After Tooth Extraction

And Socket Bone Grafting

The following information applies when a tooth was removed and grafting material has been placed into extraction sites to help preserve your jawbone in preparation for possible implant replacement of the extracted tooth.

Your bone graft is made up of many particles plus other components. The socket graft is managed in a way to keep the graft within the socket. However this wound can be easily disturbed and graft particles can come out. Do not be alarmed should this occur. There are some things you could do to minimize the amount of particles that become dislodged:

  • Do not disturb or touch the wound.
  • Avoid rinsing or spitting for 24 hours to allow blood clot and graft material stabilization.
  • Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.
  • If a front tooth was removed, do not lift or pull on the lip to look at the sutures except in a gentle manner. This can actually cause damage to the wound site and tear the sutures.
  • Do not smoke.

After 24 hours, a gentle salt water rinsing is allowed but not too vigorously as you can again disturb some of the bone graft granules. If a removable temporary tooth was placed in your mouth, you may remove it as instructed. You can wear this temporary tooth as long as it does not irritate the gum tissue. If it irritates the gum tissue at all please see Dr. Blecha and Dr. Jandali for an adjustment.

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office.

EARLY CARE AFTER SURGERY

On the Day of surgery, patients tend to do well if they follow this sequence:

  • Control Bleeding First.
  • Have the patient sit up and bite hard on the gauze until the bleeding is stopped. Do not spit. Apply ice packs immediately.
  • Get something in your Stomach.
  • A milkshake is suggested.
  • Start Medications.
  • If you have pain, start taking your pain medicine first and wait one hour to start the antibiotics.
  • If you have no pain, start taking your antibiotic first and wait to start the pain medicine until pain is just starting to occur.

BLEEDING

Apply a thumb size roll of moistened sterile gauze or a teabag over the wound and bit hard for 1 hour with constant pressure, using 80% of your maximum bite force. Make sure that the bulk of gauze is placed directly over the socket. This gauze should act as a barrier to prevent a lot of blood from getting out of the socket. If your mouth tends to fill up with blood, the gauze is not sealing off the area and needs to be adjusted to seal off the area. Another reason for blood filling the mouth is when the gauze is initially placed to seal off the area correctly but the patient only applies intermittent pressure or starts talking, which allows the gauze to move out of position in sealing off the area. It may require 3-4 hours to stop the bleeding even when the techniques described are used properly.

It is best if someone other than the patient can check for bleeding and apply the gauze for the patient. At the end of each hour, remove the gauze and check the wound directly for further bleeding.

Do not be afraid to look at the wound directly. It is the best way to check bleeding.Please ignore blood stain on the gauze as a sign of bleeding. Instead, it is best to have a second person look at the gum using a flashlight and a spoon handle for a retractor. Do not be surprised if the patient cannot open very wide. You only need partial opening to see if it is bleeding. If you see blood clots (“jelly clots”) on the adjacent teeth, wipe them off. This may stimulate some bleeding but it is the correct thing to do. These “jelly clots” form when the gauze does not seal off the gum opening and blood seeps outside of the gum and clots on the adjacent teeth. To determine if bleeding is still present, look at the wound for about 20-30 seconds. If blood is directly coming out of the socket, place a new pressure gauze to seal off the area and bite constantly on the gauze for another hour. During that hour, the patient should not be talking or opening the mouth, as such behavior will cause the gauze to move out of the proper position. Check the socket an hour later to see if the rate of bleeding has improved, worsened or stayed the same.

A variable amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. To minimize further bleeding, sleep with your head elevated and avoid exercise. If bleeding does not subside, call for further instructions.

It is normal to have some minimal bleeding with pink or red saliva during the first 24 hours. Bleeding can occasionally recur during the week after surgery. It will usually stop by itself, but pressure gauze may be used if it is persistent.

It may be useful to place a towel on your pillow the night of surgery, as minor oozing may occur from the wound at night.

PAIN

Discomfort is usually strongest during the first 12-24 hours. For severe pain, use the prescribed medication should be taken as directed. For moderate pain, use Ibuprofen (Advil or Motrin -200mg. tablets). Take 1-2 Ibuprofen every 3-4 hours. Tylenol can be use as well as listed on the package.

Most pain medications can upset the stomach, especially the prescription pain medicine and especially if the stomach is empty. If general anesthesia was used and the stomach is empty, you can prevent an upset stomach by drinking a milkshake and taking the first dose of pain medication 30 minutes later. What is even more effective is to eat bulky foods of some thickness (mashed potatoes, oatmeal, ground meats) at least one half hour before taking your medication

CAUTION – Do not drive, work or operate mechanical equipment after taking the prescription pain medication. Also, do not mix alcohol and any pain medication (or antibiotic).

Please remember to:

  • Space different medicines at least one hour apart from each other
  • Eat food of some thickness one half hour before taking any medicine
  • Follow the frequency that is prescribed on each bottle
  • Pain medicines take the edge out of strong pain; they do not eliminate all pain sensation.
  • Avoid alcohol with any pain medication or antibiotics
  • You should not drive any vehicle or work if taking narcotic medications.

The post-operative pain can vary considerably in different patients. It is often worst in the first 72 hours, but occasionally it can become worse after this period. The overall pattern to one’s pain should be that it tapers off as a general trend over 5-6 days, though the pain can vary some in any one day. Exertional activities, exercise, and a “busy” lifestyle will tend to make the wounds “throb”. Please use common sense and minimize activities that irritate the area.

ANTIBIOTIC

If you have been placed on antibiotics you may take the first dose 1 hour after taking the pain pills. Continue to take this medication as prescribed and complete the entire dosage.

Please be aware that antibiotics may decrease the effectiveness of birth control pills. Please ask your obstetrician if and how long after stopping the antibiotic you should use alternative birth control measures.

SWELLING

Drs. Blecha and Jandali try to use surgical techniques that prevent swelling. However, the swelling that occurs may be proportional to the surgery involved. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to surgery and is a part of normal healing. Swelling usually peaks by 72 hours. The swelling that develops by 72 hours then takes 5-6 days to go down.

Your swelling can be reduced with the immediate use of ice packs. Either ice packs or a Ziploc bag filled with ice and placed in a wash cloth should be applied to the sides of the face where surgery was performed. Use the ice in one half hour intervals (one half hour on, on half hour off) on the day of surgery and up to 72 hours. After 72 hours, you can use warm, moist heat applications to the side of the face to help bring swelling down.

SMOKING

Smokers are advised not to smoke for the first 48 hours, and preferably the first week, after surgery.

DIET

There is real value in re-establishing your diet after oral surgery. If your jaw is stiff to open after your surgery, such stiffness may last for 5-6 days and chewing could be difficult.

Once the bleeding is stopped we usually suggest a milk shake. After that we recommend that our patients eat “bulky” food as they are important in preventing nausea and vomiting from out postoperative medications. You must remember to not eat food in the surgical areas for one month after surgery.

Examples of bulky foods include mashed potatoes, oatmeal, and ground-up meats. Be creative. Ask a family member to take bulky foods and chop them up so that you can feed yourself these foods with a spoon and swallow them without chewing. You can eat bulky foods without having to chew them if you cut them up very finely. You should also have 5-6 glasses of liquids per day to supplement the “bulky” foods.

Your jaw may be sore and stiff, but you must eat bulky foods to tolerate your medications and avoid nausea and vomiting.

NAUSEA AND VOMITING

The cause of postoperative nausea and vomiting tends to occur if the patient is not eating well and is taking postoperative medications, especially pain medications.

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 or seven-up. You should sip slowly over a fifteen-minute period. When the nausea subsides you can try to resume eating “bulky” foods. If you can tolerate these “bulky foods,” you can slowly resume taking your medications. It is often the narcotic pain medication that causes nausea. Thus, you should minimize use of narcotic pain medications. Should they be needed, please be slow to resume taking the narcotic pain medication and you should use a low dose to try to prevent further nausea.

ORAL HYGIENE

Do not rinse or brush your teeth for 24 hours after surgery. After 24 hours, start to brush the teeth and use Gentle salt-water rinses as directed below. Please remember that your pain will resolve faster and your mouth will heal faster if you have very good hygiene after surgery. If you are too “shy” to brush and rinse, your pain will often become worse and you are much more likely to develop a postoperative wound infection.

Twenty-four hours after tooth removal, you need to brush all of your teeth, even those adjacent to the surgical area. Think of it as careful cleaning of all teeth at the gum line. Brushing is not “scrubbing” of the teeth. Rather, it is careful cleaning of the “nooks and crannies” where food gets stuck.

Twenty-four hours after surgery, start to use the Gentle salt-water rinses. Add one half teaspoon of salt to a glass of warm water and “swish out” the food that gets stuck in the wounds. Remember that salt water rinsing does not replace brushing. You need to both rinse and brush. If your jaw is stiff to open 4-5 days after surgery, you can start to do stretching exercises to try to open your mouth wider. This will improve your opening and will allow you to eat better and to clean your mouth better.

REMEMBER: A clean wound heals better and faster.

ACTIVITY

Keep physical activities to a minimum 4-5 days 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.

DISCOLORATION

In some cases, discoloration of the skin follows surgery. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

SORE THROAT / CORNERS OF THE MOUTH

A sore throat may develop from either the extractions or IV anesthesia. 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. Gargling with salt water will help this.

The corners of the mouth can be stretched from doing surgery inside the mouth and they may dry out and crack. Please keep the corners of the mouth moist with a lip balm or an ointment such as Vaseline.

FINALLY

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office.