Instructions Following Dental Extractions

Our goal is for your healing process after an extraction to be as comfortable as possible. The removal of teeth is a surgical procedure, and post-operative care is imperative. Please follow all instructions carefully to avoid any unnecessary pain and possible infection.

If you have any difficulties or concerns following your surgery, please do not hesitate to call us or return to our office for a follow-up exam.

Immediately following the extraction

After an extraction, it's important for a blood clot to form to stop the bleeding and begin the healing process. That's why your dentist will ask you to bite on a gauze pad for 30 to 45 minutes after an extraction. If bleeding or oozing continues after you remove the gauze pad, place another gauze pad on the area and bite firmly for another 30 minutes. You may have to do this several times.

After the blood clot forms, it's important to protect it, especially for the next 24 – 48 hours. It's important to NOT:

• smoke (for at least 72 hours).
• suck through a straw.
• rinse your mouth vigorously.
• clean the teeth next to the extraction site.
• touch the affected area.
• brush teeth.

These activities could dislodge the clot and promote bleeding and therefore slow down healing.

Restrict yourself to calm activities for the first 24 hours and only resume normal activity when you feel comfortable. This keeps your blood pressure lower, reduces bleeding, and helps the healing process.

You may feel some pain and have some swelling. You can use an ice bag (20 minutes on, 20 minutes off) to keep this to a minimum. The swelling usually starts to subside after 48 hours. (for further information please see section on swelling).

To control discomfort, take pain medication as recommended. (for example Ibuprofen…DO NO TAKE more than 800mg every 8 hours). In some cases, prescription pain medications may be prescribed. Don't take medication on an empty stomach or nausea may result. If antibiotics are prescribed, continue to take them for the indicated length of time, even if all symptoms and signs of infection are gone. Also:

• Drink lots of fluids.
• Eat only soft, nutritious foods on the day of the extraction and chew on the opposite side of the mouth.
• Don't use alcoholic beverages.
• Avoid hot and spicy foods.

You can begin eating normally the next day, or if not by then, as soon as it's comfortable. Gently rinse your mouth with warm salt water 4 - 5 times a day (put a teaspoon of salt in a cup of warm water, and then gently rinse, swish, and spit). Also, rinse gently after meals. This helps keep food out of the extraction site.

It's very important to resume your normal dental routine after 24 hours. This should include brushing your teeth and tongue and flossing at least once a day. This will speed healing and help keep your breath and mouth fresh. Call your dental office right away if you have heavy bleeding, severe pain, continued swelling after two or three days, or a reaction to the medication. After a few days, you'll be feeling fine and can resume your normal activities.

If sutures were placed, please be sure to keep your follow-up appointment for removal unless we have told you that they will automatically dissolve in 7 – 10 days.

Bleeding

A certain amount of bleeding is to be expected following a surgical procedure. Slight bleeding, oozing, or redness in the saliva is not uncommon. Bleeding is best controlled by the use of pressure. Excessive bleeding may be controlled by placing a gauze pad

over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding has not decreased in 3-4 hours, bite on a dampened tea bag placed directly over the surgical site. The tannic acid in the tea helps the blood to clot.

Swelling

The amount of swelling that is normally expected after an extraction depends on the type of surgery. Swelling around the mouth, check, eyes, and side of the face is not uncommon. The swelling sometimes may not appear immediately, and it may occur up to 2-3 days post-surgery. You can help to minimize the swelling by applying ice packs to the affected area. For the first 3 hours, apply the ice packs directly to the area, alternating on for 20 minutes then off for 20 minutes. Applying ice after 24 hours has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. If the swelling is significant, you may use a moist heat compresses to help suppress it.

Pain

Post operative pain will be the most severe the first day after surgery. It is beneficial to take your pain medication before your numbness wears off. For moderate pain, 800mg of Ibuprofen (Motrin or Advil) may be taken every 4-6 hours. For severe pain, take the prescribed medication that was provided. DO NOT take the pain medication on an empty stomach as nausea may result. The prescribed medicine may make you drowsy. DO NOT drive an automobile or operate machinery, and AVOID alcoholic beverages. Pain or discomfort following surgery should subside more and more each day. If pain persists, it may require attention, and you should contact our office.

Antibiotics

If you have been placed on antibiotics, take the medicine as directed. Antibiotics may be prescribed to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. PLEASE NOTE: If you are currently taking birth control pills, they will be inactivated by the antibiotic.

Nausea and 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 medication. You should then sip on water, tea, or juice. Sip slowly over a fifteen-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medication.

Activity

Over-exertion may start or intensify your pain. AVOID excessive work or play. It is not necessary to stay indoors following uncomplicated surgery. However, rest and minimal activity will help to minimize pain, swelling, and bleeding. Normal activity may be resumed the following day as tolerated.

Cleaning

Do not rinse or spit vigorously for the first 24 hours following surgery. You can brush your teeth the night of the surgery, but rinse gently. The day after surgery, you should begin rinsing four times a day and after eating. Do this gently as to not dislodge the blood clot. To rinse, mix a teaspoon of salt and a cup of warm water. DO NOT use a non-prescription rinse for 24 hours after surgery. Clean the rest of your mouth as usual.

Diet

It is advisable to eat only soft, non-spicy food for the first few days following surgery. AVOID hot food or liquid that could agitate the already inflamed area. AVOID rice, grits, and foods that are very small that may become lodged in the area.

Special Considerations

Trismus (stiffness) in the face muscles may cause difficulty in opening your mouth for a period of days. Moist heat compresses can minimize this condition. You may experience aching from other teeth. This discomfort is caused by referred pain and is a temporary condition. It is not unusual to develop bruising in the area of the extraction. There may be a slight elevation in temperature for 24-48 hours. If the fever persists, please contact our office.

Dry Socket after Extraction

Dry socket is an infection in your tooth socket after a tooth is extracted. The condition usually develops when a blood clot fails to form in the socket, or if the blood clot comes loose. Dry socket occurs in approximately 5 percent of all tooth extractions.

Normally, the blood clot that forms after a tooth is removed promotes healing, laying the foundation for the growth of new bone tissue. When dry socket occurs, this blood clot is lost and the infected, inflamed socket appears empty — hence the name. Nerves are exposed, and sometimes the bone is visible in the empty socket. You may not have symptoms until 3 to 5 days after the extraction. Then, the condition will manifest itself as severe pain that doesn’t subside, often accompanied by what feels like an earache. You may also have an unpleasant taste in your mouth, and bad breath.

Causes and prevention

Several things can cause the premature loss of a blood clot from an extraction site, including smoking, forceful spitting, sucking through a straw, coughing or sneezing. You should also avoid consuming carbonated or alcoholic beverages after an extraction, as these have also been associated with the development of dry socket. Also, you should:

• keep your fingers and tongue away from the extraction site.
• apply an ice pack to your jaw for the first 24 hours following surgery — on for 15-20 minutes, and off for 30-40 minutes — to prevent pain and swelling and stop excessive bleeding.
• not rinse your mouth the day of surgery. The next day, you can rinse gently with warm salt water; dissolve one teaspoon of salt in a cup of warm water. Be sure to rinse and spit gently.

Call our office right away if you notice any symptoms of dry socket. Treatment for dry socket typically includes a gentle rinsing of the socket.

We then pack it with topical anesthetic and a sterile gauze dressing. You’ll usually need to return to our office two to three times over a two-week time period so we can change the dressing and monitor the healing.

PLEASE CALL THE OFFICE (949-916-7800) AT ANY TIME IF YOU HAVE ANY QUESTIONS OR CONCERNS