After Surgery Instructions
After Anesthesia Do not drive, drink alcohol, or operate any kind of machinery for 24 hours after anesthesia. You will need a responsible adult to be with you for at least 5 hours after and anesthetic. You should not be left unattended. You should be supported if you try to stand up or walk while still feeling the effects of anesthesia.
Rinsing, Spitting or Sucking Through a Straw No rinsing, spitting or sucking through a straw for the first 24 hours after surgery. These things can disturb the clotting and cause prolonged bleeding. After 24 hours the blood clots should be matured and you can resume these activities.
Activity After most procedures it is advisable to take it easy for the rest of the day. Often times you should also take the second day off of work or school. Too much activity early on can cause a setback and prolong recovery. Avoid excessive exertion, working out, athletic competition, band and choir participation for 3-4 days. Use common sense. If you feel weak, have an increase in pain, swelling, or bleeding give yourself an additional day or two of rest.
Bleeding Hold the gauze packs between the surgical sites with gentle pressure. Change the first set of gauze in one hour. Take your first dose of pain medicine at this time. While the gauze is out, check the bleeding. If the bleeding continues, place new gauze packs over the surgical sites and reapply gentle pressure. In another hour remove the gauze and check the bleeding. Most people will have stopped bleeding by this point and can leave the gauze out. Minimal and intermittent bleeding/oozing is typical. Bleeding should never be severe. If it is, it usually means the packs are being clenched too tightly causing trauma to the surgical site or the packs are not in the proper place. Try positioning new packs and maintain gentle pressure. If bleeding persists or becomes heavy you may use tea bags to help control the bleeding. Soak the tea bag in cool water, squeeze it out, place over the surgical site and apply gentle pressure for 20-30 minutes. Tea contains tannic acid that promotes clotting. Activity encourages bleeding. It is important for you to lie down, rest and remain inactive for the first 24 hours.
Pain Unfortunately, most oral surgery is accompanied by some degree of discomfort. It is not uncommon that pain will radiate forward to the other teeth, to the throat or the ear. You will usually be given a prescription for pain medication. The pain should be controlled with the pain medication that we will prescribe after surgery. Please take the first pill before the local anesthetic has worn off. We find that patients do better if they take the medication on a schedule and stay ahead of the pain. Remember that the most severe discomfort occurs the first six hours after the anesthetic wears off. If you were prescribed an NSAID (example: Motrin/ibuprofen) and a narcotic (example: Lortab/hydrocodone or Percocet/oxycodone) you can generally take these medications at the same time since they are in different classes and are metabolized differently by the body. We would recommend that you at least take the NSAID on a schedule and use the narcotic for breakthrough pain. It is fine to take the narcotic on a schedule if you need to. Narcotic medications can make you sleepy, so it is recommended that you do not drive, work with equipment, drink alcohol or make important decisions while on these medications since judgment can be impaired.
Swelling Often there is some swelling associated with oral surgery. You can minimize this by using an ice pack applied to the face over the surgical areas. Ice should be used for 20 minutes every couple of hours while awake for the first 2-3 days. After this, apply warm compresses to the skin over the areas of swelling (hot water bottle, moist and hot towels, or heating pad) for 20 minutes 3 times a day to decrease swelling and stiffness.
Diet After the bleeding has stopped you should begin drinking clear fluids or have some ice chips. If you tolerate this well you may begin taking other fluids including Jell-O, pudding and ice cream. It is important to take extra fluids while you are healing. Dehydration can be very dangerous and we want to avoid this! Do not use straws as the sucking motion causes more bleeding. You may begin eating soft foods once the numbness has worn off. Temperature of the food does not matter, but avoid extremely hot foods. Eat any nourishing foods that can be taken with comfort. Over the next several days you can progress to solid foods at your own pace. It may be a couple of weeks or more before you can eat hard or crunchy foods. It is important not to skip meals. If you take nourishment regularly, you will feel better, gain strength, have less discomfort and heal faster.
Nausea and Vomiting Nausea and vomiting are not uncommon after surgery, and are sometimes caused by anesthesia or pain medicines. Preceding each pain reliever with a small amount of soft food, then taking the pill with a glass of water, may reduce nausea. If nausea occurs, try taking an anti nausea medication and keep taking clear fluids. Minimize the pain medication until the nausea goes away, but call us if repeated vomiting is a problem. Dehydration can be very dangerous and we want to avoid this!
Keep Your Mouth Clean Keeping your mouth clean after surgery is essential. Starting the day after surgery, rinse with warm salt water (1/4 tsp. salt to 8 oz. water). Gently rinse with portions of the solution, taking a few minutes to use the entire glassful. Repeat as often as you like, but at least two or three times daily for the next five days. Begin normal brushing and flossing the day after surgery. Soreness and swelling may not permit vigorous brushing of all areas. Be careful around the surgical sites, but please make every effort to clean your teeth within the bounds of comfort.
Numbness Depending on the type of local anesthetic used for your procedure, numbness can last for 1 to 8 hours. Do not do any chewing until the numbness of the lip and tongue has worn off. We do not want you to chew your tongue or lip while still numb. If the numbness continues into the next day, please report this to us.
Smoking Do not smoke for at least one week, since this is very detrimental to healing.
Antibiotics Historically, antibiotics have been over prescribed. We try to use the latest scientific studies and our best clinical judgment when determining if antibiotics are needed. If you are prescribed an antibiotic, we recommend that you take it on a schedule as prescribed, and take the entire course without missing doses.
Infection Signs of infections include pain, firm swelling, redness of the soft tissue, and the soft tissue may be warm to the touch. Fever is generally a late sign of infection and occurs after other signs have been present. Drainage of a milky white fluid can also occur during an infection, however this is a late sign as well. Infections occur in about 2% of patients after surgery. Infections can occur during the first week or up to a couple months after surgery. Everyone has bacteria in the mouth. Infections are generally caused by the bacteria from the mouth. Usually these infections can be taken care of with a short course of antibiotics and simple drainage. Sometimes surgical drainage and removal of dead and infected bone is required in severe cases. If you suspect an infection, please call us right away so that we can get you treated.
Dry Socket Osteitis, known as “dry socket”, occurs up to 20% of the time. This seems to happen when the blood clot that normally forms in the socket fails to form or is lost prematurely. The bony walls of the socket are then left exposed. Bacteria from the mouth can then colonize the bony walls and irritate the socket. This can lead to inflammation and pain. Uncontrolled pain during the first week after surgery is the main symptom of dry socket. This will heal on its own, but if the pain is intolerable, please call us and we can get you treated.
Stitches Stitches are not required for every procedure. When stitches are required, dissolvable stitches are often used. The stitches will generally dissolve in 3-5 days. Usually we only need a day or two out of them. If sutures need to be removed, we will give you a return appointment.
Allergy Allergic reactions can occur after taking any medication. This includes antibiotics, pain relievers or even anesthetics. The most common signs of allergic reaction include rash, hives, and itching. If these occur, you should stop the medication take an antihistamine like Benadryl and call your doctor. In severe cases of allergy swelling of the lips, tongue and throat, drop in blood pressure, a rapid pulse as well as difficulty breathing can occur. These are signs of a severe reaction and can lead to shock, unconsciousness, cardiac arrest and death. If a severe reaction is suspected, it is an emergency and you should call 911 to get help right away.
Bruising Bruising can occur after oral surgery. Sometimes it may not show up for a few days. Gravity can pull the bruising down to the neck or upper chest.
Cracking At Corner Of Mouth Cracking at the corner of the mouth is common after oral surgery. Keep the area clean with some peroxide, and use Vaseline or a lip balm after surgery with help this condition to be a tolerable while it heals.
Sharp Edges If you feel sharp edges in the surgical areas with your tongue it is probably the bony walls, which originally supported the teeth. Every now and then a patient will have a small piece of dead bone, called a sequestrum, work its way through the gums at the surgical site. This can happen right away or down the road a few months. On their own these usually just slough, but if it is bothersome it may require evaluation and removal by your doctor.
Call With Questions Call if you have any of the following: excessive or persistent bleeding, excessive or persistent swelling, severe or persistent pain, persistent nausea and vomiting, allergic reaction to medication, prolonged numbness, if you suspect an infection, if you have questions that our instructions do not answer.
If you have questions, please ask. Even after hours we are available. You may reach us by calling the office (785.628.1079) during business hours or the answering service (785.322.4103) during the evening or weekend hours.