After Exposure of an Impacted Tooth

The following guidelines are for you to read before and after we extract an impacted tooth. Reading these before your procedure will help you to best prepare for your recovery. Please adhere to these guidelines, so that you can have the best and fastest possible recovery.If at any time you have a question or concern, day or night, please contact our office.

First Day of Surgery Instructions

• Do not disturb the wound. If surgical packing was placed do not touch it. The pack helps to keep the tooth exposed. If it gets dislodged or falls out, do not be alarmed.
• You must stay awake for one hour following the surgery.
• During this hour, bite on moist gauze with firm pressure.The moist gauze should be thick enough to prevent the front teeth from contracting. It is this pressure that stops the bleeding. Slight bleeding, oozing, or redness in the saliva is normal on the first day.
• Discard used gauze and replace with fresh gauze every 30 minutes, until gauze is light red or pink.
• If bleeding reoccurs later, continue using the gauze in the same fashion. If the bleeding still continues, bite on a moistened tea bag for 30 minutes.The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels.
• Do not eat or sleep with gauze in your mouth.
• To help with swelling, alternate an ice pack on your face for 30 minutes while you are awake. We will provide you with an ice pack, but you can also use a bag of frozen, peas, corn or a bag filled with ice.
• Remain upright to prevent increased swelling. Sleep or rest with your head in an elevated position, such as in a recliner, or prop your head/upper body on several pillows.
• Limit your activities following the first 24 hours after surgery.
• Do not rinse, spit or touch the wound area. Doing so could cause the blood clot that has formed to become dislodged and bleeding to occur.
• Do not smoke or consume alcoholic beverages for seven (7) days after surgery.  Smoking and alcohol intake are the main causes of painful dry sockets.

Pain Management

• At the first sign of pain or discomfort, take your prescribed pain medication as directed or aspirin or ibuprofen. Over the counter pain relievers may be repeated every four hours as needed for pain. Eating a snack prior to taking your medication may prevent nausea and vomiting.
• Pain medications can make you dizzy, so be careful when going from a lying down position to standing. Becoming lightheaded when standing up suddenly is not uncommon. Before standing up, you should sit for one minute then get up.

Diet

• Eat a cool, soft diet, including foods such as yogurt, pudding, ice cream, and Jello. Hot food or solid food may stimulate bleeding.
• If you had surgery on only one side of your mouth, you can eat a regular diet on the unoperated side after the bleeding is controlled.
• Eat regularly and try not to skip meals. High calorie, high protein foods will help speed your recovery. Drink at least 5 - 6 glasses of liquid each day.You will feel better, have more strength, less discomfort, and heal faster if you continue to take in nourishment.
• Eat something 15 - 30 minutes before taking your pain medication to prevent nausea/vomiting. Penicillin should be taken on an empty stomach. Therefore pain medications and penicillin should not be taken at the same time.
• From the first sign of discomfort or pain after surgery, eat a cool, soft snack first and follow 15 minutes later with prescribed medication, acetaminophen or ibuprofen.
• Do not use a straw for drinking.
• Do not drink any carbonated drinks for three (3) days after surgery.

Recovery

• With local anesthesia plus IV sedation, numbness should last two to three hours on the upper jaw and eight to twelve hours on the lower jaw.
• With local anesthetic only, numbness should not last longer than three hours.
• Aspirin or ibuprofen dose can be repeated every four hours as needed for pain.
• Keep fingers and tongue away from the socket.
• Avoid chapped lips by using Vaseline or Chapstick to moisten them.
• Be absolutely sure to take all the prescribed antibiotics at the correct times (as directed) until they are completely gone to help prevent an infection from forming.

Second Day Instructions

Activity

• Continue resting and limit physical activities. No vigorous physical exercise, i.e., weight lifting, jogging, or hard manual labor should be done the first four (4) days.

 Oral Hygiene & Care

• Brush teeth up to the surgical area, but do not brush the surgical site for the first week.
• Chlorhexidine (Periogard or Periodex) should be used twice daily. Pour out half a cap full and swab the surgical area with a Q-tip, beginning the day after surgery. Continue use until your one week post-operative visit. Rinsing with this will stain the teeth.
• Rinsing the mouth may be started on the second day; unless you have been instructed otherwise.Use a level teaspoon of salt in an eight ounce glass of warm water. Rinse five to six times daily for the first week.

Diet

• A soft diet should be continued; but warm foods are okay to eat at this time. On day three, you may eat whatever you are able to tolerate.

Recovery

• If you continue to bleed so that the gauze pad is still red, call the office. If it is pink, keep biting down on the fresh, moist gauze at 30 minute intervals and the bleeding should stop.
• Continue alternating ice on the face for the first 36 hours while you are awake.
• Be mindful that swelling is generally the worst at 48 hours after surgery.
• Most sutures begin to dissolve within five to ten days.
• If you have been placed on antibiotics, take the tablets or liquid as directed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction.Call the office if you have any questions.

 Swelling/Bruising

• Swelling around the mouth, cheeks, eyes and sides of the face is a normal reaction to surgery. The swelling will not reach its maximum until two - three days post-surgery.Ice packs will minimize the swelling.
• Leave the ice packs on continually while you are awake. After 36 hours, ice has no beneficial effect. Swelling or jaw stiffness that persists for several days is a normal reaction to surgery.Thirty-six hours following surgery, the application of moist heat to the sides of the face can help reduce the swelling.
• Sometimes black, blue, green or yellow bruising/discoloration will follow swelling. This is a normal post-operative occurrence.Moist heat applied to the area may speed up the healing of the bruise.

 Third Day Instructions

• Pain and swelling will subside each day following surgery. If your surgery was performed under IV sedation, the worst swelling will be in 48 hours.Therefore, if you awaken on day three and are more swollen, this is a normal occurrence.If your post-operative pain or swelling worsens or unusual symptoms occur call the Southwest Oral & Implant Surgery office for instructions.
• You can brush your teeth gently being careful around the surgical sites. 

 Potential Complications

• Dry Sockets - Occur usually on the third or fourth day after surgery. Symptoms include: a jaw ache, earache, headache, or pain over the entire face. Call our office if you are experiencing these symptoms, or requiring analgesics after 48 hours.
• Sore Teeth - Teeth adjacent to the surgical area will sometimes shift slightly and be sore for several days. If this does not improve, please bring this to our attention at your one week post-op visit.
• Sore Throats /Pain upon Swallowing – After surgery, your throat muscles may become swollen and as a result, the normal act of swallowing can become painful.This will subside in 2 - 3 days. Stiffness of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.
• Drug Reaction - If you are experiencing adverse effects from drugs, such as nausea, vomiting, diarrhea, hives, itching or other affects, discontinue use of your medicine and call the office.
• Hot and Cold Sensitivity - Occasionally teeth adjacent to the surgical areas are sensitive to thermal changes for six to eight weeks following surgery.If this persists longer, please contact our office.
• Post-Operative Infections - The usual symptoms are swelling and pain.Please contact our office for antibiotics and/or an appointment.If you need to speak with the doctor on call, please call the office at (713) 439-7575.If there is any chance you may need a prescription, please have the pharmacy telephone number and make sure that pharmacy is open.
• Vomiting/Nausea - In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including your prescribed medicine.You should then sip on Sprite, tea, or ginger ale.Sip slowly over a 15 minute period.When the nausea subsides you can begin taking solid foods and your prescribed medicine. If nausea or vomiting persists, please call our office and have the phone numbers of your pharmacy that is open and available on hand.
• Numbness of the Lip, Chin, or Tongue - These are normally temporary in nature and there is no cause for alarm.Be careful not to bite your lip or tongue while it is numb.
• Slight Fever – It is not uncommon to have a slightly elevated temperature immediately after surgery. If your temperature persists, notify the office. Aspirin or ibuprofen should be taken to reduce your fever.
• Dislodged Sutures - The sutures placed in your mouth to minimize post-operative bleeding and to help healing can sometimes become dislodged. This is no cause for alarm.  Just remove the suture from your mouth and discard it.The sutures will dissolve in 5 - 10 days.

If you have heavy bleeding, severe pain, or a reaction to the medication, call our Houston office immediately at (713) 439-7575 or the Sugar Land office at (281) 277-6622.