Postoperative Instructions (Short Version)
SHORTCUTS:
To control bleeding
To relieve pain
To minimize swelling
What should I eat?
My stitches came out
My wounds are healing at different rates
The areas all look different
There is more swelling in one site than another
Detailed Instructions
Informed patients who follow instructions have the fewest complications and the highest success rate.
Please read each of the following sections that apply to you and ask any questions you may have prior to your procedure (there are no “dumb questions”). Then, refer to this page again after surgery as needed, and feel free to contact us with any unanswered questions or concerns.
The following information is detailed, but reading it is well worth your time! Unless otherwise noted, the following applies to most oral and maxillofacial surgery procedures.
These instructions are for average sized healthy adults and must be modified for small adults, children and those who are medically compromised.
MINORS
Unemancipated minors must be accompanied for all pre-op and surgery visits by a parent, legal guardian, or other responsible adult. A parent or legal guardian must sign all consents or give written permission for another responsible adult to be responsible for the care of the minor and give informed consent.
CONSULTATION AND PREOP APPOINTMENTS
The consultation appointment is our chance to meet you and an opportunity to answer any questions you may have. This is also the time when a treatment plan is formulated.You will likely need x-rays at this visit. Please remove all necklaces, earrings, tongue rings, nose rings, brow rings, and any other jewelry above the neck prior to x-rays. Also, please remove all eye glasses, removable hearing aids, hair clips and pins, dentures, and removable partial dentures prior to x-rays.You will be asked to fill out a form on line or in the office regarding your medical history, medications which you are taking, and any allergies you have. Your doctor will discuss any pertinent information which you list and may ask for further information.IF THERE IS ANY CHANCE THAT YOU ARE PREGNANT, PLEASE LET THE RECEPTIONIST KNOW, LET THE TECH KNOW PRIOR TO X-RAYS, AND LET THE DOCTOR KNOW PRIOR TO SURGERY.
INTRAVENOUS (I. V.) ANESTHESIA PREOPERATIVE INSTRUCTIONS
Do not have anything to eat or drink (including water) for 8 hours (6 hours for children age 12 and under) prior to the appointment.A responsible adult must come with the patient to the office, remain in the office throughout the procedure, and drive the patient home. The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience. Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and low heeled shoes. Contact lenses, jewelry, and dentures must be removed prior to surgery.
POSTOPERATIVE INFORMATION AND INSTRUCTIONS
(This section applies to most oral surgery and maxillofacial procedures including extraction of teeth.)
SHORTCUTS:
To control bleeding
To relieve pain
To minimize swelling
What should I eat?
My stitches came out
My wounds are healing at different rates
The areas all look different
There is more swelling in one site than another
Healing of the surgical site varies greatly from person to person and even within the same person from site to site. Any of the following conditions may occur, and all are considered normal except as noted.
Some bleeding, pain, and swelling is normal. For most procedures, the patient should reduce their activity as much as possible the day of surgery and approximately 2 days after. Then, they should slowly work back up to their normal routine over the next 2 to 4 days. For these first few hours, avoid eating, drinking, and unnecessary talking. Patients who are too active too soon have much increased pain, swelling and bleeding. Do not spit or rinse your mouth while any bleeding (other than a very minimal ooze) persists. These activities may hinder formation of a blood clot which is necessary for proper healing.
Oral hygiene is important. The day after surgery, begin rinsing the mouth gently with Peridex (chlorhexidine) twice a day for 7 to 14 days. You may use a solution of one-half teaspoonful of salt dissolved in a glass of water after every meal or snack until completely healed. Gently rinsing is helpful because it helps remove food particles and debris from the socket area and thus helps prevent infection and promote healing. We do not generally give irrigation syringes until after the first week, because they may increase the risk of dry socket if used too early and may not be needed in many patients. The day after surgery, resume your regular tooth brushing and brush your tongue to keep bacteria growth down. Be careful not to touch the extraction site so you do not disturb the blood clot.
Keep fingers and tongue away from socket or surgical area.
Swelling should be expected. Swelling usually peaks 24 to 72 hours after surgery. Use ice packs on surgical area (side of face) for first 24-36 hours, apply ice 20 minutes on, 20 minutes off while awake. Do not use ice packs after 36 hours. This may impair your recovery and increase pain.
Keep your head elevated for 24 to 48 hours. When sleeping, sleep with multiple pillows or in a recliner.
A certain amount of bleeding is to be expected following surgery. Bleeding is controlled by applying firm pressure to the surgical area using small rolled gauze for at least 30 to 60 minutes. After that time you may remove the gauze. If bleeding persists, bite on gauze again for at least 60 minutes. If bleeding persists, a moist tea bag should be placed in the area of bleeding and bite firmly for one hour. This will aid in clotting. Repeat if necessary. If bleeding still persists, call our office. A small amount of bleeding for 48-72 hours is to be expected. Some patients may notice occasional bleeding for a week or even two weeks after surgery (especially after brushing or eating).
Sutures (stitches) usually come out between 3 days and 2 weeks after the surgery, but they may come
out sooner or stay in longer. It is never an emergency when sutures come out. If you wish to call regarding a suture coming out, you should only call during regular business hours.
After heavier bleeding stops, you may eat or drink.
Drink plenty of fluids. Do not drink carbonated or alcoholic beverages for 1 week (these may loosen the clot and lead to dry socket).
Diet may consist of soft foods which do not require chewing to be swallowed for approximately 1 week. No seeds, nuts, rice, popcorn, etc. Some better choices include: soft pasta, soft fish, soft vegetables like mashed potatoes, soups and stews, casseroles, eggs, oatmeal, ice cream, yogurt, pudding,
Jello, smoothies, and shakes. Do not chew food in the surgical area.
Do not drink through a straw for 1 week.
Definitely do not eat anything that you must chew until the local anesthesia has completely worn off. Otherwise, you may bite your cheek, lip, or tongue without knowing it.
Do not drive or operate any machinery while under the influence of prescription narcotic pain medication.
DO NOT SMOKE FOR AT LEAST 7 DAYS AFTER SURGERY (6-9 months for implants and bone or soft tissue grafts; 2 months for fractures). Smoking leads to poor healing and greatly increases the risk
failure of grafts and greatly increases the risk of infection. After extraction of a tooth, smoking often leads to “Dry Socket”. This is a very painful condition that you do not want to encounter.
There may be a slight elevation of temperature for 24 to 48 hours. If it goes above 101.5 (measured) or If the elevation in temperature continues, notify us.
It is not unusual to develop bruising in the area of an extraction or other procedure. This bruising may go all the way down to the neck or even the chest. Bruising may not become noticeable for up to one week.Please take all prescriptions as directed.
Women please note: Some antibiotics may interfere with the effectiveness of your birth control pills.
Please check with your pharmacist or prescribing doctor.
Numbness of lips, cheeks, chin, teeth and/or tongue on the affected side may be experienced for a variable period of time. This may be permanent in rare cases.
The corners of the mouth may be stretched and they may crack. Your lips may be kept moist with cream or ointment.Feel free to contact us if any doubt arises as to your progress and recovery.
Additional post-op information and instructions for patients undergoing extraction of wisdom teeth or surgical extraction of any teeth:
The removal of impacted wisdom teeth and surgical extraction of teeth is a surgical procedure and is very different from the simple extraction of erupted teeth. Postoperative complications are more common, and extra care must be taken to avoid unnecessary complications. Any of the following conditions may occur, all of which are considered normal (except as noted):The surgical area will swell. Be certain to apply ice bags as directed. Swelling usually peaks 24 to 72 hours after surgery. Difficulty in opening your mouth wide should be anticipated.Trismus (stiffness) of the muscles may cause difficulty in opening your mouth for a period of days to weeks. You may have a slight earache. A sore throat and discomfort upon swallowing may occur.
Your other teeth may ache temporarily. This is referred pain and is almost always a temporary condition. There may be a void where the tooth was removed. Beginning the day after surgery, you should be gently rinse with Peridex (chlorhexidine) twice a day. After no longer using Peridex, you may also rinse following meals with warm salt water until the area is healed. This void (hole) will gradually fill in with new tissue. Sometimes the area is left open and sometimes it is closed. The decision of which way to leave it is not made until the time of surgery.Healing of the surgical site varies greatly from person to person and even within the same person from extraction site to extraction site. It is VERY common to have one of theextraction sites be more swollen, painful, or bruised, or take longer to heal than the other extraction sites.
Additional post-op information and instructions for patients undergoing I. V. anesthesia:
Do not be alarmed if your vision is blurred or if you have some dizziness for a short time following anesthesia.
Do not be alarmed if a bruise appears at the site of an injection. Your arm also may be bruised, swollen, and/or tender due to the IV.
Although you may feel that the anesthetic has worn off, your balance, motor skills, memory and judgment may be impaired. Do not drive or operate any machinery for 24 hours. Walking should be with assistance until the morning following surgery. Do not make any important decisions for 24 hours.
OTHER POST-OP INFORMATION AND INSTRUCTIONS
(This section applies to most oral and maxillofacial surgery procedures including extraction of teeth.)
To control bleeding:
Immediately following procedure, keep steady pressure on the bleeding area by biting firmly on the gauze placed there. Do not remove it for at least 30 to 60 minutes. After that time, you may remove the gauze. Firm pressure helps reduce bleeding and permits formation of a clot in the tooth socket. If bleeding persists, bite on gauze again for at least 60 minutes at a time. If bleeding persists, bite firmly on a moist tea bag for one hour. This will aid in clotting blood. Repeat if necessary. If bleeding still persists, call our office. A small amount of bleeding is to be expected.Some oozing of blood may persist for 48-72 hours. Some patients may notice occasional bleeding for a week or even two weeks after surgery. If necessary, continue the use of moist tea bags and gauze. After heavier bleeding has stopped, cautiously resume oral hygiene.Reduce your activity as much as possible for the day of surgery and at least 2 days after. Then slowly return to your normal routine over the next 2 to 4 days. Use Ice packs as directed only for the first 24 to 36 hours.Keep your head elevated.
To relieve pain:
You should take 600 mg to 800 mg of Ibuprofen (Advil, Motrin) prior to the local anesthesia wearing off. Then take 600 mg every 6 to 8 hours after that for at least 2 to 3 days. Ibuprofen in these dosages is a great antiinflammatory and has been shown to reduce pain better than Vicodin for oral and maxillofacial surgery procedures. You may take the prescribed pain medicine as needed in addition to ibuprofen.For mild discomfort take over the counter doses of Tylenol and/or Ibuprofen every three to four hours.When taking the prescribed pain medication, you should take it with food. Otherwise you are likely to become nauseated. Another way to treat severe pain is to take Tylenol 650 mg as often as every 4 hours AND ibuprofen 600 mg every 6 hours (or 800 mg every 8 hours).Do not take Tylenol and the prescribed pain medication within 4 hours of each other, because the prescribed pain medication has Tylenol in it.Reduce your activity as much as possible for the day of surgery and at least 2 days after. Then slowly return to your normal routine over 2 to 4 days.Use ice packs as directed only for the first 24 to 36 hours. Keep your head elevated.
DO NOT TAKE THE PRESCRIBED PAIN MEDICATION FOR HEADACHES. If you are experiencing headaches, they are often rebound headaches from the Tylenol (acetaminophen) and narcotics in the prescribed pain medication. The headache may go away for a short time but return as bad or worse shortly after that. Consider using nothing or Ibuprofen (Motrin, Advil) rather than the prescribed medication if you are experiencing headaches.If you are experiencing pain that is not relieved by Ibuprofen or the prescribed pain medication it may be dry socket. If you have tried Ibuprofen and the prescribed pain medications as noted above and this is not working, call our office.
To minimize swelling:
Immediately following procedure, apply an ice bag over the affected area. Use 20 minutes on and 20 minutes off for 24-36 hours to help prevent development of excessive swelling and discomfort. If an ice bag is unavailable, simply fill a heavy plastic bag with crushed ice or use a bag of frozen peas or corn. Cover with a soft cloth to avoid skin irritation. Reduce your activity as much as possible for the day of surgery and at least 2 days after. Then slowly return to your normal routine over the next 2 to 4 days.Use ice packs as directed only for the first 24 to 36 hours.If possible, keep head elevated for the first 24-72 hours. Sleeping in a recliner or with multiple pillows is best.If increasing swelling is noted after 3 days, or if you develop a fever (measured at greater than 101.5 F), contact our office.
In case of problems:
You are much less likely to experience problems if you follow the instructions and suggestions as outlined. But, even if everything goes as expected before, during, and after surgery and you follow all of the instructions, you may still have a complication. If you experience any problems such as noting any pus (looks like vanilla pudding), excessive bleeding, pain which increases after 48-72 hours, swelling which increases after 72 hours, a temperature (measured by a thermometer) greater than 101.5, difficulty in opening your mouth which worsens after 72 hours, or anything else which concerns you, call your doctor immediately for further instructions or additional treatment. If you believe you are in imminent danger or are having an emergency requiring immediate attention you should immediately dial 911. You may consider going to the nearest emergency room in cases not requiring immediate attention.
Maintain a proper diet:
A soft (non-chew) diet is the preferred diet after most oral and maxillofacial surgery procedures.
After tooth extraction, eat soft, nutritious foods, and drink plenty of liquids (no carbonation, no alcohol) with meals and in between meals. Ensure, Boost, and other supplements are fine, but may lead to gastrointestinal upset and diarrhea in some patients. Be careful not to disturb the blood clot (do not chew in the area of an extraction). Add solid foods to your diet after one week if they are comfortable to chew (do not chew in the area of bone grafts or implants until the final restoration/tooth is in place).
A soft diet includes soft fish, soft vegetables like mashed potatoes, soft pasta, eggs, oat meal, ice cream, yogurt, custard, pudding, smoothies, Jello, shakes, soup, stews, casseroles, anything you can put into a blender, liquids other than alcohol and carbonated beverages, and anything else that you can eat without chewing (AT ALL).
Cold foods and drinks are best for the first 24 to 36 hours.
Do not drink though a straw during the healing process.
Do not drink alcohol or carbonated beverages.
This is not the time to go on a crash diet. Proper nutrition is of the utmost importance to healing. Most adults need 2000 to 2500 calories with high quality proteins and proper vitamins (especially vitamin C).
You should maintain a soft (non-chew) diet until directed by Dr. Wiggins if you have had a fracture, placement of a soft tissue graft, placement of an implant, removal of a deeply impacted tooth, or if you have been directed by Dr. Wiggins or the staff to maintain soft (non-chew) diet.
If you have had a bone graft, you should maintain a soft diet for 7 days (or longer if directed). Do not chew in the area of the graft until the final restoration/crown is in place.
Remember your follow-up visit:
It is often advisable to return for a postoperative visit to make certain healing is progressing satisfactorily. If a postoperative or follow-up visit is scheduled, we highly recommend that you keep your appointment. In many cases, Dr. Wiggins may only need to see you for a very brief period of time. In the meantime, follow the doctor’s directions, maintain a healthy diet, observe rules for proper oral hygiene, and visit your dentist and physician for regular checkups.
IF YOU HAVE QUESTIONS REGARDING ANY OF THE ABOVE INSTRUCTIONS OR INFORMATION, FEEL FREE TO CONTACT US.