    • Do not attempt tasks that require close concentration.
  • Do not take any additional pain medication unless our office or pharmacist specifically directs you to do so.
  • In the days following surgery, you can alternate the ibuprofen and narcotic if you wish. You can also take both the ibuprofen and narcotic at the same time; it is safe to do this!
  • DO NOT take any extra Tylenol (acetaminophen) when taking the narcotic pain medication as this may lead to a Tylenol overdose.

SWELLING:

  • To minimize swelling:
    • “Sleep with your head elevated above heart-level” for the first 48 hours following surgery.
    • Use ice packs for the first 48 hours.
  • Swelling typically INCREASES gradually for the first 48 hours following surgery, then begins to subside. This is normal!
  • Following the first 48 hours after surgery, warm moist compresses (i.e. a washrag that you soak under warm running water and then ring out) are better than ice at helping the swelling resolve.
    • Gently massage the areas with the warm moist compress for 20 min, every hour or so.
  • Rapid swelling is NOT normal! Call our office immediately if this occurs.

DRY SOCKET:

  • You may have a dry socket if:
    • It’s day 4-5 after surgery AND,
    • You have throbbing or radiating pain from LOWER jaw extraction sites, AND
    • The pain is not controlled with all available pain medications, AND
    • You’ve been irrigating your sockets as instructed.
  • To help improve your chances of avoiding a dry socket:
    • “Baby” the blood clots! (i.e. Avoid disrupting the blood clots.)
    • Do not use a straw for 48 hours following surgery.
    • No vigorous swishing and spitting for 48 hours; instead, gently slosh your head side to side, then hang your head over the sink and let the contents drain out. o No physical exertion for 5 days following surgery (i.e. nothing more than a brisk walk.)
    • ABSOLUTELY NO SWIMMING for 7 days following surgery!
    • DO NOT USE ANY OF THE FOLLOWING: coconut oil, essential oils of any kind, hydrogen peroxide, dilute bleach, tooth whitening products.
  • If you think you are experiencing a dry socket, call the office.
  • All dry sockets resolve spontaneously over time, but we can help make the healing process much more comfortable if you do experience a dry socket.

DIET:

  • After surgery, you can eat as soon as you’re ready!
  • Take the gauze out while you’re eating.
  • Things to eat: Soft foods…”anything that can squish through the tines of a fork.”
    • Mashed potatoes, pasta, fish, applesauce, Jell-O, pudding, eggs, soups (luke warm and no small pieces or bits).
  • Things to NOT eat:
    • Anything spicy
    • Anything acidic (i.e. lemonade, orange juice, marinara sauce, soda/pop)
    • Anything with small pieces/bits/seeds (i.e. sesame seeds, strawberry seeds, raspberries, etc.)
    • ANYTHING WITH CAFFIENE FOR 48HRS! Yes, this includes coffee! Coffee contains caffeine and shrinks capillaries and diminishes both nutrient supply to (and waste removal from) your healing sites. PLUS, hot liquids damage the delicate healing tissue. If “iced decaf” coffee counts as “coffee” in your world, then go for it!
  • You may slowly “advance” your diet back to normal as you feel ready. If something is too much or uncomfortable, stop, and try again tomorrow. Most people are back to their “normal” diet 7-10 days after surgery.

ORAL HYGIENE:

  • Wait 24 hours after surgery to start brushing.
  • DO NOT BRUSH NEAR THE SURGERY SITES until 48 hours after surgery.
  • For the first 48 hours, gently rinse with salt water ONLY.
    • 1⁄2 tsp table salt in 1 cup warm water.
  • Begin prescription strength rinse again after 48 hours. Use this mouthwash for 7 days only, then stop.
  • If you have not been given a prescription strength rinse, we recommend using Crest Pro-Health (non-whitening) Mouthwash or ACT Mouthwash. We DO NOT recommend any alcohol-based rinses, such as Listerine.

SUTURES:

  • You may have sutures (stiches) at the surgical site, they usually dissolve on their own within 7-10 days.
  • If sutures come out earlier, this is okay.

ANTIBIOTICS:

  • We usually don’t prescribe antibiotics, but when we do you must take the entire amount as directed.
  • If you break out in a rash, stop taking the medication immediately and call our office.

SMOKING:

  • Do not smoke for 5 days after surgery.
  • Smoking delays healing, increases discomfort, and may cause a dry socket or bleeding to restart.
  • This includes cannabis AND VAPING/DABBING! No high-temperature vapors in the mouth!

SPECIFIC INSTRUCTIONS FOLLOWING IV ANESTHESIA:

  • ALL GAUZE MUST BE REMOVED FROM THE MOUTH BEFORE THE PATIENT LIES DOWN TO REST/SLEEP!! Sleeping with gauze in the mouth is extremely dangerous and can lead to aspiration of gauze and death.
  • You have been given the IV form of ibuprofen. DO NOT take more ibuprofen (Advil, Motrin, etc.) for at least 6 hours following discharge home.

IRRIGATING INSTRUCTIONS: (Follow these ONLY if you are instructed to do so.)

  • WAIT UNTIL DAY 4 AFTER SURGERY TO IRRIGATE YOUR SOCKETS! (e.g. If your surgery was Monday, you would begin irrigating on Thursday)
  • Use either the salt water or your prescription mouthwash.
  • The tip of the syringe (1-2mm) has to go into the holes before your start rinsing; you can’t just “aim and pray.”
    • Open as wide as you can, gently retract the cheek out with a tongue depressor and carefully insert the tip of the irrigating syringe.
    • Use one half syringe full at each socket, or enough to make the site clean.
    • The site is clean when: the irrigating fluid is clear and contains no food debris. It may ooze blood at first…this is normal and expected. The cleaner you keep it, the less it will bleed.
  • This should be done after every meal.
  • Irrigating may need to be done for 4-6 weeks (yes, weeks!) following surgery as the gum tissue can take this long to fill in the holes.
  • You will know when you can cut back on the irrigating. If you start to get a funky taste or smell, it’s probably time to irrigate again.

SINUS PRECAUTIONS: (Follow these ONLY if you are specifically instructed to do so.)

  • Avoid blowing your nose as much as possible. If you must, you should do this with VERY little force.
  • Avoid sneezing or holding in your sneeze. Sneeze with your mouth open so that the force of the sneeze does not build up pressure in your sinuses.
  • DO NOT use a straw or smoke.
  • DO NOT play any wind instruments.
  • Use all medications as directed.

WHEN TO CALL:

  • Call us anytime if you have questions or concerns!
    • Call the office during normal business hours at (970) 669-4802
    • If it’s outside of normal business hours, please call Dr. Auble directly.
  • Rapid swelling
  • Difficulty breathing
  • Sudden onset of hives/rash
  • Streaky redness on skin
  • Temperature greater than 100.7 F over 4 consecutive hours that does not respond to 500mg of Tylenol