Post-operative Instructions

To minimize the risks for pain, infection, and other healing complications after oral surgical procedures, we provide patients with the following set of post-operative instructions:

1. Oral hygiene: Do not touch the surgical area(s) with your tongue or fingers. Do not brush or floss directly where stitches have been placed. Doing so may cause the stitches to release earlier than desired.
   
   
2. Mouth rinsing: Do not rinse your mouth on the same day as treatment. The following day, saltwater rinse or a prescribed mouth rinse may be used. Do not rinse your mouth if you are still bleeding from the extraction sites.
   
   
3. Activity: After removal of wisdom teeth, multiple teeth, or after a bone grafting procedure, refrain from any heavy lifting or strenuous activity (including exercise) for the first 7-days after surgery.
   
   
4. Bleeding: Avoid spitting and rinsing if bleeding persists. It is normal for saliva to be blood-streaked for a day or two after surgery. To stop bleeding, first wipe away any excess clot on the gums and then bite on gauze to apply continuous firm pressure for 20 minutes. Remove the gauze and repeat as necessary. If this does not stop the bleeding, you may instead bite down on a moistened tea bag. The tannic acid is an astringent which helps to form and stabilize a blood clot. Again, repeat as necessary.
   
   
5. Pain: Normally, pain begins on the evening of surgery and lasts for 2- to 3-days, becoming less noticeable with each passing day after that. A sore throat is also common due to suctioning of debris and secretions during the procedure. Some surgical site discomfort may persist for up to a week. Prescription pain medications are provided to make patients more comfortable. If pain is severe or unrelenting, contact your surgeon at the number provided.
   
   
6. Facial swelling: This is a perfectly normal occurrence, which can last up to 10-days. The swelling generally increases up to 72-hours following surgery and then starts to reduce in size. By 1-week after surgery, the swelling should be minimal, if not gone. During the first 24- to 48-hours after surgery, a cold compress (ice pack or frozen peas wrapped in a washcloth) may be applied to each side of the face for 15-mins on, 15-mins off. From 48-hours onward, a warm compress (warm washcloth) should be applied 15-mins on, 15-min off to promote blood flow to the area(s).
   
   On occasion, delayed swelling may occur at the lower wisdom tooth sites several weeks or months after surgery. This may be a low-grade infection due to food debris becoming trapped in the socket. If this occurs, call the office. Antibiotics or cleaning of the socket may be required.
   
   
7. Trismus (reduced mouth opening): This is quite common due to post-operative swelling and inflammation in the muscles around the lower wisdom tooth sites. Trismus may last for 1- to 3-weeks and can be improved by gently moving the lower jaw through its natural range of motion (like stretching). If trismus persists or causes severe pain during opening of the jaw, call the office.
   
   
8. Diet: For regular extractions, patients should eat a soft, mushy diet for the first week after surgery. Try to avoid hot (high temperature) foods/liquids, and avoid anything spicy. If you have had bone grafting performed or a dental implant placed, you should maintain the soft, mushy diet for 3-weeks.
   
   
9.  Straws: Do not drink through a straw until at least 48-hours after your surgery. Avoiding straws reduces the chances of having a blood clot dislodged in the early healing period.
   
   
10. Bad taste or odor: This may be due to bacteria collecting on the surface of the stitches or blood clot(s). Use the prescribed oral rinse or make your own saltwater rinse.
    
    
11. Stitches: If stitches were placed, they will dissolve and fall out after 3- to 10-days. In certain cases, non-dissolving stitches will be placed, and your surgeon will have you back to remove them.
    
    
12. Dentures: If a denture is inserted immediately after multiple tooth extractions, leave the denture in place for the first 48-hours following surgery. The denture may initially be loose, but the tissues will swell and hold it more snugly in place. Any denture relining or adjustments will be performed by the clinician who made the denture for you. If you had implants placed, see #19 below for denture instructions.
    
    
13. Sharp bone edges (pieces of socket bone): When a tooth is removed, the thin socket bone often projects through the gingiva and may feel sharp to the touch. Most of these bony projections will smooth out as the bone remodels over 4- to 6-weeks. Other times, you may need to return to your surgeon to have minor bone smoothing (alveoplasty) performed. Do not hesitate to call the office for advice.
    
    
14. Bruising of the skin: May occur on your arm/hand at the site of IV placement or on the face/chin/neck due to extractions or other oral surgery. Facial bruising will worsen over the first 48- to 72-hours after surgery and will then begin to drain downwards into the neck with gravity. The color will start as blue/black and will fade to a greenish/yellowish color over 1-2 weeks, then finally disappear. Older patients, patients with fair skin, or any patient taking a blood thinner will have more noticeable bruising.
    
    
15. Numbness, burning and/or tingling of the lip, chin, tongue, gingiva and/or teeth: This may rarely occur for deeply impacted wisdom teeth lying close to the mandibular nerve. Any of such sensation changes normally resolve completely within 3- to 9-months. It is very uncommon to have permanent sensation changes. In any event, your surgeon will assess your individual risk factors at the consultation appointment and will determine the appropriate course of action to reduce all risks.
    
    
16. Sores or abrasions: These may occasionally appear on the lips, tongue and/or corners of the mouth due to dryness or stretching of the tissues. Use petroleum jelly or lip balm for the first week following surgery to facilitate healing.
    
    
17. Alcohol and recreational drugs (including cannabis): To prevent drug interactions, uncontrolled movements, and airway complications during sedation, patients should not consume alcohol or use any non-prescription drugs/medications (including cannabis) within 2-weeks before sedation. Alcohol and recreational drugs should also be avoided while taking prescription pain medications after surgery.
    
    
18. Smoking: To decrease the chances for healing complications, do not smoke tobacco (cigarettes or cigars), cannabis, and do not vape for 7-days following surgery.
     
19. Dental implants: Patients must adhere to a mushy soft diet for 3-weeks during the early implant healing period. After that, avoid biting any food in the area of the implant(s) until 4-months have passed. Occasionally, the metal cap (healing abutment) portion that protrudes through the gingiva may loosen and fall off. This should not affect the stability or healing of the dental implant, which is in the bone under the gingiva. If this cap loosens or falls off, call the office. Keep the displaced metal cap and bring it with you. Flippers or dentures worn over top of healing dental implants MUST be removed while eating to prevent pressure being applied to the implants, which can lead to implant failure.
    
    

IF YOU HAVE ANY QUESTIONS CONCERNING YOUR SURGICAL PROCEDURE, THE ANESTHETIC, OR ANY OF THE ABOVE INSTRUCTIONS, PLEASE DISCUSS THEM WITH YOUR SURGEON PRIOR TO TREATMENT.