THE FIRST HOUR
Bite down gently on the gauze for the first hour after surgery. Do not spit, drink, or take out the gauze, until the hour has passed. At that time, the gauze can be removed, and the patient can have something to drink and something to eat. Additionally, this is a good time to take the first dose of ibuprofen and one half of the Norco if needed. The gauze should then be replaced every 30–45 minutes thereafter until the bleeding has stopped.
It is normal to have some continued bleeding or a red tint to the saliva for up to 24 hours. Biting gently on gauze places pressure on the surgical site and encourages bleeding to taper. As time passes through the afternoon and evening of the day of surgery, it will be necessary to change the gauze every 30–45 minutes.
Each time a piece of gauze is placed in the mouth, the patient should commit to the gauze for at least 30–45 minutes without drinking, spitting, or changing the gauze. A blood clot is forming in the site, and continued disruption of the clotting process by the activities listed above may lead to persistent bleeding.
It may be advisable to place an old T-shirt or towel underneath the patient’s head where they are resting after surgery, as they will likely have a pink stain next to them upon awakening.
LOCAL ANESTHETIC/NUMBING MEDICINE
The numbing medicine tapers off over the remainder of the day and does so gradually, generally lasting 4–6 hours. It can be normal for a patient to feel the continued effects of the medication for the remainder of the day.
EATING AND DRINKING
Soft foods are advisable for the first several days after surgery. Soups, ice cream, milkshakes, mashed potatoes scrambled eggs, yogurt, applesauce, and foods of this consistency are advised. The patient is, however, only limited by the amount of discomfort they have; if they would like to advance their diet, they may do so as long as they are comfortable and using the mouth rinse after meals to rinse loose food debris from the sockets.
It is advisable to test or have a friend/family member test the temperature of any foods or drinks for the remainder of the day of surgery. The numbing medicine may prevent the patient from feeling an extreme temperature, which could result in a burn.
The peak of any swelling is usually 48 hours after the surgical procedure is performed. The swelling usually increases to that point and gradually subsides over the remaining 5–7 days.
Pain and soreness are normal parts of the post-operative recovery period. The medications prescribed are geared toward keeping the pain and soreness tolerable. Unfortunately, it is impossible for our team or the medications to completely eliminate pain and soreness after surgery. If used as prescribed, a large majority of patients tolerate the medications well and go on to heal without consequence.
ICE AND HEAT
Application of ice can help curb swelling over the first 12–24 hours. Thereafter, many patients apply heat pads or moist heat for comfort. Either application may be used in the days after surgery if they are providing pain relief or comfort.
Pain medications can make patients experience nausea. The surgeon recommends always taking pain medication with a small amount of food and recommends starting with half of a pain pill to see how the medication is tolerated, and only taking the narcotic pain medication as needed, if needed.
Patients can gently brush their teeth the evening of surgery, avoiding the surgical sites and allowing the antibiotic mouth rinse to perform the cleaning in those sites.
If you feel something hard or sharp adjacent to the surgical site, it is likely normal. The bony walls of the extraction site remain, and it takes time for the gum tissue to re-grow and solidify over those areas.
Occasionally, small slivers of bone may work themselves out through the gum tissue over the first several weeks following surgery. This can be considered normal.
Bruising can occur after surgery, especially in the aging population and in patients who are taking blood thinning medications like aspirin, Plavix, Coumadin®, or Eliquis®. Gravity can pull the bruising and discoloration into the jawline and neck over the course of several days after its initial appearance. Bruising generally resolves over the course of the first 10–14 days but does so slowly.
Normal healing after tooth extraction should be as follows: the first 2 days after surgery are generally the most uncomfortable, and there is usually some swelling. Days 3 and 4 see a decrease in the swelling and a return to a more substantive diet. The remainder of the post-operative course should be a gradual and steady improvement. At the end of the first week, the patient is generally eating 75% of the types of foods they normally enjoy, and at the end of the second week are able to eat their pre-surgical diet, including crunchy foods.
It is our desire to make your recovery as smooth and pleasant as possible. Following these instructions will assist you, but if you have additional questions about your progress, please call the office.