After Your Surgery

After Dental Implant Surgery

After Wisdom Tooth Removal

After Exposure of an Impacted Tooth

After Removal of Multiple Teeth

After Dental Implant Surgery

After surgery you should try not to disturb the surgical site(s).  Avoid rinsing, spitting, or touching the site(s) on the day of surgery.  You may have a temporary healing abutment that can be felt above the gums at the surgical site; do not disturb it.

Bleeding

A small amount of bleeding or redness in saliva is normal during 24 hours after surgery, and should be expected.  You can control excessive bleeding by placing a gauze pad directly on the wound and biting down with firm pressure for 30 minutes.  If you do this and the bleeding continues please call AZ Max for further instructions.

Swelling

Swelling is normal after surgery.  To minimize swelling, apply an ice pack or wrap an ice-filled plastic bag with a towel and apply it to the cheek next to the surgical site.  In the first 36 hours after surgery apply the ice continuously for as long as possible.

Diet

Drink plenty of fluids.  Avoid hot liquids or food.  Soft foods and liquids should be eaten on the day of surgery.  Return to a normal diet as soon as possible unless your doctor instructs you otherwise.

Pain

Take your prescribed pain medication as needed when the anesthetic wears off.  For moderate pain take one or two Tylenol or Extra Strength Tylenol every four to six hours.  If  you choose, you may take ibuprofen (Motrin or Advil) instead of Tylenol.  Over the counter ibuprofen comes in 200mg tablets; take one or two of these every four to six hours as needed for pain.  If pain is severe, take your prescription pain medication as directed.  If you are allergic to any of the medications above - or your doctor has instructed - do not take the mediation.

Antibiotics

If you are prescribed antibiotics following surgery, be sure to take them according to instructions in order to help prevent infection.

Oral Hygiene

Good oral hygiene is essential to good healing. The night of surgery, use the prescribed Peridex Oral Rinse before bed. The day after surgery, the Peridex should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Gentle, warm salt water rinses (1/2 teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, as well, especially after meals. Brushing your teeth and the healing abutments as usual, but be gentle initially with brushing the surgical areas.

Activity

Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should stop exercising. Keep in mind that during recovery you are probably not getting your regular food intake. This may weaken you and further limit your ability to exercise.

Wearing your Prosthesis
Partial dentures, flippers, or full dentures should not be worn immediately after surgery and for at least ten days.

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After Wisdom Tooth Removal

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

Immediately Following Surgery

• The gauze pad placed over the surgical area should be kept in place with moderate pressure for a half hour following surgery. After this time, the gauze pad should be removed and discarded.
• 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 as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
• Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
• Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. The extra gauze given to you is to be used if the bleeding is more than a small trickle.  To properly place the gauze, fold it into a small cube and place it directly on the surgical site(s).  Hold it there with firm pressure for 30 minutes.  If bleeding continues around the recently placed gauze this could mean the gauze wasn't placed properly.  Replacing the gauze too frequently (less than every 30 minutes) will disturb the clot before it has had a chance to get firm, tearing it and causing bleeding to continue.  Repeat if necessary. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside after this, call AZ Max for further instructions.

Swelling

Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon after wisdom tooth removal. This is the body's normal reaction to surgery and eventual repair. The swelling will not be noticeable until the day following surgery and will not reach its maximum until two or three days later. The key to preventing swelling is to start icing  right after surgery and keep at it all day. Two baggies filled with ice, or ice packs 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. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. 36 hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four to six hours. Ibuprofen; (Motrin or Advil) two-four 200 mg tablets may be taken every four to six hours. Tylenol and Ibuprofen may be taken together for added pain control.  For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call AZ Max.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Refer to your Postoperative Instructions brochure. for suggested appropriate foods during recovery. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. Drink at least five or six glasses of liquid daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. 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 one minute before standing.

Oral Hygiene

No rinsing or brushing of any kind should be performed until the day following surgery.  Brushing, either with a manual or electric toothbrush, should be done very gently.  The day after surgery you should begin gently rinsing at least 5-6 times a day (especially after eating) with a cup of warm water mixed with 1/2 teaspoon of salt.

Skin Bruising

In some cases, bruising of the skin follows swelling. The development of black, blue, green, or yellow bruising is normal and can move from the surgical site to the cheek(s), lower eyelids, chin and to the neck or even chest area.  This is a normal post-operative occurrence, which may appear 2-3 days after surgery and last from 7 to 14 days. Moist heat applied to the area may speed up the removal of the bruising..

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.

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 medicine. You should then sip on Coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.

Other Potential 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. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call the doctor if you have any questions.
• If you had anesthesia or other medications administered through an IV during your surgery, note that it is not uncommon for there to be some swelling and redness at the IV site.  Any swelling up to the size of a pinky-width is normal for up to 4 days following surgery.  If you have swelling of a larger area, swelling that persists for more than 4 days, or other concerns please call AZ Max.
  
• A low fever immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
• After your surgery, please be cautious as you change positions from lying down to standing. You may become light headed unless you slowly change positions.  If you have been lying down, sit up for one minute before you stand up.  Taking pain medications can make you dizzy. 
• Occasionally, patients may feel hard bumps in the mouth with their tongue. They are not roots; they are the bony walls which supported the tooth. These bumps usually smooth out on their own. If not, they can be removed by the doctor.
• If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.
• Sore throat and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This should go away in two to three days.
• Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is normal after surgery and will resolve in time.

• Sutures (stitches) are placed in the area of surgery to minimize post-operative bleeding and to facilitate healing. We often use resorbable sutures which may break into fragments as they begin to dissolve.  Do not be alarmed as this is completely normal. Remove any dislodged suture from your mouth and discard it. If your sutures are not resorbable, they will be removed by us at your return visit approximately one to two weeks after surgery. You will find this procedure to be quick and painless.
• The pain and swelling should subside more and more 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 cavity where the tooth was removed. Over the next month the cavity will gradually fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush.
• Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your problem with the professionals best able to effectively help you: your doctor or your family dentist.
• Brushing your teeth is okay - just be gentle at the surgical sites.
• A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur two to three days following surgery. Call AZ Max if this occurs.
• If you exercise regularly, be aware that your normal food intake is reduced during recovery. Exercise may weaken you. If you get light headed, stop exercising.

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After Exposure of an Impacted Tooth

Do not disturb the surgical site. If surgical packing was placed, leave it alone. The pack helps to keep the tooth exposed. If it gets dislodged or falls out do not get alarmed.

Bleeding

• Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (more than a small trickle) can usually be controlled by biting with firm pressure on a gauze pad placed directly on the bleeding site for 30 minutes. If bleeding continues please call AZ Max for further instructions.

Swelling

• Swelling is normal after surgery. To minimize swelling, apply an ice bag or a plastic bag or towel filled with ice cubes on the cheek in the area of surgery. Apply the ice continuously as much as possible for the first 36 hours.

Diet

• Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

Pain

• You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, 1 or 2 Tylenol or Extra Strength. Tylenol may be taken every 4 or 6 hours. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol or with Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 4-6 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed.

Oral Hygiene

• Mouth cleanliness is essential to good healing. Clean your mouth thoroughly but gently after each meal beginning the day after surgery. Brush your teeth as best you can. Rinse with warm salt water (1/2 teaspoon of salt in a cup of warm water) six times a day. Continue this procedure until healing is complete. REMEMBER: A clean wound heals better and faster.

Activity

• Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

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After Removal of Multiple Teeth

• A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding persists, take a new piece of gauze and hold direct finger pressure over the area that is bleeding; then bite on the gauze for 30 more minutes. If bleeding continues, a moist tea bag can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.
• Use ice packs (externally) on the same side of the face as the operated area. Apply ice for the first 36 hours only. Apply ice continuously while you are awake.
• For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 6 hours. Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 4-6 hours.
• For severe pain use the prescription given to you. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, finish your prescription regardless of your symptoms.
• Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day.
• Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt water rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One half teaspoon of salt in a glass of lukewarm water.). After you have seen your dentist for denture adjustment, take out denture and rinse 3 to 4 times a day.
• Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.

The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:

• The area operated on will swell reaching a maximum in two days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 36 hours after surgery (remember ice packs are used for the first 36 hours only)
• A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
• If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline. There may be a slight elevation of temperature for 24-48 hours. If temperature continues, notify our office.
• If immediate dentures have been inserted, sore spots may develop. In most cases, your dentist will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.

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