Do NOT disturb the wound. Avoid spitting or touching the wound for a few days after surgery. There may be a metal stump slightly protruding through the gum tissue. Some bleeding or redness is normal for 24 hours. Excessive bleeding can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues, please call the office for further instructions.
Some discomfort is normal after your operation. If you are not allergic or intolerant to nonsteroidal anti-inflammatory drugs, 400–600 mg every 4–6 hours of ibuprofen (Advil®, Motrin®, or generic) is usually an excellent choice. If you are asthmatic, do not take ibuprofen unless you have tolerated it in the past. If we have prescribed narcotic medicine for you, alternately taking the ibuprofen and narcotic when needed will improve your pain control. Some liquid or food in your stomach before taking pain medicine is usually a good idea to prevent nausea. Remember, pain medicines that contain a narcotic can impair judgment and reflexes. Avoid driving or doing anything potentially dangerous while taking these medications.
Gauze pads should be placed over the surgery site(s) with gentle pressure applied to the pads when you bite down; proper placement helps you avoid swallowing blood, which can make you more nauseated. The gauze pads should be replaced every 20–40 minutes. When the gauze pads have little or no blood on them, they are no longer necessary. The amount of bleeding will vary from person to person. Any heavy bleeding should slow within 3–4 hours. A small amount of blood is common up to 24 hours after your surgery and occasionally during sleep the first night. Avoid touching the area with your fingers or tongue.
Do not rinse your mouth the first day. Starting the second day, gently rinse with diluted Listerine® for 30 seconds every morning after breakfast, after brushing, and at bedtime for 2 weeks. During the daytime, rinse with warm salt water every 3 hours with approximately 1 teaspoon dissolved in a glass of water (a pre-made bottle each morning will lessen the amount of work). Do not use full-strength mouthwashes of any kind during the first week (mouthwashes contain alcohol, which will retard healing).
Swelling is a normal occurrence after oral surgery and is a major cause of discomfort. Swelling normally reaches its peak by the third day and then starts to resolve; it can be reduced by using an ice pack (or bag of frozen peas) over the affected area. Apply the ice pack for 10 minutes, avoiding heavy pressure, then remove or transfer it to a different area for 10 minutes. Do not freeze the skin. Apply the ice continuously, as much as possible, for the first 36 hours. Also, keep your head elevated on 2 pillows for 4 days. These measures won’t eliminate swelling, but they will help to reduce its severity.
Do not eat for 2 hours after surgery (to allow blood clotting to begin undisturbed), then start with clear liquids, such as apple juice, tea, or broth. Gradually ramp up your diet as tolerated. Always cool down any hot foods or liquids during the first 24 hours. If you were sedated for surgery, avoid fatty, creamy, or oily foods to help minimize nausea. You should eat only soft food for the first few days: for example, soups, juices, mashed potatoes, and meatloaf are fine. Avoid any hard and chewy foods, such as European breads, pizza crust, steak or jerky, and nuts or popcorn. Avoid using straws for a couple of days.
Brushing your teeth and the healing abutments is no problem. Be gentle initially with brushing the surgical areas. It is important to brush all your teeth, even if the teeth and gums are sensitive. For proper healing, it is important that plaque and food are not allowed to accumulate near the extraction site. Smoking is strongly discouraged for at least a week. As with the use of straws, suction causes increased bleeding, and the nicotine and tar can cause delayed healing and loss of blood clot. Warm saltwater rinses (½ teaspoon of salt in a cup of warm water) should be used at least 4–5 times a day, especially after meals.
Keep physical activities to a minimum for several days following surgery. Avoid bending over, heavy lifting, or strain. Physical activity will increase your blood pressure, which will cause an increase in your swelling and increase your bleeding. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.
If any serious problems or questions need immediate attention, Dr. Daniel is available 24 hours through the answering service at (707) 545-4625.