Patient Instructions

• Before Anesthesia
• After Dental Implant Surgery
• After Wisdom Tooth Removal
• After Surgical Exposure of an Impacted Tooth
• After a Tooth Extraction
• After Multiple Extractions

After Wisdom Tooth Removal

The removal of impacted teeth is a serious surgical procedure and post-operative care is very important. Unnecessary pain and swelling can be minimized if these instructions are followed carefully.

Immediately Following Surgery

• The gauze pad placed over the surgical area should be kept in place for a 45 minutes to an hour. After this time, the gauze pad should be removed and discarded. If there is additional bleeding, replace with new gauze and bite for an additional 45 minutes.
• 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 before the numbness wears off. Repeat on a regular schedule for the first 24 -48 hours after surgery.
• Restrict your activities the day of surgery and resume normal activity in 24-48 hours or when you feel comfortable.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on Swelling for an explanation.

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 rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for 45 minutes.  Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 45 minutes - the tannic acid in the tea bag assists clot formation by contracting the blood vessels.  To minimize further bleeding, stay calm, sit upright, and avoid rigorous exercise.  If bleeding does not subside, call the office for further instructions.

Swelling

Swelling of the tissue 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.  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 use of ice packs can minimize swelling – these should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake, for up to 36 hours after surgery.  Swelling or jaw stiffness may persist for several days, but there is no cause for alarm unless accompanied by a fever.

From thirty-six hours following surgery, the application of heat to the sides of the face is beneficial in decreasing swelling and improving comfort.

Pain

After surgery, medication will be prescribed according to your anticipated level of discomfort.  Take your pain medication before numbness from local anesthetic is gone and repeat on a regular schedule for the first 24-48 hours.  Take medication with a milk shake or other beverage to avoid nausea.  Do not drive, operate hazardous machinery, or drink alcohol while taking pain medication.  Keep a log of all medications taken, noting the time and amount taken, to ensure appropriate dosing.  If pain is not relieved by the medication, you should call the office.

Diet

A high calorie, high protein diet with plenty of liquids is essential for proper healing.  Do not use straws when drinking, as the sucking motion can dislodge the blood clot.

Your food intake will be limited for the first few days and you should compensate for this by increasing your fluid intake.  You should aim for half of your body weight in ounces.  For example, if you weigh 200 lbs, you should drink around 100 ounces, or about twelve 8 ounce glasses of fluid a day.  This will also prevent dehydration, as long as you avoid all caffeinated or alcoholic beverages.  You will feel better, have more strength, have less discomfort, and heal faster if you stay hydrated and maintain your calorie intake.

At your post surgical appointment, Dr. Pennington or her staff will advise you on how quickly you can get back to your normal diet. Please refrain from eating hard, chewy foods, such as nuts, chips and tough meats, until you return for your post surgical visit. When you do begin to eat, try to stay away from the surgical sites.

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 a minute before standing.

Keep the Mouth Clean

Beginning the day after surgery, gently rinse your mouth with diluted mouthwash or salt water (1/2 teaspoon salt in a cup of lukewarm water) 3 to 4 times daily.  Continue rinsing daily until you return for your post-operative exam.  You may gently brush your teeth the day after surgery, being careful around the surgical sites.

Bruising

In some cases, bruising of the skin appears as the swelling resolves.  This is a normal postoperative occurrence, and heat applied to the area along with massage, may speed up resolution of the discoloration.

Antibiotics

If you have been placed on antibiotics, take them as directed.  Antibiotics may be given to help prevent or to treat infection.  Do not discontinue without calling the office. Eating yogurt daily while on antibiotics will help prevent stomach upset. Any brand is fine, as long as it contains live yogurt cultures.

Nausea & Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip slowly on cold water or ginger ale and lie down for 30 minutes. When the nausea subsides, you can begin taking solid foods and the prescribed medicine.

Possible 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. Be very careful because you can bite your lip or tongue and not feel the sensation. Call Dr. Pennington if you have any questions.
• A slight elevation of temperature in the first 24 hours following surgery is not uncommon. If a fever persists, notify the office. Tylenol or ibuprofen can be taken to reduce the fever.
• Dizziness may occur, due to dehydration, prescription pain medications or from getting up from the lying position too quickly. Please be careful and move slowly.
• You may feel hard projections in your mouth with your tongue. These are not tooth roots; they are the bony walls which supported the tooth. These projections usually smooth out spontaneously, but can be removed by Dr. Pennington if necessary.
• If the corners of your mouth are stretched, they may dry and crack. Your lips should be kept moist with an ointment such as Vaseline.
• Sore throat and pain when swallowing can occur. This will subside in two to three days.
• Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event that will resolve with time.

Important Reminders:

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. If the sutures become loose there is no cause for alarm. Simply remove the suture from your mouth and discard it.  Any remaining sutures can be removed at your postoperative appointment. This requires no anesthesia or needles and takes only a few minutes.

The symptoms of pain and swelling should improve each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call the office for instructions.

There will be a opening in the gum where the tooth was removed. The cavity will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean, especially after eating, by rinsing with salt water or dilute mouth rinse.

Remember that every human being is unique and each surgical procedure is unique. Please do not accept well-intended advice from friends. Instead, discuss your problem with the professionals best able to effectively assist you: Dr. Pennington or your family dentist.

A clean mouth promotes speedy healing.

A “dry socket” occurs when the blood clot is prematurely dislodged from the healing tooth socket. Symptoms typically occur two to three days following surgery, and include bad breath, a bad taste in your mouth, and pain at the surgical site and radiating to the ear. Call the office if this occurs.

Keep physical activity to a minimum the day of and the day following your surgery Avoid vigorous exercise for 7 days after surgery. When you do resume regular exercise, be aware that your normal nourishment intake is reduced. If you get light headed or dizzy, stop exercising.